Saroj Pachauri is a Population Council Distinguished Scholar and director of the Council's activities in India. A community health physician, she is extensively engaged with research on reproductive health.
I’m a community health physician in India, where maternal deaths due to pregnancy and childbirth are very common. There is no reason why, in the twenty-first century, a woman should die because of pregnancy and childbirth, but in India, the maternal mortality ratio is high, and in fact had stagnated for many decades. This was primarily because programs had failed to focus on women’s health, and maternal health in particular.
In India, there is pressure on the government to reduce the maternal mortality ratio by three-fourths by 2015, which is coming very close. In response, the government initiated a program called Janani Suraksha Yojana (JSY) that provides a cash incentive to a woman if she gives birth in a health institution and not at home, where she would be less likely to receive adequate care. The goal is also to provide advice on breastfeeding practices, and postpartum counseling on family planning to enable women to limit or space their births.
JSY is the largest program of its kind in the world. It was begun in 2005 and has gained significant momentum. Today the success of the program is surprising all of us. Large numbers of women are going to health facilities for their deliveries. We couldn’t have imagined this, especially in rural areas.
The Population Council is very interested in this program, and we evaluated it to see what’s going on in terms of the quality of care that women receive when they go to hospitals. We wanted to know their perspectives on delivering their babies in institutions. We wanted to know how long they stay and what difference delivering in an institution makes to them. These sorts of questions are very important for this program, which is investing large sums of money to bring down maternal death rates. We have shared the results of our work with the government and other stakeholders.
The Council has also been concerned with the issue of early marriage in India. Close to 50 percent of women 20–24 years old in India are married before the age of 18, the legal age of marriage. A significant number of these girls who are married early have their first child very early, too. Young girls who are not prepared for marriage or childbirth often give birth to their children one after another in succession. We know that short birth intervals affect the health of both the mother and child and survival rates as well.
One Council study showed that married young people had a higher risk of sexual and reproductive health problems. It was recommended that multipronged programs be undertaken to focus on young people, their families, and communities, and health care providers to enable youth to make informed, safe, and wanted reproductive health choices.
We’re also designing strategies that would help prevent child marriage. We know that when age at marriage increases and childbearing is delayed, there is a dual benefit: the health and survival of women and children are improved, and there are significant reductions in fertility.
Through our analysis of programs like JSY and our research on child marriage, we are working to give women in India the ability to have safe deliveries and choose the number and timing of their children. This is a fundamental right, one that is key to sustainable population growth and to individual, social, and economic development.