Anemia in pregnancy is defined by the World Health Organization (WHO) as a hemoglobin concentration below 11 g/dL.[1] It continues to be a major health problem in many developing countries and is associated with increased rates of maternal and parental mortality, premature delivery, low birth weight, and other adverse outcomes.[2]
All India Institute of Medical Sciences (AIIMS) has almost 40 beds in the maternity ward that can adjust 40 patients. “It may accommodate 40 patients altogether, but it becomes thoroughly overbearing for a limited number of doctors” according to a source. Right outside the main building a couple of female patients were asked how often they visit AIIMS for maternity problems. Though most of them believe in coming to hospitals, the elder child was mostly born by a ‘dai’ or a midwife.
More than half of the pregnant women in the world have hemoglobin levels indicative of anemia.1 Although only 15% of pregnant women are anemic in developed countries,[3] the prevalence of anemia in developing countries is relatively high (33% to 75%). The most common cause of anemia in pregnancy worldwide is iron deficiency.[4] The predisposing factors include grand multiparty, low socio-economic status, malaria infestation, late booking, HIV infection, and inadequate child spacing – among others.
“Eighty % of the health services in Delhi are being provided in the private sector because the Government has not been able to provide public health services to all the people of Delhi,” Harsh Vardhan, Delhi Bharatiya Janata Party president said to The Hindu on 14 sept 2006. But now, suddenly his attention seems to wander away to transportation, water supply and infrastructure for the current fiscal.[5] So the question is- is there anyone in the government to care about this vital situation for poor, pregnant, malnourished, anemic women?
Bhaukti Devi, who sat near an electricity board and continued to roast herself under the sun in the AIIMS, was under serious tension for her husband who was suffering from lung infection. As he lay flat under the shade, she spoke of how he is immediately rushed to the hospital when he feels unwell. But as far as her health is concerned, coming to the hospital was more a liability than a need. For her, a ‘jhulachap’ was more convenient and cheaper when in need of a cure.
Communities like UMANG (Uplifting Marriage Age, Nutrition, and Growth), found nine out of ten adolescent girls to be anemic and two out of three illiterate. These factors severely limit the life prospects of young women and also negatively influence the future of their children and families. An anemic or malnourished mother has a very high probability of giving birth to a low birth weight baby, the single biggest predictor of future malnutrition. And a mother’s level of education is correlated with all sorts of behaviors which can strongly influence whether her child will survive past his first five years. Adolescent anemia can be the start of a vicious cycle of poverty which is difficult to escape from. However,UMANG is a project which provides iron supplementation to these girls, as well as a forum to discuss the issues they face in daily life related to health, education, and family in the absence of Public Health Centers in the rural districts.
The problem of anemia (due to malnutrition) in pregnant mothers is not just in rural districts. The problem of a hemoglobin deficiency is also prevalent in women who can afford any kind of treatment at any expense. However, they prefer the more expensive hospitals because of the quantity and quality of services provided. One only wishes to avail public health centers and public hospitals when it is not easy to pay a bigger price. According to Doc. Shah who works at the Max, “Most patients here prefer the quality and the expertise we provide. We do not just charge more because of being a brand, but because of the time, energy and patience each doctor puts into every patient, unlike government facilities.”
However much we may try to boast about the new technology and the greater set up of medical avenues in the health sector, there is always a rich and a poor demarcation. Most of India's billion-plus people struggle with a public health care system which is virtually nonexistent in villages[6]. On the other hand, private health care is booming, and the country's state-of-the art hospitals and highly skilled doctors even attract patients from countries where health care costs are much higher. The challenge before India is to make such top quality care accessible for the majority of its people and to put such high quality services within reach of the poor.
[1]World Health Organization (WHO). The prevalence of Anaemia in women: a tabulation of available information.
[2]Mahomed K. Iron and folate supplementation in pregnancy. Cochrane Database Syst Rev. 2000;(2) CD001135: World Health Organization Reproductive Health Library CD-ROM. 2004;7.
[3]World Health Organization (WHO). Prevention and Management of Severe Anaemia in Pregnancy: Report of a Technical Working Group.
[4]Nyuke RB, Letsky EA. Etiology of anaemia in pregnancy in
[5] The Hindu, It will slow development: Harsh Vardhan,
[6] Public Health Foundation of India, India Offers Both Best, Worst of Health Care ,Voice of America Press Releases and Documents , 3 May 2006, http://www.phfi.org/news/newsdetail.asp?id=74
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