To Trust or Not to Trust

Does not look like like this subcentre has been opened for quite some time...

   Our respondent was a poised young mother of three beautiful children. The youngest kept trying to play peek-a-boo with me while the mother was responding to survey questions. Most of the IHDS survey limits itself to factual questions but at the end of the interview I could not contain myself. I asked this young woman why she did not go to hospital for delivery. She blushed and confessed to being afraid. I asked her what about a hospital delivery made her afraid. She responded that her sister had gone to hospital for a delivery and must have gotten some infection, which led to cancer and her subsequent death. This respondent was Muslim and I could not help relating her answer to my perception that Muslim families are somewhat alienated from formal systems of various types. Next door I confronted a similar response from a Hindu respondent.  She also expressed concerns about quality of care in hospitals and preferred to deliver at home.  There goes my religious stereotyping!

      Given the intense investment Government of India is making in encouraging hospital delivery, this is perplexing. Janani Suraksha Yojana (Safe Motherhood Scheme) provides Rs. 1,400 to mothers to defray transportation and other costs. If a health worker helps the mother with the logistical arrangements, this worker would receive Rs. 600 as an incentive.  So why this distrust in hospital delivery?  It took a walk by the local subcentre to make me understand why.  In the Indian Health System, a subcentre is the first point of service and covers a population of 5,000 in plain states and 3,000 in hill areas.  It is supposed to be the focal point for rudimentary care and the Auxiliary Nurse Midwife attached to the subcentre is expected to provide antenatal and postnatal care. 

    The subcentre was a busy place, a few children were enjoying themselves climbing on its gates, a cow was happily snacking on the grass growing next to the subcentre and there were mosquitoes aplenty.  However, there was no sign of any medical personnel, the door was locked and the path going to the clinic looked like no feet had touched it in weeks.  When I talked to a neighbor, she said that the building was almost never used. The nurse who visited it usually sat in the verandah of a neighbor’s house and vaccinated children…. Definitely not a conducive spot for antenatal checkup. 

    Looking at this clinic I was not surprised that virtually none of the women in its shadows would have trust in hospital delivery! If this forlorn building shapes one’s image of a health facility, I can’t imagine anyone wanting to go to a hospital. 

9-October 2011

© Sonalde Desai 2012