Dear Secretary Clinton,
As advocates for women's health and human rights, we write to request your support on a matter of utmost importance for Indian women. We hope that this week when you meet with the Indian Prime Minister, Dr. Manmohan Singh, you underscore the dire state of women's reproductive health in India. As the nation with the highest number of maternal deaths annually, India alone accounts for nearly a quarter of the world's maternal deaths. Every year, more than 100,000 Indian women are dying from childbirth related causes. In addition, another 3,000,000 women will suffer long-lasting illness or injury. As such, maternal mortality in India is long-standing public health crisis, as well as a global human rights concern. The Indian government must be held accountable for its inaction in the face of this gross neglect of women's reproductive rights.
Maternal mortality in India is a multifactorial problem, stemming from medical, socioeconomic and health system-related factors. Despite the complexity of the problem, maternal mortality is understood to be a preventable epidemic, as it generally occurs due to the unavailability of care or substandard quality of care. The fact that these deaths are largely preventable is the very reason that such high rates of maternal mortality and morbidity are unacceptable. The virtual eradication of maternal mortality in many developed nations indicates that we possess the wherewithal to make pregnancy and childbirth extremely safe. Even in developing nations such as India, at least 75% of maternal deaths can be averted. Yet, an Indian woman dies in child birth every five minutes.
India's rate of maternal mortality exceeds that of other developing nations, including Pakistan and China. Despite its booming economy and evolution as a major political power, India lags far behind developed nations in terms of maternal health. The rate of maternal mortality in any given country is said to reveal more about the condition of its health care system than any other indicator. By this measure, reforming the health care system in India ought to be a national priority. Yet, the priorities of the Indian government lie elsewhere. Economic development in India has not only failed to adequately include women, but it is seemingly occurring at their expense. Despite the fact that India has the world's 12th largest economy, India's expenditure on health care, at 3.6% of the GDP, is significantly lower than the global average of 9.8%.
The high rate of maternal mortality among Indian women reflects continuing violations of their rights to life, liberty and security, health, and freedom from cruel, inhuman and degrading treatment. Efforts to promote women's autonomy and empowerment, which are critical aspects of the human rights paradigm, have historically been absent from strategies to improve maternal health. There has also been inadequate attention paid to discriminatory practices against women based on gender and caste, both on a societal level and within the health care system, that frequently lead to maternal deaths.
The Indian government must be held accountable for its failure to provide the necessary conditions for safe motherhood. The government of India, like that of the U.S., has committed itself to upholding the Programme of Action of the International Conference on Population and Development (ICPD), which recognizes "the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant."
The Indian government has failed to advance the agenda of the ICPD and meet other international policy commitments, such as the UN Millennium Development Goals. India is among the 189 nations that undertook an obligation to achieve a 75% reduction in levels of maternal mortality by 2015. Even if it were to achieve this goal, which recent data suggests it will not, India would continue to have a rate of maternal mortality that far surpasses that many developed and developing nations.
We were heartened by your recent statement that "maternal health is now part of the Obama administration's outreach." Given the magnitude of this largely preventable threat to women's lives, we hope that you will avail yourself of this opportunity to urge Prime Minister Singh to reevaluate the government's efforts to reduce maternal mortality and provide for safe motherhood in India.
For your reference, we are linking to a report by the Center for Reproductive Rights,
Maternal Mortality in India: Using International and Constitutional Law to Promote Accountability and Change.
President, Center for Reproductive Rights