New Delhi:
At a time when the world celebrates Mother's Day, it turns out that India scores poorly among the middle-income countries when it comes to health care and well-being of mothers.
The country is ranked 73 in the list of 77 nations rated for the "best place to be a mother", according to a report by child rights organisation 'Save the Children'.
What is more shocking in the 'State of the World's Mothers 2010' report is that India is rated much lower than a host of conflict-ridden African countries like Kenya and Congo.
Cuba tops the Mother's Index ranking followed by Israel, Argentina, Barbados, South Korea, Cyprus, Uruguay, Kazakhstan, Bahamas and Mongolia.
Among the neighbours, China is at 18th place, Sri Lanka at 40, while Pakistan lags behind India at 75th place.
Bangladesh, featured in the list of 40 least developed countries, is ranked 14.
The report analysed a total of 166 countries, among which Sweden is placed at the top while Afghanistan is at the bottom.
The report has highlighted the shortage of trained health workers, mostly in the semi-urban and rural villages that house majority of Indian population, as the main reason behind the country's sorry state of health care system.
It says that there is an estimated shortage of 74,000 Accredited Social Health Activist (ASHA) workers in India, while the figure is pegged at 21,066 in the case of Auxiliary Nurse Midwives. As per government norms, there should be one Asha worker for 1,000 population and one ANM for 5,000 people in plain areas and 3,000 in rural areas.
Shireen Vakil Miller, Director of Advocacy, Save the Children, pointed out that though India's flagship National Rural Health Mission (NHRM) has prioritised female health workers from the communities, there still remains an acute shortage and training requirement.
"We have to close the health worker gap and women have to be part of the equation to save the lives of other women and their children," she said.
"The health of a woman is closely linked to her educational status and socio-economic status. Despite maternal mortality rates showing a decline in India, thousands of women are still dying every year because they cannot access the most basic health care facilities or if these are available, are of poor quality."
India's child mortality rate, the number of deaths in every 1,000 children below five years of age, was 68 in 2008, while the current maternal mortality rate (MMR) is 254 deaths per one lakh live births.
The report also placed India at number one in the list of 12 countries that account for two thirds of under five and maternal deaths in the world.
According to a latest UNICEF report, the country accounts for 1.95 million child deaths (under five years of age) every year, which translates into 5,000 deaths every day, or one in every 20 seconds -- the highest in the world.
The complications related to pregnancy and child birth also kill 67,000 women annually. And it is estimated that 74 per cent of these mothers could have been saved if they had access to a skilled health worker at delivery and emergency obstetrics care for complications.
Similarly, 63 per cent of children under five could also have been saved if all children were to receive a full package of essential health care that includes skilled birth attendance, immunisations and treatments for pneumonia, diarrhoea and malaria.
"If every pregnant mother and sick child had the option to see a doctor in a clinic, that would be good news but we know that is far from reality in rural contexts and even in urban contexts," said Miller.
She also stated that the Janani Suraksha Yojana, a centrally-sponsored scheme aimed at reducing maternal and infant mortality rates, has not been able to make the desired impact, especially in states with high maternal and child mortality rates and has been bogged down by irregularities.
The report also emphasised the need for more investments, especially for the child and women, to further improve the health care system in the country.
Currently, India spends a mere 1.45 per cent of its GDP on health care, which is much below than that of its neighbouring countries like Sri Lanka and Bangladesh, which spend 6 per cent and 7 per cent of their GDP respectively on health care.
The report also uses examples from around the world including from Indonesia, Nepal, and Bangladesh to show how these countries have invested in training and deploying of female community health workers to bring down maternal and newborn mortality.