Mahals & Maternal Mortality
by Maria Prebble -- August 15th, 2014
“The sight of this mansion creates sorrowing sighs and makes the sun and moon shed tears from their eyes.” – Emperor Shah Jahan
And Shan Jahan was right—the Taj Mahal is quite simply the most beautiful and incredible site in the world. Entering the complex from the darwaza, the main gateway, my friend and I were so overwhelmed we could only smile at each other. Arriving at six in the morning, we were some of the first people to pass through the gardens, see the Taj reflected in the clear, blue and tranquil pools, and enter the tomb through the main iwan, or arched doorway. Even with exterior damage due to modern day air pollution and the looting of decorative and priceless jewels during the time of British colonialism, the Taj Mahal is perfect.
A heartbroken Emperor Shah Jahan commissioned the Taj Mahal as a mausoleum for his favorite wife, Empress Mumtaz Mahal, after she died giving birth to their fourteenth child in 1631. Twenty-two thousand workers took twenty-two years to construct the Taj Mahal. Almost four hundred years later, two million people visit the monument annually.
While the Taj Mahal is an adamant symbol for eternal love, it is also a monument to modern India’s tragic—and preventable—maternal deaths. As of 2013, India’s maternal mortality ratio (MMR) is 190 maternal deaths per 100,000 live births. Put another way, a woman dies in childbirth every 10 minutes in India. In the state of Rajasthan, the MMR is 255. Several factors contributing to India’s high MMR are inaccessibility to healthcare services, inadequate healthcare, poverty, an unmet need for family planning, poor sanitation, malnutrition and the low social status of women.
Studies suggest that climate change will increase the risk of maternal mortality because of the effects of malnutrition, heat exposure, infectious disease and poor sanitation. Population, health and environment (PHE) is an approach in international development that addresses the interconnected challenges between humans, their health and the environment in intervention and project development and implementation.
PHE programs are particularly important to implement in “biodiversity hotspots.” More than one billion people live in biodiversity hotspots, areas that are both biologically diverse and severely threatened by human activity. As the map below shows, India is experiencing a high population growth rate with a low resilience to climate change, a decline in agricultural production, water scarcity and an unmet need for family planning. Approximately 20 percent of the world’s population lives within “hotspots,” which cover only 12 percent of the planet’s land surface.
Although India’s MMR has fallen dramatically in the last decade, India is unlikely to meet its Millennium Development Goal target MMR of 109 by 2015. Over the last few decades, the Indian government and local NGOs have implemented schemes and programs to decrease maternal deaths. For example, the Indian government sponsors a program that provides free transportation for women to and from delivery centers.
However, as I mentioned in previous posts, it is exceedingly challenging to disseminate information regarding available government and NGO schemes to women and their communities in rural Rajasthan. In some areas, I met women who choose not to travel to health centers because they are dissatisfied with the inadequate care they (or family members, friends, etc.) received during a previous visit. The factors contributing to maternal deaths are complex and multidimensional and PHE programs with community involvement are essential in international development because they provide a holistic response to the interconnected challenges of an issue such as maternal mortality.