Here is a heretical thought. Being a mother is good and great. Only a killjoy will say no flowers, no home-made card or no treat on Mother’s Day. But now that we are done with that fuzzy, touchy-feely moment, one can be blunt. Glorifying motherhood alone will not save mothers.

The State of the World’s Mothers (SOWM) 2011, brought out by Save the Children, the international non-governmental organisation, makes clear that the countries where mothers are most at risk are also the countries which fare poorly in many other areas — women’s health, education, economic and political status and children’s well-being. In other words, motherhood is a risky affair in a community or country where girls and women remain severely neglected and disempowered, never mind the public homage to the idea of motherhood.
Last week, somewhere between the Indian Premier League, the ongoing “Osama dead” show and the 2G drama, a bitter truth slipped through. No matter what we say in public, India does not treat its mothers well. According to Save the Children’s latest ranking of mothers, India is 75th out of 164 countries that were surveyed for SOWM 2011. This is two notches below 73rd, its previous rank.
India is not the worst country to be a mother. That dubious honour goes to Afghanistan. Pakistan and Papua New Guinea also trail behind us, as do a bunch of poor countries in Africa. We can also draw comfort from the fact that “a woman in the US is more than seven times as likely as a woman in Italy or Ireland to die from pregnancy-related causes and her risk of maternal death is 15-fold that of a woman in Greece”.
But among our peers, the emerging economies, we cut a sorry figure in the motherhood stakes. Just two examples: Brazil is 12th and China is 18th, against our 75th.
So what are we doing wrong? Why is it that nearly 70,000 women continue to die from complications related to pregnancy and childbirth every year and why do we lead the world in newborn deaths, despite a raft of policies and programmes?
Public health experts cite a slew of measures that need to be taken — basic training to female frontline health workers to deliver inexpensive low-cost health interventions, more encouragement to women to deliver at a hospital or health centre, better-equipped hospitals, better knowledge and choices of family-planning measures and so on. The National Rural Health Mission has already initiated many of these steps, but implementation continues to be patchy as has been pointed out time and again. Many more mothers and newborns can be saved if more is done to monitor and evaluate the programmes that have been launched.
Safe motherhood, however, is not a stand-alone experience that can be delinked from everything that has happened or not happened to the mother in the years that preceded what should be a joyous moment.
What gives mothers and children the best chance to survive and thrive? Maternal and child healthcare, of course. But it depends equally on whether mothers had access to education and economic opportunities and the condition of their life in general. The ranking of mothers worldwide was done this year using a wide set of criteria which included lifetime risk of maternal death, female life expectancy, women’s economic equality, child mortality, and working conditions for mothers.
Norway is at the top of this year’s Mother’s Index and provides a study in contrast with bottom-ranked Afghanistan. Norway is rich, Afghanistan is not. Skilled health personnel are present at virtually every birth in Norway, while only 14 per cent of births are thus attended in Afghanistan. But other crucial socio-cultural factors are at play as well. “A typical Norwegian woman has 18 years of formal education and will live to be 83 years old; 82 per cent are using some modern method of contraception. At the opposite end of the spectrum, in Afghanistan, a typical woman has fewer than five years of education and doesn’t live to be 45. Less than 16 per cent of women are using modern contraception, and one child in five dies before reaching age five”, says the report.
The underlying big difference is in the status of women. Where women enjoy a high status, mothers are safe and fare well. Where women are neglected, mothers fare poorly. On women’s status, SOWM 2011 ranks India 76th out of 80 countries for which data was available. Here again, Brazil is at 13th position and China at 11th. India’s Children’s Index rank (out of 81 countries) is 75th compared to Brazil’s 12th and China’s 43rd.
Some states in India are much ahead of others. Example: The maternal mortality ratio (MMR) or the number of maternal deaths per 1,00,000 live birth is 335 in Madhya Pradesh, 95 in Kerala. The stark contrast has a lot to do with the status of women.
Saving mothers must start with saving girls. In India, discrimination against women starts from the womb and extends till death. Today, even in rich, educated and metropolitan homes, a son is preferred to a daughter and there are umpteen instances of female foeticide in homes rich and poor, despite the law. In millions of homes across the country, girls are fed less and educated less because they are not seen as assets. Girls are rarely sensitised about their rights and child marriage continues in many parts of the country despite another law. When girls are married off at a time when they should be at school, it not only robs them of education and their future but early child bearing affects their health and has a direct impact on maternal deaths. Only a wafer-thin minority of women get to make the decisions that impact their lives in India including about their healthcare. Nobody will say they are for killing mothers, but when a woman dies in childbirth it very often is the extreme manifestation of this discrimination.
I remember visiting a home in rural Rajasthan where a woman had died while delivering a child. She could have been saved but the family did not take her to the hospital in time because the “elders” did not think she was sick enough to merit urgent medical attention. When they took her to the doctor, it was too late. The decision to go to a doctor, as so many other decisions, was not hers to make.
This is the elephant in the room we have to address if we want to go up the Mother’s Index, and make Mother’s Day mean anything to most Indian mothers.

Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at patralekha.chatterjee@gmail.com