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 According to the Cairo Convention, reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other relevant UN consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. Implicit in this is the right of access to health care services that will enable women to go safetly through pregnancy and childbirth. All countries are called upon to strive to make reproductive health accessible through the primary health care system to all individuals of appropriate age.
In 2000, while documenting cases of violation of the right to reproductive health in different districts of UP, SAHAYOG began to find cases of denial of maternal health services leading to either maternal death, near-misses or prolonged illness. Contrary to belief in policy circles that the rural community was too ignorant to access EmOC, we found in most stories that women had been denied life-saving information from service providers, and were also denied services if they attempted to access institutional care. Since uncovering these ground realities, SAHAYOG has been working through partnerships with other organizations to promote women’s right to maternal health.
Objectives
- To increase community women’s access to and control over maternal health services through advocacy and monitoring using rights-based approaches.
- To promote women’s reproductive rights, including the right to reproductive health, by engaging in evidence-based policy advocacy with state actors, donors and the media, and monitoring the quality of RH programmes.
To fulfill these objectives, the Maternal Health and Rights Programme uses a human rights-based approach to create ‘rights consciousness’ among the rights holders (in this case low-income low-literacy women) and a corresponding ‘sense of accountability’ among the duty-bearers (including the health bureaucracy and political actors). Through research, monitoring, case documentation, campaigns, capacity-building, casework and advocacy with policy makers and the media, the Maternal Health and Rights Programme seeks to understand the ground realities of maternal health, investigate the reasons behind poor maternal health indicators and experiences, engage in advocacy to hold the government accountable for creating and implementing effective maternal health policies, and build the capacity of underserved and marginalized women to claim their rights to quality maternal health services and government entitlements.
The Maternal Health & Rights Programme works at the following levels:
State Level
National Level
International Level
**SAHAYOG is also actively involved in advocacy on the issues of maternal health and reproductive health rights in collaboration with Healthwatch Forum, for which SAHAYOG is anchoring the secretariat. Healthwatch forum is a network active in several north Indian states for advocacy and monitoring on reproductive health and rights. Healthwatch Forum maintains the Reprohealth Listserve which is used by advocates and concerned civil society members to communicate about maternal and reproductive health and rights across India **
State-Level
Women's Health Rights Forum (Mahila Swasthya Adhikar Manch)
Women’s Health Rights Forum, known in Hindi as Mahila Swasthya Adhikar Manch(MSAM), is a network of approximately 8,000 poor, rural, Dalit, Muslim, and tribal women leaders in twelve districts of Uttar Pradesh that works towards realizing women’s right to health and safe motherhood. MSAM was formed at a gathering in Lucknow on 26th May 2006, during the culmination of a state-wide three month-campaign on women’s right to maternal health services called “Complete Citizens, Total Rights” (Puri Nagrik Pura Haq).
MSAM builds rural women’s capacity to recognize their own entitlements as ‘rights holders, to identify ‘duty bearers’ who are accountable to ensure their right to health, and to advocate for their rights to maternal health services with their local, state and district-level officials and health care providers. Each woman member receives a membership identification card that entitles her to the support of the entire network in case she faces any problems in accessing health services. MSAM identity enables women leaders to negotiate improved quality of care at health facilities, and take an active role in identifying cases of denial of services or maternal death.
MSAM monitors and documents the quality of local health services and advocates at the district, state and national levels for improvement in the situation of maternal health. Currently, members of MSAM are monitoring local health expenditure, following their community audit of entitlements to nutrition services. In several districts, MSAM leaders are in active dialogue with local legislators for improving maternal health care, especially Emergency Obstetric Care services, and have presented recommendations at the state level.
Objectives:
- To raise rural women’s awareness about their rights to maternal health services.
- To train rural women to monitor the quality of local maternal health services and identify cases of denial of services or maternal death.
- To build rural women’s capacities to advocate at the local, district and state levels to improve the situation of maternal health in Uttar Pradesh.
Outcomes:
Women have been trained about the Right to Information Act and have been motivated to use this Act at the community level to gain access to information on different government schemes (ie. Janani Suraksha Yojana, Aganwadi, Public Distribution System, etc.)
Women have taken action to improve maternal health services by doing monitoring and case documentation of service provision, participating in district-level dialogues with health department officials, holding signature campaigns, filing petitions and making recommendations to the government.
Each year since 2004, SAHAYOG and Healthwatch Forum have brought together government officials, donors, technical agencies, civil society and community women on 28th May (International Day of Action for Women’s Health) for a State-Level dialogue on ways to improve maternal health in Uttar Pradesh.
National-Level Work
Negotiating Rights: Building coalitions for improving Maternal Health services in Uttar Pradesh, India
The Negotiating Rights project is a new 2-year action research project that was initiated in 2008 and is working to build coalitions of stakeholders around maternal health services, including women users of maternal health services, providers and policy makers. The formation of these coalitions will make a difference in the way maternal death is currently perceived among the diverse actors involved in the pluralistic health system in Uttar Pradesh state. This project is being implemented by SAHAYOG, with support from Research Advisor Dr. Hilary Standing of the IDS Sussex.
Objectives:
- To investigate how the different actors currently think about and approach maternal health issues and how they conceptualize their roles and associated constraints.
- To identify groups of actors who may think alike on critical maternal health issues.
- To engage in environment building and document preparation towards Future Search dialogues among certain actors in order to move towards a shared vision about the problems of maternal health in India and develop a practical action plan.
Outcomes:
The project aims to produce the following outcomes:
Creation of a notion of ‘unacceptability’ of all preventable maternal deaths
Increased importance given to maternal health services by relevant policy actors
Better quality and more responsive maternal health service provision.
Access to Maternal Health Services for Women Workers in the Unorganized Sector
This collaborative and participatory study seeks to examine access to health services, and maternal health services in particular, for women workers in the unorganized sector in three Indian states in order to improve these women’s ability to receive the health care they need.
For more a complete description, visit the Research page...
National Study on Maternal Health and Institutional Delivery
This national study is being carried out in 9 states of India in order to examine the effectiveness of the Indian government’s maternal health policies by documenting women’s experiences seeking and receiving care at institutions during childbirth.
For a complete description, visit Research page...
International-Level Work
International Initiative on Maternal Mortality and Human Rights
The International Initiative on Maternal Mortality and Human Rights is a collaboration among leading safe motherhood and human rights organisations from around the world that is aimed at addressing maternal mortality as a human rights imperative. The International Initiative on Maternal Mortality and Human Rights was launched in October 2007 during the Women Deliver Conference in London. The Initiative was founded by six international organizations in the health and human rights fields, which currently serve as the provisional steering group: the Averting Maternal Death and Disability Program of the Mailman School of Public Health, Columbia University; CARE; the Center for Reproductive Rights; Family Care International; Physicians for Human Rights; and the UN Special Rapporteur on the Right to the Highest Attainable Standard of Health (Paul Hunt).
SAHAYOG is one of only 7 organizations around the world that have been selected to join the Initiative’s Steering Committee which is responsible for the governance of the Initiative and for advancing its goals and objectives. As part of the Steering Committee, SAHAYOG will help set policy decisions, develop and approve strategic plans, provide expertise and guidance for field activities, and conceptualize and shape the development of key resources on maternal mortality and human rights.
Objectives:
- To promote government accountability for the implementation of effective and equitable policies and programmes to reduce maternal mortality.
- To secure increased resources at the global and national levels committed to reducing maternal mortality.
- To promote understanding among and provide expertise to key stakeholders on addressing maternal mortality as a human rights issue.
- To support and amplify existing efforts on human rights approaches to reducing maternal mortality.
Outcomes:
This Initiative aims to reduce maternal mortality by holding governments accountable for implementing effective and equitable policies and programmes, securing increased resources at the global and national levels, and promoting understanding among, and providing expertise to, key stakeholders on addressing maternal mortality as a human rights issue.
Tracing Pharmaceuticals in South Asia: Regulation, Distribution and Consumption
In South Asia, almost 80% of all private health care expenditures are on medicines, and ill -health is the major reason why South Asians fall into poverty. Yet not enough is known about the processes through which pharmaceutical products and their patterns of use help or hinder efforts to meet the MDGs.
This study aims to use anthropological, public health and political economic approaches to investigate the reasons behind the misuse of drugs that are vitally important from a public health perspective by tracing the journey of three generic drugs - oxytocin, rifampicin and fluoxetine from production to consumption in India and Nepal.
Objectives:
- To understand how each of the three drugs is marketed, prescribed and used.
- To understand the overall pharmaceutical industry behaviour around these drugs.
- To examine the pharmaceutival industry’s behaviours, including distribution and retailing, as well as the health practitioner behaviours and the community behaviours and impacts.
This inter-disciplinary project will combine detailed ethnographic interviews, semi-structured qualitative interviews with key opinion leaders and shapers, organisational analysis and secondary data sources using government statistics, and information and pharmaceutical industry data.
This research is being led by a research group at the University of Edinburgh, including members of the Centre for International Public Health Policy and the research network on the Sociology and Anthropology of Health and Illness. CHSJ, in partnership with SAHAYOG, is responsible for coordinating the study in Uttar Pradesh, West Bengal and Delhi.
Outcomes:
The desired outcomes of this research are to uncover the local rationalities that underlie much apparently "irrational" drug use behaviour and display how these patterns fit into trans-local processes, to assist the development of effective interventions to improve MDG and other health outcomes and thereby contribute to poverty-reduction strategies, and to generate a new analytic framework for examining interactions between the political, cultural, commercial and medical aspects of pharmaceutical use.
WHRAP South Asia Regional Task Force
Since 2005, SAHAYOG has been part of building a South Asian Task Force made up of elected representatives, senior officials and civil society members from the four participating countries – Nepal, Pakistan, Bangladesh and India. The Task Force’s role is to ensure that the WHRAP advocacy agenda is represented in the programmes of relevant South Asia forums, as well as to influence local and national-level policy changes, including budget allocation and utilisation, and to monitor progress towards improved maternal health conditions and young people's SRHR. Other envisioned functions include initiating regional advocacy on donor accountability, acquiring access to reliable data on agreements between governments and lending institutions in the interest of transparency, and building capacities of health advocates and health programme managers and auditors, especially on the point of health sector reforms. The last Task Force meeting was held in October 2007 in India.
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