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No Tally of the Anguish
Accountability in Maternal Health Care in India
Abbreviations
Glossary
Summary
Disparities: From Global to Local
Recurrent Healthcare System Failures
Improving Accountability: The
Critical Need for Need for Better Monitoring and Timely Investigations
Improving Accountability: Reforming Grievance
and Redress Mechanisms and Creating Emergency Response Systems
Seven Concrete Recommendations
Methodology
Scope and Limitations
Note on Estimates
Note on Terminology
I. Preventable Maternal Mortality and
Morbidity: A Global Public Health Emergency
Causes and the Three Delays
Reduction Strategies
International Commitments and
Progress on Maternal Mortality Reduction
II. Maternal Mortality and Morbidity
in India
Estimates and Causes
Delivery of Basic and Comprehensive
Emergency Obstetric Services
The Janani Suraksha Yojana
Critiques of the Government's
Approach to Maternal Health
The Importance of Accountability
III. Recurrent Health System Gaps
Reflect Accountability Deficits
Poor Access to Emergency Obstetric
Care
Poor Referral Systems
Gaps in Continuity of Care
Financial Barriers to Care
IV. Improving Accountability: The
Critical Need for Better Monitoring and Timely Investigations
Poor District-level Monitoring
Barriers to Accurate Reporting of
Maternal Deaths
The Tamil Nadu System of
Investigating Maternal Deaths
Failure to Use Appropriate Indicators
Institutional Deliveries as an
Inadequate Indicator of Progress
Poor Long-term Monitoring
V. Improving Accountability:
Reforming Grievance and Redress Mechanisms and Creating Emergency Response
Systems
Establishing an Emergency Helpline
Role for an Ombudsman's Office
Problems with Existing Complaints
Mechanisms
Women's Poor Awareness of
Entitlements
Poor Access to Grievance Redressal
Procedures
The Need to Follow-Through in
Response to Grievances
VI. International Human Rights and
the Indian Legal Framework
International Human Rights Law
International Commitments to Reduce
Maternal Mortality
In-country Obligations of States
International Assistance and
Cooperation for Maternal Mortality Reduction
Indian Legal and Policy Framework
Constitutional Law and Supreme Court
Decisions
The Need for a Policy Requiring
Health Officials to Report Maternal Deaths
VII. Recommendations
To the Indian Central Government and
Uttar Pradesh State Government
To Donor Countries and International
Agencies
Acknowledgments
Appendix I
Appendix II
Appendix III
Appendix IV
Appendix V
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