Sonu Bohra's first pregnancy coincided with one of the longest periods of drought ever seen in her home village, high in the Indian Himalayas.
When she went into labor, it had not rained for almost six months and the taps had been dry for days.
When her water broke, an ambulance arrived to take her to the medical center in the nearest town.
But they refused to enter it, claiming that they had run out of water.
The ambulance driver decided to take her to the next center, 55 kilometers away, a trip of several hours on roads in poor condition.
They had the same problem there.
They set off to the next health center, but it was too late: the baby was on the way.
In the end, Ella Bohra gave birth on the side of the road, assisted by the ambulance driver.
As she watches her healthy two-year-old son play and squeal with joy outside her home in Sal village in Champawat district of Uttarakhand, Bohra remembers the excruciating pain she suffered while giving birth.
She knows that everything could have ended very differently.
“She was terrified,” she says.
”Everyone knows that [maternal] deaths are frequent in this area.
When the first hospital said no, I was worried that I would end up dying too.
“I started praying.”
Women queue to fill buckets of water from the only tap in Dhunaghat (near where Sonu Bohra gave birth in the ambulance), a village in Champawat district.
Cheena Kapoor (The Fuller Project)
India has been working to improve its maternal health record for almost two decades.
It has expanded maternity units in rural areas, provided free ambulances to ensure women can reach them safely, and created a wide network of Accredited Social Health Activists (ASHAs) to advise , organize prenatal check-ups and coordinate transportation to the hospital when women go into labor.
The proportion of women giving birth in hospitals or clinics rather than at home has more than doubled, from just over 40% in 2005-2006 to almost 90% in 2019-2021.
The maternal mortality rate has fallen from 400 deaths per 100,000 births (in 2007-2009) to 97 per 100,000 (2018-2020), meeting the Government's objective of placing it below 100 in 2020. This is one of the country's greatest public health victories in recent decades and has earned international praise.
However, as Bohra's experience demonstrates, the strategy of encouraging births in medical institutions has hit an unexpected obstacle: climate change.
Around the world, 16.6 million women give birth each year in hospitals and clinics without enough water, according to the NGO WaterAid.
More than 11% of maternal deaths and 26% of neonatal deaths can be attributed to births without water
India has 18% of the world's population, but only 4% of its water resources, according to the World Bank.
It is the world's largest consumer of groundwater, surpassing the United States and China combined, according to a United Nations report published in October, which warned that groundwater availability in India's northwestern region would be critically low by 2025.
Climate change has brought more erratic and less predictable rainfall patterns than before, making it impossible for hospitals in drought-stricken areas to operate year-round due to water shortages.
Even in large cities, some have to delay planned surgeries during the driest times, when water reserves are depleted.
And unlike a planned surgery, delivery cannot be postponed.
Two children carry water home from school near Sal village in Champawat district.
Cheena Kapoor (The Fuller Project)
The main hospital in Uttarakhand's Champawat district has been suffering from water shortages for years.
The main aquifer from which its supply comes dried up in the middle of summer, when it has to depend on water arriving by truck.
The hospital needs 25,000 liters of water a day, but the trailers only supply about 10,000, if they can get there, as they are sometimes blocked by landslides.
This year, a new pipeline was installed that draws water from a different aquifer.
But because extraction outpaces the rate at which these underground sources replenish themselves naturally, it won't last forever.
“More springs are drying up every year,” says Parmanand Punetha, chief engineer of the Uttarakhand Water Department.
On a hot day during the dry season this year, a long line of pregnant women waited to be seen.
Rukmani Devi, 33 years old and six months pregnant, says she often finds the hospital toilets closed.
“I am very worried about giving birth here,” she confesses.
“There is no place even to wash after giving birth.”
KK Agarwal, medical director of the hospital, knows of other cases like Bohra's, but cannot say how many.
“We have been raising this issue [water supply] with the authorities for years,” he says.
“Any project that needs government approval has to go through a long chain of procedures to obtain authorizations... It takes time.”
With no data on the frequency of water-related maternity closures, it is difficult to know how many women have been affected.
Emergency services records show that Sonu Bohra gave birth in the ambulance on March 23, 2021, while she was on her way to the Lohaghat government hospital.Cheena Kapoor (The Fuller Project)
Rakesh Kumar runs a small public health center in the eastern state of Bihar that relies on tankers for water supply during the dry season, but receives far less than it needs to operate at full capacity.
The center has been forced to turn away women for fear of infection if hygiene standards cannot be maintained.
“We carry out a minimum of 200 deliveries a month,” he says.
“But during the summer peaks, we only receive one tanker a day.
Most days we have to ask the patients' attendants to bring water from the nearby hand pump, or we are forced to send them somewhere else to give birth.”
In the neighboring state of Jharkhand, a health worker says her local primary care center has suffered constant shortages in recent years.
“The submersible pump at the health center stopped working a few years ago because the groundwater dried up,” she explains.
“The toilets are never open.
Now women prefer to give birth at home.
We have to invest a lot of time and energy to convince them to go to the nearest hospital.”
We keep hearing news about pregnant women having abortions while carrying water home or being denied admission [to hospitals] due to water shortages.
However, there is no comprehensive analysis
Anant Bhan, global health researcher in bioethics and health policy
Margaret Montgomery, head of the World Health Organization (WHO) for issues related to water, sanitation and hygiene in health centres, says: “If toilets don't work, women don't want to go to a centre;
“It is a real deterrent,” she says.
“India has made great progress in reducing the maternal mortality rate, but climate change and the lack of indicators in monitoring the national health system and a systematic review of budgets will exacerbate the risks to the health of mothers. and newborns.”
More than 16 million affected each year
Around the world, 16.6 million women give birth each year in hospitals and clinics without enough water, according to the organization WaterAid.
Annie Msosa, an adviser to the international health charity, says that more than 11% of all maternal deaths and 26% of neonatal deaths can be attributed to waterless births.
“Every two seconds, a woman gives birth in a facility without adequate water.
However, there does not seem to be specific data on maternal health, despite the fact that the WHO resolved in 2008 to investigate more about the impact of climate change on health,” she says.
Even where hospitals have adequate supplies, water shortages are affecting pregnant women's ability to access health care.
Hospitals in drought-affected areas of Kenya have recorded a decline in births as local nomadic or semi-nomadic communities have deviated from their traditional migratory patterns in search of pasture for their livestock, pushing them further apart and making it more difficult. their timely arrival at hospitals.
Antony Apalia, who heads the government's health effort in the worst-affected county of Turkana in northwestern Kenya, explains that during the worst of the drought this year, only one in four births there were attended by a registered nurse. well below the 70% registered in October 2022.
To solve the problem, authorities in arid and semi-arid areas of the country have deployed mobile health centers with vans or even camels.
They are also using chips placed in bracelets traditionally worn by young women to track the location of new and pregnant mothers and try to ensure they can access prenatal and postnatal services.
A little attended matter
In India, reducing maternal mortality remains a key policy objective, as does the consequences of water scarcity.
But the connection between the two has received little attention, according to experts.
A 2019 report on water management by an Indian public policy think tank noted that at least 200,000 Indians die each year from lack of sanitation resulting from water scarcity.
However, the main policy focus of the report was agriculture.
Maternal health care was not mentioned.
“We keep hearing news about pregnant women having abortions while carrying water home or being denied admission [to hospitals] due to water shortages.
However, there is no comprehensive analysis,” laments Anant Bhan, global health researcher in bioethics and health policy.
If current trends continue, India will miss the global target of bringing maternal mortality below 70 per 100,000 live births by 2030, warns WHO's Montgomery.
“The problem of maternal and neonatal mortality caused by lack of water can be solved.
It is just a matter of political will and leadership,” she says.
“But on current trends, the world will fall short of ending avoidable maternal mortality and more than a million lives will be lost.”
With information from
Allan Olingo
in Kenya.
This report was originally published in English on
The Fuller Project
.
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