A 30-year-old pregnant woman who was living with HIV died outside the hospital building in Indore (Madhya Pradesh state (MP), India) after the government healthcare staff denied to provide adequate medical care and hospital admission.

It is not only shocking that alarming levels of HIV associated stigma and discrimination runs high in MP but also that despite of repeated alerts sounded on rising maternal mortality in the state, nothing much has improved.

Madhya Pradesh figures among the list of those Indian states where maternal mortality is high, particularly in rural areas, where the healthcare system is virtually non-existent and awareness on the subject among the people extremely low.

According to UNICEF, Madhya Pradesh along with Assam and Uttar Pradesh, has a high Maternal Mortality Rate (MMR) of 700 or more per 100,000 live births as against the national figure of 407 per 100,000 live births as per the 2001 Census figure. However, regional disparities in maternal mortality are wide with the death ratio being low in Kerala, Tamil Nadu and Punjab and extremely high in most northern states in India.

President of Madhya Pradesh Network of People living with HIV (MPNP+) Manoj Verma said that on 3 April 2007, a 30-year-old pregnant woman who was living with HIV, died outside MY Hospital after the government healthcare staff refused to admit the patient. She was referred from Bhuranpur, Nehru Hospital, village Gambhirpura on 31 March 2007.

After the preliminary examination, she was referred and was taken to the ward for admission. But when the doctors came to know of her HIV positive status, they intentionally discharged the patient despite of the fact that she was in labour pains. But the doctors blatantly refused to admit her. While the patient came from the fifth floor of the hospital and reached the compound, she delivered the baby girl near the water tank of the MY Hospital. The relatives again tried to approach the healthcare staff to re-admit her but the security guards refused their entry into the hospital building.

As her condition was critical on 2 April 2007 she was brought to the MY Hospital at 9.30 am and fortunately got hospital admission, but was not fortunate enough to get proper medical attention. On 3 April 2007, her condition worsened, with no doctors to attend to her and she succumbed owing to severe medical negligence during and after child birth. She belonged to 'Banjaran' backward class and had five children.

MPNP+ President Manoj called the collector of Indore who asked him to register an FIR (first Information Report) at the nearest police station. However the nearest Sayogitha Gunj police station refused to lodge an FIR.

"I am shocked to hear of the blatant discrimination against a pregnant HIV+ woman in the hospital in Indore. This is even more so because right now there is a huge campaign by UNICEF and others to work on maternal health issues in MP" said India's noted women's health rights activist Jashodhara Dasgupta of SAHAYOG ( www.sahayogindia.org).

Many reports reveal the extent to which people are stigmatised and discriminated against by health care systems in India. Many studies reveal the reality of withheld treatment, non-attendance of hospital staff to patients, HIV testing without consent, lack of confidentiality and denial of hospital facilities and medicines.

Fear of discrimination often prevents people living with HIV from seeking existing healthcare services. Perhaps the most conspicuous context for HIV/AIDS-related discrimination, stigmatization, and denial is the health care sector in India, whether public or private. Many infected people trace some of their AIDS-related fear, anxiety, and denial to their traumatic experiences in health care settings.

Health activists in India stress on the dire need to frame strategies to address women's health care, including HIV vulnerabilities, in the context of rights. The issues they seek to resolve include confidentiality, partner notification, and free and informed consent — all difficult issues for women who risk violence and neglect if their HIV status is disclosed. Without increasing gender sensitivity among health planners, healthcare workers, policymakers, judiciary, and other stakeholders, the high rates of maternal mortality fuelled with HIV associated stigma are unlikely to come down.

(The author is a senior health and development journalist, writing for newspapers in Asia and Africa. He can be contacted at: bobbyramakant @ yahoo.com)

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