research institute for compassionate economics

Infant mortality

Written by Diane Coffey on July 29th, 2012

This was a tough week. When I left Sitapur in the last days of March, I said good-bye to 21 women who I had been visiting weekly throughout February and March. Three were pregnant, and 18 had little babies, all less than 4 months of age. As I wrote in “Caring for baby in the heat,” I have been worried: worried that some of them might not make it.

Indeed, I found out over that last few days that two of the 18 babies died in the past few months, and one of the pregnant women came home without a baby.

The young woman who came out without a baby, we’ll call her Farzana, is nineteen years old and has been married for seven years. She and her in-laws were all excited for the pregnancy: they had been afraid that she might not be able to conceive. Farzana told me that she felt the baby moving in her belly up until the time of delivery. When she felt her labor pains coming on strong, she told her mother in law, and they went to the hospital.

She saw the nurses put the little baby girl she delivered in “the machine,” basically a baby warmer, but two hours after the birth, someone told her that the baby had been born dead. Farzana doesn’t know what to believe about whether her baby was born alive, but if she is to believe the nurses story, then this baby would not properly be counted in an infant mortality statistic, which is defined as deaths per 1000 live births. (I don’t know what to believe, either. It is not in a government hospital’s interest for babies to be tallied as having died in its care. It seems strange to put a dead baby in the warmer.)

The infant mortality rate in rural Sitapur from the Annual Health Survey was 82 deaths per 1000 live births. Hearing Farzana’s story made me wonder how high it would be if we knew more about early neonatal mortality. Certainly Farzana mourns the loss of her baby like the other two mothers, whose babies died at 3.5 and 4.5 months old.

I thought I would also share the story from my field notes that Ramila told me; she seemed to want to tell it. She is the mother of the 4.5 month old baby who died in mid-June. This baby was the third of Ramila’s babies to die—she had a little girl who died shortly after birth, and a little girl who died when she was about a month old. I didn’t audio record the story, so what is here is a paraphrasing from field notes, with some of Ramila’s exact words mixed in:

Ramila said that the baby had been having lots of diarrhea, and that she’d taken her to Deepak doctor, the baby doctor in the town. She took the little girl to this doctor several times; she was even going to this doctor before I left in March. Once, she went to the baby doctor during the day time, spent all day there, and had to come home late at night by herself, because her husband was away doing migrant labor work. She could only get transportation for part of the trip; she walked more than half of the 10 kilometers back to her village in the dark by herself. She was scared. The doctor had said: “She [the baby] has very little blood. There is no blood in her body. Her blood has become water.”

Knowing that Deepak doctor had given up on her baby, she followed the advice that another villager had given her and took the baby to Latehar, three and half hours away by bus, to see the “Rickshawale doctor.” Her husband’s sister lives in that city, so she knew that she would have somewhere to stay. When she got down from the bus, she just asked for the Rickhawale doctor, and someone pointed him out to her. The Rickshawale doctor told her to stop giving any sort of milk to the baby: no breastmilk and no cow’s milk. He gave her a package of “electrole powder,” (oral rehydration salts), and gave the baby some medicine, which she thinks was to help the baby sleep.

Then she went to her husband’s sister’s house. That evening, the family was sitting around, drinking Pepsi. Someone wanted to give some Pepsi to the baby, and she said, “Don’t do it, it will bother her.” Still they put a couple of drops on her tongue and she seemed to like it. Again she said, “don’t do it, it will bother her.” Then, before she went to sleep, the baby started to cry a little, and Ramila felt sad. She did not want the baby to be hungry, perhaps to die hungry, so she gave it a little bit of breastmilk, and it fell asleep.

In the morning, when she woke up, the baby opened its eyes, and closed them, and then opened and closed them again. She patted the baby to put it to sleep, and then laid it down; she thought it was sleeping. Then, she and her niece went out to openly defecate.

When she came back her husband’s sister had the baby in her lap. Ramila was washing her hands with water from a lota, a steel jug. Her husband’s sister asked, “Did you give the baby any milk?” At first Ramila lied and said no, and then she admitted that she had. She saw that her husband’s sisters eyes were wet, and then she understood that something bad had happened to the baby. She threw down the lota with a crash, and went to see what had happened. The baby was dead.

At this point in the story, Ramila stopped using the word for “baby” to refer to her daughter, and started using the word for “body.” She called someone from her village to come and get her on a motorcycle, and rode the three and a half hours back home on the back of the motorcycle carrying the body on her lap. She explained: “You’re not allowed to bring a body on the bus.”