Women wait outside the only maternity hospital in Srinagar, India, in 2008. (Mukhtar Khan/Associated Press)

Tens of thousands of Indian women die needlessly every year during pregnancy or because of childbirth-related problems, a human rights group said Wednesday, blaming a medical system hobbled by poor planning, caste discrimination, a lack of accountability and limited access to emergency care.

India has a maternal mortality rate 16 times higher than Russia, and 10 times higher than China, Human Rights Watch said in a report. That means one out of every 70 Indian women who reach reproductive age will die because of pregnancy, childbirth or during unsafe abortions.

"For an emerging global economic power famous for its medical prowess, India continues to have unacceptably high maternal mortality levels," the report said.

Aruna Kashyap, a lead researcher on the report, summed it up simply: "Seventy-five per cent of maternal deaths [in India] are preventable."

While India has had an overall decline in maternal mortality in the past few years, the rights group says those figures mask continuing — and sometimes worsening — problems in parts of the country.

Some states, including the heavily populated north Indian states of Haryana and Punjab, "actually showed an increase in maternal mortality. And significant disparities based on income, caste, place of residence and other arbitrary factors persist even within every state, including those that appear to be improving access to care for pregnant women and mothers."

The results have led to staggering numbers. In 2005, the last year for which overall figures were available, about 117,000 women died due to maternal-related reasons, Kashyap said.

Obstetric fees high

A big part of the problem, the report found, was a lack of accountability over maternal mortality, with government officials, hospitals and health workers dodging responsibility for the problems that lead to such high death rates.

Those problems range from ill-trained obstetric staff to charging crippling fees to poor villagers — $10 US for a delivery in some clinics, plus $1 to cut the umbilical cord and $1 for the delivery room cleaner. Those numbers may not look high, but many Indian villagers support their families on less than $2 US a day, and are seldom able to save at all.

Plus, deliveries, and pre- and postnatal care are supposed to be free.

"These guarantees exist on paper, but when it comes to translating paper guarantees into practice there's a big gap," Kashyap said in an interview.

The report said that in Uttar Pradesh, the country's most populous state, only about one in 100 community health centres, the government-run clinics where many women deliver, have storage facilities for blood. In many smaller hospitals, even minor complications often require transporting mothers more than 100 kilometres over bad roads to larger hospitals.

In addition, caste discrimination continues to plague Indian mothers. One 2007 study in six north Indian states found that 61 per cent of maternal deaths were among Dalits — as "untouchables" are now called — and the indigenous people known here as tribals, Human Rights Watch said. Those two communities are at the very bottom of India's complex social ladder, and are far more likely to live without equal access to jobs, education or health care.

In Uttar Pradesh, caste discrimination is an ingrained part of the medical system, doctors and activists say.

"Upper-caste health workers refuse to visit Dalit communities," said Lenin Raghuvanshi, a rights activist. Because of that, "pregnant Dalit women do not get [nutritional] supplements and the majority of them are anemic."

Human Rights Watch made a series of recommendations to improve maternal medical care, including:

• Requiring that all pregnancy-related deaths be formally reported to authorities.
• Institutionalizing a system of investigating those deaths.
• Establishing an early response system, including a telephone hot line, for obstetric emergencies.

With files from The Associated Press