Sama meaning equality in Sanskrit, is a resource group based in New Delhi, India that works to improve women’s sexual and reproductive health and rights. The International Women’s Health Coalition (IWHC) has funded and supported Sama since 2016, and we have partnered in global advocacy spaces for more than two decades.
IWHC spoke with Sama about its work ahead of the International Day for Maternal Health and Rights.
How is Sama working to promote maternal health and rights in India? How does this intersect with other issues that you focus on?
At Sama, our work is particularly focused on building evidence about gaps and violations related to maternal health and rights at the policy level. We do this through research and fact finding processes. We recently completed two research studies in collaboration with the National Human Rights Commission (NHRC). The first was a country assessment of sexual and reproductive rights in India, which included a mapping of maternal health and rights, and recommendations to the government. The second was primary research, which focused on health status and access to care for tribal communities in three states (Odisha, Jharkhand, and Chhattisgarh).
The research findings identified disproportionate gaps in the health care system for women from tribal communities, as well as poor access to information, nutrition, and other socio-economic determinants of maternal health and rights. Sama has pushed to address these issues through policy advocacy and public engagement processes, and through coordinating and contributing to reporting to human rights bodies, such as the United Nations’ Universal Periodic Review and the Committee on the Elimination of all Forms of Discrimination Against Women (CEDAW). This work intersects with our efforts to strengthen health system responses to gender-based violence, ensure access to medicines, and protect the rights of surrogates.
What are the major challenges and barriers that women in India today face in this area? What threats and/or opportunities do you see ahead for advancing maternal health at the national level?
Poor maternal health continues to be a significant, unjustifiable problem in India. Maternal mortality is a primary indicator of a country’s maternal health status, and although the rate of maternal deaths in India has improved over the years, it remains extremely high. The approach to addressing maternal health continues to be fragmented and focused on promoting deliveries in health facilities. With this narrow focus, the state overlooks the poor quality of care overall for women and pregnant people—including lack of information, weak infrastructure, obstetric violence, and barriers to access—which reinforces a limited understanding of the full framework of sexual and reproductive rights.
This is evident from the limited access to safe, quality abortion services in India. Despite the legality of abortion, unsafe abortions are believed to contribute to 9 to 13 percent, or more, of the maternal mortality rate in India. In some districts, those numbers rise to as much as 50 percent. The absence of necessary facilities and adequate numbers of trained, legally registered health care providers pose major challenges for those accessing abortion care. The failure to provide women, girls, and health care providers with comprehensive information about the Medical Termination of Pregnancy Act often further compromises abortion access, especially for those who belong to marginalized communities. Far too often, the consequence of insufficient information, care, and access is maternal mortality and serious morbidity.
How does support from IWHC help you push for progress on sexual and reproductive health and rights?
IWHC’s support has been critical to furthering Sama’s initiatives to improve access to sexual and reproductive health and rights—especially for young people—and to advance our policy advocacy. We’re pushing at the national and sub-national levels to strengthen programs such as the Rashtriya Kishor Swasthya Karyakram (National Adolescent Strategy), which allows young people to access a range of sexual and reproductive health information and services, including abortion care and services for survivors of violence.
IWHC has additionally supported our work to sensitize public health workers on the sexual and reproductive needs of youth. We collaborate with allied nongovernmental organizations and community-based groups to improve the quality and sustainability of public adolescent services and programs. Partnering with IWHC allows us to build our own technical capacity and invest in systemic progress.
This interview has been edited and condensed.