The state of Uttarakhand is bordering Himachal Pradesh in the north-west and Uttar

Pradesh in the South and has international borders with Nepal and China. The state is
very rich in natural resources. The soothing weather in the valley supports a variety of
rarest flora and fauna. The life of the people here seems to be little slow compared to
the metropolitan cities. The State has two divisions (Garhwal and Kumaun), with 13
Districts, which can be grouped into three distinct geographical regions, the High
mountain region, the Mid-mountain region and the Terai region. Dehradun, being the
capital of the state is supposed to be most developed of all the other regions and is
well known for its salubrious climate and natural beauty.

The major issue in this state on the whole is of the poor and unhygienic healthcare
facilities available to the people of less developed districts like- Almora, Pauri
Garhwal, Tehri Garhwal, Bageshwar, Chamoli, Haridwar, Champawat, Udham Singh
Nagar, Uttarkashi, Pithoragarh, and Rudraprayag. The most vulnerable is the
condition of women’s, especially the pregnant women’s. Though the concern for the
women’s health in India has grown over the past three decades more so since the
United Nations Cairo Conference (1994). It was during this conference that the rights
of women and reproductive health was identified as a human rights all over the world
and India being signatory to the conference agreed to bring about changes in the
policies and programmes exclusively for the welfare of the women’s reproductive
health. The marginalization and health of the populations comprising of the hilly area
are a growing public health concern as they represent one of the most ‘at need’
groups. The National Family Health Survey (NHFS) of Uttarakhand, portrayed the
gloomy picture of the health status of women in general. According to the survey the
girls get married at a very less age resulting in early and risky pregnancies with no
medical facilities available. A pregnant women is supposed to have regular check up
in the first trimester and thereafter is recommended to receive full antenatal care
comprised of Iron and Folic Acid tablets, in addition with two or more tetanus toxoid
injections. Being a mother needs all the basic requirements for the nourishment of the
newly developing baby inside the mother’s womb without neglecting the mother’s
own health. This journey of nine months is supposed to be the happiest and
simultaneously the most difficult and crucial period in a women’s life. The state due
to its geographical condition is hampering the women’s real enthusiasm of nurturing
the fetus in its fullest form.

The public health report of Human Rights Law Network based in Almora states that
most of the pregnant women’s die before reaching hospitals owing to dismal transport
and road conditions in these mountainous regions. There could be many reasons
giving birth to these obsolete circumstances. Illiteracy and blind faiths, might be one
of the reasons as following the old traditions women’s don’t prefer being delivered at
the hospitals rather feel comfortable giving birth at home with the help of midwives
(dais). Poor women’s unaware of the unhygienic conditions of the surrounding, being
delivering the baby by the untrained hands and non-sterile instruments, sometimes
becomes the victim of this old and traditional practice leading to the various serious
life threatening reproductive health issues like Abnormal Vaginal discharge,
Reproductive Tract Infections, Sexually Transmitted Infections, Hemorrhage etc.

Though, it is true to the fact that the women’s of today are standing at par with men’s
in every field fighting for their rights, and now that their ‘say’ in the form of ‘rights’
are being recognized also at international level, but the condition of women’s in the
lower strata of the society is still below the grade line. On one hand, where WHO is
issuing guidelines on ‘reproductive health and taboos (female genital mutilation)
being practiced in the name of traditions and rituals, there on the other hand women’s
are not even able to deliver their child in the hygienic environment. The condition of
health sector is so pathetic that there are only one or two district and sub-district
hospitals in which most of the time doctor’s are on leave. Due to the extreme climatic
conditions and connectivity issues none of the qualified doctor’s wishes to be posted
in this region, especially the Gynecologists. The most disheartening fact is that only
one gynecologist is appointed for the district and sub-district hospitals, who cater the
OPD section as well as the Caesarean section at times of emergency and sometimes
they are also on leave.

Pregnant women in the less developed districts of Uttarakhand are facing acute
shortness of good and hygienic reproductive health services provided by the
government of the state, owing to the dismal of connectivity and sometimes ignorance
to the health of gestating mother’s. Gestating mother’s are the one to be best taken
care off, as a new life is germinating inside their womb, who needs physical, mental,
emotional and medical care and support to develop in its fullest form. Her antenatal,
safe delivery and post natal care should be given importance, since the egg fuses with
the sperm and implants on the uterus walls of the ‘being to be mother’.

The recent survey conducted by The National Family Health Survey (NHFS-4 2015 –
2016), provides a better picture and a positive step towards the improvements in the
reproductive health sector. But, there is still lot to be done in this sector for the better
and healthy gestational period of the pregnant mother’s.

TFR in the State, according to NFHS-III, is almost on the same level as the national
average. Infant mortality is lower than the national figure. But, MMR, a highly
sensitive indicator of social development and span of health services is much higher
MMR (440) in Uttarakhand compared to the rest of the Country. The proportion of
childbirths taking place in institutions is slightly lower in the State (32.6%) compared
to the national average. On the positive side, the sex ratio and female literacy rate of
the State are much better than the Country’s figure indicating a more favorable social
climate for women.

Availability of health facilities and human resources are critical to the delivery of
health services. Health facilities should not only be present but should be functional.
Health personnel must not only be available but must have adequate technical
knowledge, appropriate mix of skills and inherent sensitivity to provide high quality
health services to communities in need. Availability of health care infrastructure and
human resources for delivering health services at three levels in rural areas: Sub
centres (SCs), primary health centres (PHCs) and community health centres (CHCs).
Uttarakhand currently has 1765 SCs, 239 PHCs and 55 CHCs. There is an excess of
SCs, PHCs and CHCs in the state compared to the number required. However,
Uttarakhand does not have adequate number of key frontline health care providers and
specialists, especially for maternal and child health services. There is a shortfall of
101 ANMs and 1149 male health workers
On Monday, Jul 22, 2019 Hindustan Times published an article “No girl born in 132
villages of Uttarakhand in last 3 months” as At a time when the Central
government has been aggressively promoting its ‘Beti Bachao Beti Padhao’ scheme,
sex ratio at birth data from 132 villages in Uttarkashi district reveal that no girl child
was born in these areas in the last three months.
According to official data, 216 children were born in 132 villages of the district in the
last three months. However, not a single girl was among the newborns which has left
the district administration baffled.
District Magistrate Dr Ashish Chauhan said, “We have identified areas where the
number of girl childbirth is zero or in single-digit numbers. We are monitoring these
areas to find out what is affecting the ratio. A detailed survey and study will be
conducted to identify the reason behind it.”
He also held an emergency meeting with ASHA workers and asked them to increase
vigilance in these areas and submit a report over the data. Gangotri MLA Gopal
Rawat was also present at the meeting.
Speaking to ANI, social worker Kalpana Thakur alleged that zero girl child birth
clearly indicated the prevalence of female foeticide. “No girl child was born for three
months in these villages. It cannot be just a coincidence. This clearly indicates female
foeticide is taking place in the district. The government and the administration are not
doing anything.”
Senior journalist Shiv Singh Thanval urged the government to take strict measures to
end the practice. “Shocking sex ratio data has come up in the district. It raises a
question on the Centre’s “Beti Bachao Beti Padhao” scheme. The numbers clearly
show that female foeticide is taking place. The administration needs to take strict
actions to put an end to this,” he said.

On July, 25 2019 Hindustand Times published an article “No girl child birth’ claim
on Uttarkashi village may have been misread” as Uttarkashi grabbed the headlines
this week after local data showed that no girl child was born in 133 villages in the
district in the past three months, prompting Uttarakhand chief minister Trivendra
Singh Rawat to order a probe.
But the ground reality appears to be different with local authorities arguing that the
data was misinterpreted and taken out of context,
Uttarkashi district magistrate Ashish Chauhan said while it was true that 133 villages
showed no girl child birth in three months, another 129 villages showed no birth of
male children during the same period — indicating there was no specific gender bias.
Chauhan said many villages in the region were thinly populated, and, therefore, saw
the births of only one child in the three-month period. He added that 166 villages
recorded the birth of a single child — 78 saw a boy being born and 88 recorded the
birth of a girl child.
“This is basically a misinterpretation or mis-analysis of the data....because of the
confusion in the data, we have decided to conduct a re-verification by district-level
officers in places where the gap is high. The officials will submit the report to us by
the end of this week and then a final number will be released,” added Chauhan.
DP Joshi, chief medical officer of Uttarkashi district, said that there was an error in
analysing the data, and said that when the district was considered as a single unit, the
sex ratio [a measure of the number of women per 1,000 men] was 1024 women per
1000 males -- higher than the national average of 933 women per 1000 men.
“Uttarkashi has a good sex ratio with 1,024 females for 1000 males. Overall if we see
then there was a problem in analysis of the data, as the sex ratio is good. This is an
administrative fault, and we are looking into why this happened,” said the chief
medical officer. On Wednesday he conducted an inspection in Chinyalisaur block to
confirm the local birth trends.
Chauhan said he was trying to monitor the sex ratio at a village level .
In Saundari village, Shaila Devi (43), Accredited Social Health Activist (ASHA)
worker, said, “No cases of abortion or female foeticide has been reported from this
area in over five-six years now.”
ASHA workers report pregnancies to hospitals and take care of pregnant ladies.
“Everyone here understands that female foeticide or determination of sex is a crime,”
she added.
The residents of villages from areas categorized as red zones, where the percentage of
birth of girl children is reported to be less than 25%, say they welcome both genders
equally into their homes.
“I have four girls and I am giving proper education to all of them. It is by God’s grace
that we got daughters, why would we discriminate between boys and girls?” said
Ramkala Devi (40), a housewife from Saundari village in Purola block of the district,
which is classified as a red zone by the district administration’s report.
Roshni Rawat (31) from Saundari village who has a five-year-old son and is
expecting her second child said, “Be it girl or boy, we only pray that the child is
healthy and happy.”
Saroj Sarpal (42), who had come for a check-up at the Community Health Centre in
Purola, said, “There isn’t an ultrasound machine here for normal check-up to know
whether the child in the womb is healthy or not, so determination of sex is far-fetched
in such a scenario.”
This year from April-July, 43 male and 45 female newborns were reported from
Purola CHC. From April 2018-March 2019, 226 male and 224 female newborns were
reported from the same hospital. There is an ultrasound machine at the Community
Health Centre in Naugaon block, which has also been declared a red zone, but it is
available to patients only twice a week.
At Naugoan CHC, 88 male and 122 female newborns have been reported between
January 2019-June 2019, informed the medical superintendent of the hospital.
The data for July had not been compiled yet.
Speaking about the chances of sex determination and female foeticide still taking
place in the block, Deepa Rawat, constable at Naugaon police station who is pregnant
herself, said, “Doctors at government hospitals never go for abortions, and private
practitioners are not available here. People anyway do not differentiate between girls
and boys here.”
In these villages, people said that a high rate of migration and low population could
cause skewed statistics.
A senior doctor at the Naugaon CHC who did not wish to be named said, “There are
184 villages that come under this CHC, and not all villages record multiple deliveries
every year. This year, most of the deliveries that have been reported from this hospital
have involved mothers who gave birth to their first child. Families anyway do not
abort their first child...”
Locals say that couples in these villages are more likely to keep having children till
they have a boy child rather than go for adoption or kill the female child.

On 3 June 2019, Amar Ujala published an article stating an obstreticican left suture
needle inside womb of a women during cesarean section in a facility in durga colony.
.