Against all Odds: Saving mothers and newborns in rural Telangana

Ankita Bhalla
Posted January 18, 2017 from India
A 20 minute old boy adjusts to the bright new world in his grandmother Peeramani's lap at an Area hospital in Nizamabad.
A 20 minute old boy adjusts to the bright new world in his grandmother Peeramani's lap at an Area hospital in Nizamabad. Swaddled in a grubby cloth brought from home, his family was waiting for his mother to be shifted into the ward from the theatre. Photo: WaterAid/Ronny Sen
The damp on the wall in the monsoons puts the unit under risk for mould and respiratory diseases.
The damp on the wall in the monsoons puts the unit under risk for mould and respiratory diseases.: P Kaveri, carries her nine day old son in a newborn intensive care unit at an area hospital in Nizamabad district. Born with jaundice, he was placed under phototherapy. The attendants and staff place high care on cleanliness, but the damp on the wall in the monsoons puts the unit under risk for mould and respiratory diseases.Photo: WaterAid/Ronny Sen (1/2)

Padmaja* announces excitedly that her daughter is set to be married soon. “She will be moving to New Zealand after the wedding with her husband!” she exclaims and shows off the engagement pictures. A 45 year old auxiliary nurse midwife in the Nizamabad district, she cannot remember how many babies she has delivered in her 16 year career. “I have been working in the village sub-centre and the Primary Healthcare Centre in this mandal for five years. I really cannot tell you how many babies!” she laughs. Eyes full of mirth and with a strong poise, her warm smile masks many concerns and trials she undergoes at work.

Water Woes

The PHC where Padmaja works looks serene, with whitewashed rooms surrounding a spacious courtyard. Under the Janani Suraksha Yojana (a safe motherhood intervention under the National Rural Health Mission of Government of India), poor women in India are being encouraged to deliver at institutions like health centres to reduce maternal and neonatal mortality. The PHC in its verdant green surroundings has been devoid of water supply for five months now. The water table has dropped too low for even the bore wells, which they were dependent on so far, to function. The toilets and washing points have been rendered dysfunctional. The village head has arranged for a tanker to deliver water around the village once a day, including to the PHC. “The trouble is, the tanker comes in after it has finished going around the entire village. If we are lucky, we get 100 litres for the entire day. Or we make do with 50 litres. Do you know how many litres it takes for one delivery? Hundred!” says Padmaja in exasperation.

Water, Women and Safe Deliveries

“Water is essential to facilitating deliveries. When you administer an enema for instance, it helps the mother push the baby better. Or there is the danger of the baby being born among faecal matter and catching an infection as soon as it is born,” Padmaja explains. But the gravity of water shortage is such that sometimes, they do not have the mug or two of water required for even administering an enema. She recalls a stark case, “Once, I was sitting with my hands covered in blood, fresh after delivering a baby, and the district collector walked in. What could I tell her? That we did not have water to wash up, let alone deliver babies?” The PHC was promised that the overhead tank at the PHC would be filled up every day. Two months later, they are yet to see the promise fulfilled.

There are tough choices Padmaja faces some times with the lack of water. A woman recently came in with severe labour pains. Padmaja administered an enema but could not send her to the toilets in the facility because not only were they Indian commodes, which made squatting unthinkable in her condition, but also because there was no water to clean up. Taking a tough call between sending the crying mother out into the open versus the defunct toilets, Padmaja chose to take her out of desperation into the labour room, put her on the table and made her ease herself, cleaning her up and then inducing labour.

She adds that it is not just mothers and newborns who need water at healthcare facilities, “Nizamabad also has increasing instances of cervical cancer among women. Can you imagine, we do not even have water for sterilising speculums to examine women at times at the village sub-centre.”

“I worry sometimes. I am capable of handling stress, and I always make sure to keep smiling because I want the mother to be as relaxed as possible during the birthing process even though all factors outside are against her. But not everyone can function under pressure and lack of facilities like this. I may be transferred soon, but I worry for the midwives posted here after me,” signs off Padmaja.

WaterAid India and its partner LEPRA undertook an assessment of the primary and community health care centres and district hospitals in Telangana’s Nizamabad district to understand the status of safe water, sanitation and hygiene (WASH) in these health facilities. Through Village Health Sanitation and Nutrition Committees, WaterAid India and LEPRA are working to build long term behavioural changes towards WASH and conduct trainings for different stakeholders, including healthcare facilities.

*Name has been changed to protect identity.

How to Get Involved

Through its new Healthy Start campaign, WaterAid India aims to highlight the critical role of WASH in ensuring better health for pregnant mothers and a healthy start for newborns. To know more about the campaign and how you can support it, please click here.


All about WaterAid India's Healthy Start Campaign
Assessments of WASH in Healthcare Facilities in India
This story was submitted in response to Women’s Bodies and the Law.

Comments 4

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Jill Langhus
Jan 19, 2017
Jan 19, 2017

Hi Ankita. Welcome to World Pulse. Thanks for sharing your important story about the shortage of water in Telangana. It's absolutely amazing the work that earth angels, like Padmaja, do every day to help other women. I don't know how they do it. Thanks also for sharing the WaterAid India call to action. I will share your story on my social media platforms. Do keep us updated on progress of the crucial matter. I hope it improves very soon.

Carrie Lee
Feb 03, 2017
Feb 03, 2017

Thank you for highlighting the challenges and work being done to help mothers and babies in Telangana. I love how your story provides a solutions lens, focusing on the good work of Padmaja, how she is responding to the situation, and also the work of WaterAid India.  I'm looking forward to hearing more! 



Tamarack Verrall
Feb 12, 2017
Feb 12, 2017

Dear Ankita,

Welcome to World Pulse, and thank you for sharing this news of what is taking place in Telangana. This is why we are coming together to raise our voices. This is why we are so determined to create change together. No woman on earth should ever have to experience what these women are going through in childbirth, no woman or child should ever have to experience this pain, this utter disrespect, this all too often loss of health and even all too often death. These women have been betrayed by the broken promise of water, and by the conditions they face even in the health centres. The work of Padmaja is the only soothing balm. No one should ever have to give birth in these conditions, nor should anyone have to do this work day after day without basic needs met. This is disrespect of and neglect of women in such a fundamental way, and this is what we are collectively here to change. I am glad to see that WaterAid exists and hope that they are successful in addressing this in Telangana and everywhere. I have held this story in my heart for 24 hours now. This will now remain part of what I can describe as the emergency that faces women on this planet. If there are ways that we can create pressure on the local Government, and/or if you have ongoing news please keep us informed.

With love to you, to Padmaja and to the women in Telangana, 

In sisterhood,


Feb 15, 2017
Feb 15, 2017

This is incredible Ankita.

I did not know how much nurses and midwives put in to help give life.

Thanks for opening my eyes to that, and welcome to World Pulse. I trust that you will enjoy being on this forum. There is much love, encouragement and support.

Press on sister!

In solidarity,