When researchers with WaterAid India, an international nonprofit, presented their new evidence showing links between poor sanitation and maternal and neonatal mortality, they did not anticipate that the findings would irk other health rights activists. At the presentation at a conference in Delhi last week, activists said that focussing on evidence undermines discussion about rights of people to have water and sanitation.

WaterAid India launched their campaign Healthy Start to contribute towards preventing neonatal and maternal deaths by trying to improve sanitation and hygiene facilities in the public health facilities.

“There has been evidence for over 200 years that the number of maternal and neonatal deaths reduce mortality,” said Arundathi Muralidharan, from WaterAid India. She added that approximately 8% of the maternal deaths were attributed to sepsis, or severe infection, alone.

Muralidharan presented evidence from assessments carried out in 343 facilities in 12 districts across six states – Uttar Pradesh, Odisha, Andhra Pradesh, Telangana, Madhya Pradesh, and Karnataka which spoke of lack of adequate facilities to wash hands, for clean toilets, and adequate medical waste managements in the facilities. The presentation also highlighted cases such as that of the midwife from Telangana who did not have enough water to wash the blood off her hands after delivering babies.

Data versus rights

Dr Vandana Prasad, convener of Jan Swasthya Abhiyaan, a network of health rights-based organisations in the country felt that the campaign should have a different tone.

“I feel a lot of anguish and anger when I think about the pathetic circumstances in which children are born," said Prasad. "But why do we need evidence to show that we need sanitation in labour rooms. When it comes to rights, this is not the language we should be speaking.”

Prasad feels that it is important to launch a campaign with the use of more strident rights-based language. “It is every person’s right to water to drink," she said. "Our language cannot become so tame. We have to stand by the people in their distress so grave, that we do not need evidence.”

According to Prasad, health officials are more interested in bringing in vaccines to prevent cholera, diarrhoea, and other water borne diseases, instead of increasing access to safe water for the people.

“The women in drought prone areas such as Bundelkhand in Uttar Pradesh, parts of Maharashtra, Andhra Pradesh and Telangana are desperate for water," said Dr Mira Shiva, a public health expert. "These women do not need to be told that water is important. They know.”

There are many unseen bottlenecks in the process of increasing access to hygiene and sanitation. One such bottelneck is the sparsity of soap.

“The money has to come from untied funds which can be used for purchasing of soap or whitewashing," said Manish Wasuja from UNICEF. "The district- and block-level authorities are more keen to tick off the access to a provision, like the toilet, but are not checking whether the toilet is functional or not.”

Wasuja added that improving these facilities will also increase the popularity of public facilities, over private hospitals.

Shiva warned against a market-based solution for the problem of sanitation, such as building more toilets, and stressed the importance of access to sanitation and clean water instead.

“Any needless death of a mother or child because of lack of access to water is not a shame,” she said. "It is a crime."