SRIKANTHI Devi came close to being a death statistic. She was what they call in the hospital that treated her, a "near miss", when in the final stages of her pregnancy, she felt a sudden stabbing pain in her abdomen and collapsed at her home, a tiny hut in one of the poorest villages in the poverty-stricken state of Bihar in north east India. Her uncle heard her scream and found her unconscious on the floor. Too often women in her condition don’t make it to hospital. Either the family considers medical treatment is too expensive, or ambulances or other transport aren’t available to get to the hospital, or it is too far, the roads are too bad, or the decision about when help is needed simply comes too late. But her uncle knew that she needed medical care. He knew that he had to get her to a hospital in nearby Raxaul.

Birth is a risky process, whether you are a mother or a baby. Death lurks around childbirth, a distinct possibility, even here in the UK, where around nine women die for ever 100,000 births. But in some parts of the north east of India, a woman is around 30 times more likely to die in childbirth than here, and there are 50,000 maternal deaths a year across the whole of the country. The chances of dying aren’t nearly as bad, of course, as they are in many countries in sub-Saharan Africa, but they are not good – indeed they are bad enough that Indian Prime Minister Narendra Modi recently described them as “scary and worrisome”.

Nor are there particularly good chances of a growing foetus getting through birth, the first few weeks of life, and early childhood. In India 1.3 million newborns die every year during or immediately after delivery. Close to two million children die before their fifth birthday. Girls are also more likely to die than boys – since, in many parts of India, girls are not considered as worth the expense of treatment as boys. Female children, indeed, are considered, by many, a burden from the moment of conception.

The fine line between a mother and child living and dying can be seen frequently on the wards of a hospital in Bihar when I visited last month with EMMS International, an Edinburgh-based charity which funds projects there. A newborn, for instance, kept alive on a ventilator is tagged “precious baby” because already his mother has lost four babies and needs this boy child to survive. For such a mother this child is crucial, as too often women who lose babies are often sent back to their parents, tortured or abandoned. A researcher at the hospital runs through the statistics. She notes that one survey conducted by the hospital in the area it serves found a maternal mortality ratio of around half the state average. This may suggest, the staff theorise, that their interventions, are whittling away at the mortality rate. Women, like Srikanthi, are being transformed from death statistics to near misses.

Now healthy, Srikanthi sits in the small yard outside the hut that is her home, surrounded by family, her four-year-old daughter peeking from inside a door, and smiles as she stares down at her baby son, gurgling in her lap. This is the boy who, along with her, only just survived, who doctors feared might have been deprived of oxygen for too long. The last she remembers of the day her uterus ruptured was the pain, and then passing out. When she arrived at hospital, doctors report, she was barely breathing. But, a speedy c-section and surgery saved her - the time from her entering the labour room to the delivery of her baby was only ten minutes.

When she woke up, Srikanthi recalls, she was surrounded by the strange and foreign white walls of the hospital. “I opened my eyes and saw the machines and the tubes and blood flowing down through them. Someone was wiping my face. Someone combed my hair. Then they were feeding me rice and lentil porridge.” She was in intensive care for three days. At first she was too scared to ask if her baby was alive. In fact, he was on a ventilator in the room next to her. “I asked someone, is my baby alive? And she said, 'yes come and see him'. I was scared to see all the tubes coming out of him.”

For Srikanthi’s household her survival was crucial. Who would raise her daughter, let alone her son, if she didn’t survive?

Some families are not so lucky. On the earth floor of a small hut in a dusty village, Aisha, her face marked by years of struggle and poverty, sits as two small children clamber over her. For the past two years she has been mum to these, her grandchildren - their carer since their mother, Ravina, died just a few weeks after she had given birth to Muniya. The only photograph that still exists of Ravina is her electoral identity card. She was 23 years old at the time of her death. In the days that followed Muniya’s birth, she refused to feed her baby. Her mother-in-law, Aisha recalls that she tried to persuade her to do so: “I said just feed her a little bit, otherwise your milk will dry up and they you won’t be able to feed at all.”

Aisha bought six bottles of iron syrup for her, but instead of taking the medicine, Ravina poured it in the mud . The young mother’s mood was so black and despondent that at one point she said to Aisha: “You already have two sons who cannot walk and you are carrying them through life, now you will also have my two children to care for.” She was acknowledging that knew she was going to die. Doctors at the local hospital believe Ravina had postpartum psychosis. She beat her mother-in-law. She refused to eat for three days. She became, Aisha recalls, “septic”, feverish and delusional, and by the time she arrived in hospital she was near death.

The loss of this mother had a huge impact on the family, and particularly on Aisha who has had to raise her children. Now, however, because she fears she will not live so many more years herself, she has arranged for her son to marry another young woman so that she can be “the mother of the two children” and do jobs around the house.

This new member of the household is young, and looks more like an older sister to the children, as she plays with the two infants and their toy aeroplane in their dusty backyard. Her eyes express alarm and wariness. What is clear is that she has very little say in her own destiny, little sense of her own rights. Aisha, for instance, declares that she has already decided that she is going to arrange for her new daughter-in-law to have an intra-dermal contraceptive implant. “I’ll take her to get it,” she says. “I’ve already taught her about it.” She doesn’t want her to have any children of her own. “These two will be neglected if she does. I’m going to die soon, and then who will take care of these kids?”

What are the reasons for this high maternal death ratio in this part of the world? Multiple factors are involved. Poverty and malnutrition resulting in anaemia weakens the women. Pre-eclampsia, a high blood pressure condition, which can be treated with medication if identified before labour, is common. A review of maternal deaths in Bihar, conducted in 2010 found a huge shortage of health infrastructure at the rural level, and that many deaths occurred because the nearest health institution was more than 20km away. For the families lack of money is a factor too, since half of them have insufficient finances for treatment. Part of the problem, many tell me, is the roads. These rough, ragged tracks tell a lot of the story of Bihar poverty. Rocky and cratered, along some sections a cloud of dust hovers above the ground. Men crouch at intervals defecating, since many houses do not have toilets.

But there are cultural reasons too. In Bihar, there is a high level of child marriage, which according to campaigners, is, along with early pregnancy, one of the major factors underpinning high maternal and child mortality rates. Teen pregnancy, while a problem globally, and notably high in the UK, has a different pattern from the one it has here in India, where it mostly occurs as a result of child marriage, sanctioned by family. Bihar has the highest rate of early marriage in India, at 68%, and its young women are among the most likely to give birth as teenagers, with over half of young women doing so by the age of 19. Most of the women I met had been married before their first period, and began to live with their husbands by the age of 14 or 15. Marriage below the age of 18 is illegal, but in many deprived areas the law is basically ignored.

As well as the maternal mortality rate, also of concern in Bihar is the deaths of babies and small children. The neonatal mortality rate in the state is the second highest in India at 28 in every 1000. Deaths in the first five years are 70 per 1,000 live births. Also a factor in infant mortality is the undervaluing of girls. Across the state of Bihar, the mortality rate for girls is higher than it is for boys. Partly this is because they are given less treatment, vaccinated less, and brought into hospital less. One survey of the babies on the neonatal ward at the hospital I visited found that 200 girl babies were brought in by comparison with 500 boys.

Almost every family in these rural villages has their own matter-of-fact tale of neonatal death. Among them is Seema, a young mother who knows what it means to keep losing her children. Again and again, her babies died within the first few days of life, six children in succession, born at home, seemingly healthy, then deteriorating over the first three days. For this she was held, as mothers here often are, to blame. She began to be seen by her in-laws, and herself, as a cursed woman.

Each time one of her babies passed away, her husband would beat her, believing that it would drive the curse away. This was what her in-laws demanded. Rather than imagining that there might be some physical cause that was leading to the babies’ deaths, they blamed black magic and evil spirits. They also said she should be sent home, back to her own parents and their son should find himself a new wife, one who could produce children. Seema recalls that she wished herself dead. “I thought that when my children died, if I also could have died it would have been better.”

Now, however, this fragile, softly-spoken young woman holds her precious baby, her three-month old boy, Krishna, and he is thriving. A nurse from the Karuna project at the local hospital was key to identifying that her babies might have had jaundice, a highly treatable condition. A plan was made to ensure the right medical treatment was given. But that’s not all that happened. The family also tried to save this next baby with magic, by banishing the curse, by making a mud figure and raising and releasing a goat.

When Krishna was born, he was sent to a government hospital in Patna and received treatment, which cost, for them 10,000 rupees (£100) and left them burdened with what, for an Indian family, is a huge loan. Seema believes that both the magic and the medicine contributed to the survival of her baby. Her mother-in-law, meanwhile, believes it was mainly their attempts to ward off the curse. Magic is still part of how they try to protect him. His eyes are still rimmed with the dark make-up that they believe wards off the evil eye.

Magic, more often than not, is what the locals in this area turn to before medicine. Frequently, says Sister Kavita Rani, head nurse at the local antenatal department, when a baby dies at home, after being delivered safely, she asks the mother why she thinks it happened. “They say evil has killed it,” she says. “Evil has killed my baby. That’s what they blame. Because here whenever a baby gets sick they used to go to a person who does magic. That’s what they still do, even an adult. They go first for magic, and then when they get very sick they go to hospital.”

At this Raxaul hospital they believe that the real difference is to be made not so much on their emergency wards, but in the community. Through a project which works providing local clinics, house visits, check-ups and local advocacy groups, they hope to create change in health and attitudes. Among the things they educate against is early marriage. One community worker, who runs discussion and education groups has already seen a change in attitude among boys he coaches. “Before I talked to them,” he recalls, “they didn’t know this whole concept that the human body is developing and that there is an age at which the human body is ready for sex and reproduction. Now they understand.”

Too many women and children are dying both in India, and globally. As Katja Iversen, CEO of global advocacy group Women Deliver, puts it: “It’s interesting that we can put a man in space, but we can’t save a woman from dying in childbirth.” In rural Bihar what prevents these women and children from being saved is complex. Cultural factors - superstitions, early marriage, the devaluing of girls and women – are part of it. As is poverty, malnutrition and poor infrastructure. By tackling all these elements the EMMS-supported hospital, and other projects like it, are already making a difference. They are turning deaths into near misses, and near misses into pregnancies and births that don't come anywhere near to death at all.

Text GIRL to 70660 to donate £5 to EMMS International whose projects help break this cycle of darkness for girls in Bihar, India’s poorest state. Donations will be doubled as part of the Send a Light appeal. Or donate online at