Bashi Kumar Hazard
The recognition of preventable maternal mortality as a human rights issue was a huge step forward for women’s health and rights. But when maternal healthcare only recognizes the right to survive childbirth, the violation of women’s other human rights is rendered invisible, with immediate and long term implications for mothers, babies and communities. In India, while small improvements have been reported in survival rates, questions arise as to their enduring effect, given the continuing, and in some cases, exacerbated violation of other human rights.
Is it because India presents its own unique challenges?
Picture your educated, modern urban Indian woman who can afford to choose her private maternity healthcare and obstetrician in New Delhi. Now, take your mind to the village woman who lives some 150km from Madurai, who will travel several hours by bullock cart to the nearest health centre to access maternity healthcare. Finally, conjure up the homeless mother in Mumbai. She could attend the nearest maternity hospital where she may at least get a meal and a bed for the night, but she says she would rather risk childbirth alone, on an abandoned platform next to a polluted river. These images serve to illustrate the wide range of social circumstances affecting the women of India. Despite the difference in access to resources and their education levels, these women are all likely to experience a human rights violation in pregnancy and childbirth which, in turn, could compromise their and their baby’s safety at the time of birth immediately and in the long term.
eHow can this be? Is the source of the problem an under-resourced government hospital? The Indian Government has dedicated significant resources to institutionalizing childbirth as an immediate solution for improving maternal and infant health; this has led to a significant upswing in the amount of births that occur in India. But studies have questioned the effectiveness of coercive health measures on the long term health outcomes of mothers and infants. Could this be why our homeless Mumbai mother would rather face a significant risk of death in childbirth than access much need support just minutes away from where she sits everyday?
While health centers can provide life saving options on arrival, who will support the village woman who cannot afford to leave her work or her children to travel to a health service many, many hours away? How will requiring a woman facing serious complications in childbirth to travel several hours just to access care improve her safety or her chances of survival? Most importantly, how can these measures prevent maternal mortality?
What of our modern, educated New Delhi woman? With access to modern technologies and the most qualified doctors- will she have a better and safer pregnancy and birth? If so, how do we explain the very tragic reported events that take place in our private maternity hospitals?
Or is it because India reflects a global problem and can offer lessons for a global solution?
Throughout the developing world, in the push to eliminate preventable maternal and infant mortality, resulting systems of care have come to resemble industrial assembly lines more than systems which support the provision of woman centred, respectful healthcare, both in the private and in the public sector. Billions of dollars are being invested in maternity care infrastructure which require ongoing maintenance, skilled operation and access to expensive medications, and which have resulted in systems of highly interventionist care, even in low-resource settings, which are proving unsustainable. In the private sector, the easy access to financial resources has translated to a massive increase in rates of surgical delivery and profit, over people-centered, drivers.
At the same time, the voices and needs of women and mothers, accountability and oversight of these systems of care, and the provision of critical ante-natal and post-natal woman-centered care, has been sidelined.
Women in India have reported that decisions are being made about their bodies and their babies without obtaining informed consent (such as with forced sterilization following childbirth), without medical indication (use of misoprostol to speed up labor in private facilities), with threats (forcing mothers to formula feed infants) and contrary to the practice of evidence-based medicine (use of bilateral episiotomies, fundal pressure in birth and immediate cord clamping). At the same time, women are being denied access to essential information and education, a profoundly simple yet highly effective measure for improving maternal and infant health for generations to come. The desire to obtain information and education to empower them to take control over their bodies in pregnancy and birth is shared by women all over the world.
The caesarean section pandemic is, in itself, evidence of widespread human rights violations around the globe. Are women being given the information needed to understand the short and long term risks associated with this major surgical procedure before they are processed for surgery? Do care providers discuss and take into account the needs and concerns of mothers – such as her obligations to her family, her financial status, and her personal needs, as part of the decision making? What are the long term risks for mother and infant of repeat C-sections, and how do they measure against the goals set to improve maternal health worldwide? Economic studies in developed countries show that the shift toward cesarean section delivery in obstetrics has been driven by profit and time convenience incentives for providers and hospitals, even as these deliveries increase the risk of death for baby and for its mother, especially if that mother plans to have more children. If preventable mortality and morbidity is the goal, why are resources not being dedicated to much needed ante-natal and post-natal care, education and support? In this respect, the women of India share much in common with expecting women around the globe.
Who is accountable to a woman denied adequate access to care, pain relief, and support in childbirth? Who defends a woman who is being abused, disrespected or sexually violated during childbirth? Why are mothers reporting that when they try to stand up for their rights, they face serious repercussions from both the legal and the medical fraternity in India? Women who access private healthcare learn the painful truth – that oversight and accountability is often restricted or handled by the Director of the hospital who is driven by profit considerations over the human rights of an individual woman and her baby. There is limited oversight of private hospitals in India. Women who utilize the public sector have already learnt, from the way they were treated by their care providers during their most vulnerable, that there is limited or no accountability.
The goal of the Human Rights in Childbirth India Conference is to catalyze a reconsideration of how maternity care should be constructed, so as to fulfill every woman’s right to survive childbirth (if healthcare support can enable survival), as well as her rights to dignity, autonomy, privacy, and freedom from discrimination.
India is the perfect nation to lead this discussion.
Although Indian maternity care has developed similar policies and practices to many other developing nations, India is uniquely placed to lead this discussion, due to its strong cultural tradition of critical reasoning, scepticism, and debate, as well as placing emphasis on diversity and tolerance. This conference will bring together a wide variety of perspectives on bioethics, medicine, and maternal healthcare, in order to facilitate deep questioning and the open exchange of ideas and experience. If any nation has the capacity to critically examine the path that it is on and reconsider whether this path constitutes the wisest use of national resources, it is India. If India can lead a meaningful stakeholder dialogue on the prudential path forward for 21st century maternity care, this discourse has the potential to lead the global community toward a new paradigm of rights-based, culturally grounded, woman-centered maternal healthcare worldwide.
Don’t forget to register to attend the Human Rights in Childbirth Conference in Mumbai, India.
Sign this petition to make it mandatory that Indian hospitals declare their c-section rates!
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Ask questions, find support and information at Birth India’s Facebook Support Group.