Hello and welcome to Mind the Gap, a newsletter that looks at the week’s gender developments. This week saw the publication of yet another report that documents the horror of labour room practices in government hospitals. Why we continue to be unmoved by this is a mystery. Elsewhere, two Dalit sisters are found hanging from a tree after being raped in Uttar Pradesh in a horrific crime that brings back memories of Hathras in 2020 and Badaun in 2014, Read on… THE BIG STORY: If men gave birth, labour room violence would be headline news When Reena went into labour she was taken to the community health centre in rural Uttar Pradesh where she lives. By then she had begun to bleed and since the health centre didn’t have blood transfusion facilities, she was moved to a district hospital. Two hours later when she arrived at the hospital, she was bleeding profusely, her blood staining the floor. She was terrified she would lose her baby. Instead of empathy, she was yelled at for dirtying the floor. When she began to cry, the attending doctor scolded her and when she wouldn’t stop, a nurse slapped her. She eventually had a still birth. Reena’s story is not an unusual one. One in three women who give birth in public hospitals is slapped or hit, finds a new study on labour room violence. The first-hand witnessing of 31 deliveries in government hospitals in Madhya Pradesh and Chhattisgarh is a small study, but its findings are significant, and alarming, as it found “widespread mistreatment of pregnant women”. Physical violence and verbal abuse are not the only hardships women in labour face. “Women were also often humiliated for their fertility choices and had intrauterine devices (IUDs) inserted into them without their full knowledge or consent,” found the study, findings of which have been published in The India Forum. Straining under stress The drive to reduce maternal mortality (MMR) has resulted in more women being brought to the hospital to deliver. The Janani Suraksha Yojana, launched in 2005, provides cash assistance to women and ASHAs are incentivized to bring in women to hospitals and community health centres. The National Family Health Survey-5 found that institutional births had risen to 89%, compared to 79% in the previous round. That’s good news. But this has resulted in overburdening health facilities that are simply not prepared for the increase in volume, according to Soumya Gupta, a gynaecologist who has worked in government hospitals in Meerut and Delhi. In hospitals, even in the big cities, it is not uncommon to see three or four women on a single bed going through labour, Gupta said. “In this scenario, how do you offer an epidural where you need to have one-to-one monitoring of the mother and baby?” Pain relief options are rarely offered. Epiostomies, or vaginal cutting to prevent tears, are routinely done minus consent and, often, minus painkillers. In other places, women are denied a bed and forced to deliver on the floor so that they don’t make a ‘mess’. Or they are loudly berated by nurses and ayahs for shouting (apparently a favourite slur is: “You weren’t shouting when f***ing, so why are you yelling now?)." High levels of poverty and inequality affect the capacity of poor women to obtain quality and respectful services, found a 2011 paper by Jashodhara Dasgupta. “The poor are likely to travel great distances for treatment, may be obliged to pay bribes…may not receive appropriate treatment or may even be humiliated,” the paper found. The paper trail The physical and verbal abuse of women in the delivery room is well undocumented. In 2019, a study found that all 275 mothers in 26 private and public sector hospitals in three districts in Uttar Pradesh had been subjected to at least one indicator of mistreatment: 92% were not offered a birthing position of choice, others were disallowed birthing companions, denied privacy and even slapped, pinched or kicked by medical personnel, nurses, doctors and ayahs. This violence is not limited to India. In October 2019, Lancet published findings that found that mistreatment in four countries including Myanmar and Nigeria involved physical or verbal abuse, stigma or discrimination. It found that 13% of caesarian births and 75% of episiotomies were performed without consent and, often, without a painkiller. In fact, 57% of women said they had not been offered any relief for pain. Journalist Sohini Chattopadhyay went undercover to an unnamed government hospital in Kolkata. Her story makes for distressing reading. The Covid-19 pandemic exacerbated the situation. In May 2020, Human Rights in Childbirth, an international non-profit, found that pregnant women, especially those from marginalized communities, were bearing the burden caused by strains on the health system. Covid made a bad situation worse. In June 2020, Neelam Kumari Gautam died during labour after being turned away from eight hospitals. At the first, the doctor reportedly told her: “I will slap you if you take off your mask.” Why don’t we talk about it? When we talk of violence against women, we tend to talk about domestic violence or sexual assault. Rarely do we include the almost universal experience of obstetric violence. There are several reasons for the silence. First, the women who are subject to the most extreme violence are also the most marginalized in terms of socio-economic and caste status and lack the agency to complain. “From a poor ragpicker to a rickshaw puller’s wife, these women are helpless and have no recourse,” Gupta said. Second, she continued, is the dehumanization of women’s health. “If men were giving birth in such horrendous circumstances it would make headlines,” she said. Third, women are brought up to not complain. Child birth, we are told, is an inevitable rite of passage that must be painful and endured. Mothers tell their daughters, “We went through it and so can you,” said Gupta. Fourth is just a lack of awareness and sensitivity by medical professionals. A friend who is herself a gynaecologist told me about an examination by a peer. “I was lying on the table and she just inserted her glove into my vagina without giving me the most basic courtesy of a heads up. The labour room seems designed to strip you of your dignity. There is no privacy as everybody casually passes by and thinks it ok to take a look,” she said. Jashodhara Dasgupta, an independent researcher on maternal health for over two decades said she is perplexed at the lack of outrage by feminist groups and healthcare activists. “Issues like sexual harassment at the workplace, domestic violence and rape have caught on. But not obstetric violence. I can’t explain it,” she said. [Would you like to share your labour room story? Write to me at: namita.bhandare@gmail.com.] |