During the 2000’s, India had a maternal mortality rate of 540 deaths per 100,000 deaths which is amongst the highest in the world. Under the United Nations Millennium Development Goal, India was asked to reduce it to 109 deaths per 100,000 deaths. In response to this task, on April 12, 2005, the prime minister of India launched the ‘Janani Suraksha Yojana’ with the aim of promoting institutionalised child birth amongst ‘poor pregnant women’ as specified in the National Health Mission website. The source of attraction of this scheme is the “integrated cash assistance with delivery and post-delivery care” provided to all women admitted in government hospitals, especially all BPL/SC/ST women getting institutionalised to deliver in these health centres.
At this time, in one of the most prestigious public hospitals in Calcutta, Santhal women who were institutionalised reported that they were thrown into wards, made to lay down on floors without beds, and denied the provision of water even during delivery as they pleaded for their lives.
While completely dismissing the pain that a woman goes through when she is in labor, in 2015, one of Uttar Pradesh’s public hospital experienced multiple infant deaths as the mothers were made to deliver on floors in order to avoid dealing with ‘soiled sheets’, sometimes even asked to ‘clean up their own mess’ by the hospital attendees.
Recently, in another government hospital in Delhi, a woman was slapped as she cried and screamed during labor and was threatened in order to make her stop. The body of her child, still unwashed, was then handed to her in a polyethene bag.
These are three of the many instances that lead to low maternal mortality rates in our country. This ‘labor room problem’ is not new. While women continue to be paid in order to institutionalise delivery, they also continue to face psychological and physical violence in the same space. The accounts of many women who have been beaten, mistreated, abused, and discriminated under the name of improving institutionalised child birth still remain untold. Varun Patel, an intern in the Sassoon hospital in Pune writes, “in an Indian government hospital, giving birth to a child is not a unit less than suffering third degree torture in jails”. While pregnant women receive varying degrees of violence in the labor room, the doctors and the hospitals find a way to justify it. Adding to this, institutionalised child birth continues to be promoted and justified by government schemes and programs such as the Janani Suraksha Yojna, while placing the blame of maternal mortality on individual women rather than the treatment of these women. In an already violent and inaccessible healthcare system, the funding that is used to attract women of all sections, may not always be enough if it leads to compromises in the treatment provided to these women. While safe healthcare continues to get privatised, public health systems continue to inflict violence on the women who do not have access to the private hospital space. Hence, institutionalising child birth can not be the solution to reducing maternal mortality rates when the flawed public health-care system only treats these women with apathy.
Women are vulnerable to obstetric violence across the globe, however, in India there seems to be a pattern in which certain women are most likely to be at the receiving end of this torture. Government hospitals attract the poor and more vulnerable women through faulty schemes such as the Janani Suraksha Yojna where they are paid to get institutionalized. A large section of women who are abused in government made labor rooms, belong to a lower socio economic background. As they agree to get institutionalised expecting basic medical facilities during the process of their delivery, they are not only denied sanitation and other facilities, but are also treated unethically. This has now become a normalised reality for those belonging to the lower castes, who often refuse to get institutionalised due to their anxiety of being treated inhumanely. Since information regarding the entitlements of women of the lower castes are not conveyed to them, women are unable to claim their rights or report any kind of abuse. This culture of impunity that is perpetuated by government hospitals who think they can get away with mistreatment, is a depiction of not only the medical abuse against women but also of caste based discrimination in India.
A distinct bias is often observed in cases where the same doctor runs a private practice but also makes visits at the government hospitals in the same city. The disempowerment of certain sections of women is highlighted when these doctors carry an ethical, legal, and respectful attitude towards women belonging to higher castes and classes who visit private hospitals, and their ethicality, legality, and basic human decency of being respectful is lost when it comes to speaking to women from lower castes being admitted in government hospitals. The ‘respectful’ attitude of doctors towards women belonging to upper castes changes when the women belong to lower castes, with the usage of crude language, exerting physical threats, dismissing the human pain, and trivializing the importance of asking for consent. An instance of medical violence against marginalised groups was seen in 2015 when women from the Santhal tribe admitted in the gynaecology department at a Kolkata hospital were screamed at for expressing their pain. Following this, they were asked insensitive questions such as “Why are you screaming now, weren’t you screaming in pleasure when you were getting fucked?”, while dismissing any requests for provision of drinking water during delivery. Without any prior consent, unwanted episiotomies were also conducted on these women.
Women in India, especially those belonging to lower castes are vulnerable to varying degrees of obstetric violences and other such invasive procedures. One of the most common method of violation of a woman’s medical right is through episiotomies —
Episiotomy, the process of making a cut in the women’s vagina during childbirth in order to aid a difficult delivery, is not always beneficial and undoubtedly extremely painful. While doctors cannot legally perform an episiotomy without first explaining the procedure to the patient, informing them of the consequences, and then taking consent of the patient, in India, most episiotomies conducted in government hospitals take place without the knowledge of the expectant mother. They are often used as an illegal techniques to fasten the process of delivery on women who belong to a lower caste and justified with medical jargon hence leaving the women in a helpless state of being unable to claim the abuse. Episiotomies in government hospitals are often conducted without anesthesia and are accompanied by fundal pressure manoeuvres, which involves the application of pressure towards the uterus for spontaneous vaginal birth. In 2005, ‘The Journal of The American Medical Association’ found that episiotomies are not beneficial at all as Friedman, the lead author stated how conducting episiotomies would lead to extremely high levels of postpartum pain and discomfort to the woman. Following this in 2006, the American Congress of Obstetricians and Gynaecologists declared that episiotomies must be prohibited in all cases. However, in many government hospitals in India, episiotomies are seen as standard procedure to speeden the delivery.
While medicalisation of women during childbirth is meant for ensuring a regular pregnancy with interventions in case of emergency, the healthcare industry in india has maintained the lack of any care for admitted women. With a rise in unnecessary caesarean births, episiotomies and tubectomies conducted on women (most of the times without their consent) with justifications of increasing efficiency, the woman loses any control over her body and is depersonalized in the eyes of the practitioner/surgeon. This enables abuses of neglect, verbal dehumanisation, physical torture, and sexual violence against female patients, disregarding their right to life, health, and medical facilities.
While the ‘poor pregnant women’ who belong to lower castes are the victims of this maltreatment, the government’s reaction to improve their conditions is concerning and disgraceful for women across the world. One of the aims of the Janani Suraksha Yojana was to encourage institutionalisation in order to reduce sufferings caused by home births. However, this faulty scheme makes no effort to ensure the safety of women obtaining these services. Infact, it does the opposite. It enables violence against women in varying degrees. While the government was tasked to reduce maternal mortality rates, the usage of unwanted episiotomies has proved to be a major cause of maternal mortality. While the scheme may have partially succeeded quantitatively as the maternal mortality rates decreased to 168, it fully fails qualitatively as it disregards the pain, the assaults, the verbal threats, the unethical medical techniques, the psychological torture, and the inhumane treatment of women in government hospitals. These schemes further affect accessibility to medical care especially for women belonging to lower caste and class who may not be able to access private hospitals, hence remaining more vulnerable to this violence.
Picture credit: Time