Obstetric violence is rampant, specially in rural India
Photo for representation: iStock The statistics on maternal health worldwide deal primarily with measuring skilled birth attendance at birth, antenatal care and post-natal checkups. But even in the rapidly transcending digitised era and age of ethical governance, maternal health care delivery patterns do not endorse personalised, patient-driven and compassionate care, particularly in rural areas.
The incidence of physical and verbal abuse; neglectful, unconsented and discriminatory care; forced procedures on child-birthing women has become part of child birth culture of many health centres.
A study conducted in Punjab, India revealed many cases of discriminatory and violatory care practices in the labour rooms, toting up to obstetric violence.
Janani Suraksha Yojana (JSY) is a central scheme for safe motherhood intervention under the National Rural Health Mission. A beneficiary of JSY told this researcher, “My labour pains triggered around 4 pm and my mother-in-law went twice to call doctors for help during the delivery.”
Alas, the doctors were busy having tea; they responded in a callous tone and the baby was born without assistance.
An Accredited Social Health Activist (ASHA) belonging to Rupnagar district, Punjab reported another incident. “I accompanied a 20-year-old woman to the primary health centre (PHC) for delivery. She fled from the waiting area of the PHC, citing the need to use the restroom. She was afraid of the treatment she would receive during childbirth by the auxiliary nurse midwives (ANM),” she said.
The woman reached her village in a state of childbirth, with the baby’s head already emerging. When the ASHA arrived looking for her, she discovered her with the woman Sarpanch (the elected village head), who assisted her in giving birth.
Another JSY beneficiary described her experience of giving birth and said she felt haunted, recalling the condition of the labour room in a PHC. “The filthy cloth on the labour bed, the stinking floor and the blood clots on the floors took my breath away when the closed doors of the labour room were opened after one month by the pharmacist,” she disclosed.
The doctor assigned to the PHC had been on leave and hadn’t reported to work for the past six months. As no medical or paramedical professionals were available in the PHC, the ANM from the nearby sub-centre came to conduct delivery in the PHC upon receiving a call from ASHA.
Due to the urgency, the delivery was conducted in the same, filthy labour room, leading to a severe infection in the woman. Both ASHA and ANM displayed an unsympathetic attitude, making the woman feel like a puppet for a forceful delivery in an unhygienic place.
The root cause of the problem is gender sensitisation in society, whether it is among victims’ families or medical practitioners from the same social milieu, a doctor from a PHC remarked.
Field images of primary health centres taken during the author's research study visits. Photos: Vijayetta Sharma
These incidents are consistent with other forms of discrimination in the country, such as slanderous remarks, power imbalances between medical practitioners and patients, forced surgeries and unconsented physical examinations, among others.
Low- and middle-income countries experience a higher rate of obstetric violence incidents due to factors such as women’s lower socioeconomic status, poverty, inadequate health services, including health-care worker training and cultural and geographic factors.
Care during childbirth should include values such as lawful care with dignity, compassionate care, personalised or informed care and timely and uncompromised care. Obstetric violence is a measure of the unwelcome, discriminatory, or violent medical-behavioural treatment that women receive during the critical hours of childbirth.
The magnitude and gravity of incidents such as verbal or physical abuse, unconsented procedures and unethical practices demonstrate the failure of medical institutions, legal entities and socio-cultural practices to protect women’s rights during childbirth. According to studies, women who are subjected to abusive treatment experience feelings of stress, anxiety, sadness and helplessness, which can often lead to postpartum depression or post-traumatic stress disorder.
An obstetric specialist in Rupnagar, Punjab, believed that allowing women to participate in decisions about the labour process would have a positive impact on their mental and physical well-being, as well as increase the chances of child survival. When institutional care during the hours of birth is infused with dignity, respect and compassion, it yields evidence-based results for improved maternal and child care.
Obstetric violence extends beyond the labour room. It is ingrained in various forms during and after pregnancy, using different words, mediums and actions. It also has a direct link to maternal mortality and newborn illnesses.
Healthcare authorities and professionals are the first to be held accountable for the incidence of obstetric violence on their premises, which violates women’s dignity during childbirth. The lack of legislation addressing obstetric violence allows perpetrators to escape without punishment.
Obstetric violence is also prevalent in home births. All of these cases of obstetric violence go unheard, unaccounted for and unreported in the absence of appropriate legislation and institutional mechanisms.
In order to establish a clear definition and legal framework for protecting women’s obstetric rights, India requires an obstetric violence policy.
The obstetric violence law in India should clearly define the authority, roles, definitions and remedies for various acts that constitute abusive behaviour towards women during the prenatal, childbirth and postpartum periods. A clear articulation of grievance redressal authority and a legal framework would help to protect women’s rights, ushering in a new era of inclusive maternal health.
Trust and security are required to ensure that our healthcare systems are sustainable and that the entities of care embody medical ethics and pro-care regulations. If women feel safe and cared for during their obstetric phase, their maternal health outcomes will improve and thus better civilisations will emerge.
Dr Vijayetta Sharma is Associate Professor of Public Policy at Manav Rachna International Institute of Research and Studies.
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth
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