The bane of Indian women

Inflicting a physician-induced ailment on women is tantamount to murder

Published: Sunday 31 October 1999

-- nothing illustrates better the ill-effects of excessive and unnecessary intervention in the field of reproductive and child health more than the rising rates of ectopic pregnancy -- an iatrogenic or physician-induced condition. In this condition, the fertilised ovum, unable to pass through the partially-blocked uterine tube, fails to reach the uterus and gets implanted in the thin-walled tube itself. In most cases, the tube soon ruptures. What follows is a grave life-threatening condition. Indiscriminate and excessive interventions in the maternal passage lead to greater episodes of infection of the passage, blockage of the tubes and enhanced incidence of ectopic (tubal) pregnancies.

At the sdm Hospital in Jaipur, a 300-bed leading outfit, there were 29 ectopic pregnancies for 1,218 deliveries in 1998. At another leading private hospital, the Bhandari Hospital, in the city, there were 10 ectopics for 427 deliveries in the same year. The corresponding data from the Medical College Hospital could not be obtained. But recently, the professor of obstetrics and gynaecology of Mahila Chikitsalaya, one wing of the maternity centre of the college, reported that over 8 per cent of all ectopic pregnancies occurred in patients who had been tubectomised, alleging faulty surgery as the cause of such a high rate.

A Medlar search -- searches in the international database on the subject for ectopic pregnancies -- revealed that the incidence of ectopic pregnancy is rising the world over. The report shows the concern of the health care providers, worldwide, to analyse the cause of such rising rates in their respective countries and to take measures to prevent it and gear up surgical facilities to deal with it.

Sadly, there is no such concern in India. With thousands of dilatation and curettage ( d&c) operations done in the country for the flimsiest of causes -- a procedure called safai ; about five million medical termination of pregnancies in the country (about one million reported from government hospitals) every year, approximately 10 million tubectomies and intra uterine device ( iud ) insertions, mostly under compromised surgical conditions are responsible for the high rate and mind-boggling number of estimated ectopic pregnancies.

The maternal passage, being in communication with the exterior, is always in potential danger of acquiring an infection from the environment. The periodic presence of blood in the passage provides rich nutrient fluid during that period. A passage, already at a high potential risk of getting infected, when subjected to invasive interventions in the form of d&c , iud s, medical termination of pregnancies ( mtp s) and caesarean sections, leads to greater chances of infection. Infection of maternal passage goes to the uterine tubes and, even if controlled by drugs, it frequently leads to their partial blockage. It thus hinders the passage of the fertilised ovum to the uterus, resulting in tubal pregnancy.

Besides, tubectomies have a failure rate of one per cent. Though the body is able to reunite the disrupted tubes, partial recannalisation only leads to the same effects. In how many unfortunate women, especially post-tubectomised women in rural area, can the condition be recognised? And even if it is suspected or diagnosed, will emergency surgical facilities be available, accessible and affordable? But for timely diagnosis and availability of emergency surgical facilities, the birth attendants will only be death attendants!

With excessive non-therapeutic interventions in the lives of women today, without concern for their ill-effects, modern obstetrics in India has progressed (rather degenerated) to barbarous midwifery. Inflicting such a high rate of ectopic pregnancy on a population that has such a poor access to modern surgical facilities is to inflict a very high rate of mortality, and is tantamount to manslaughter (womanslaughter) by default.

The author is a senior scientist at the Indian Institute of Health Management Research, Jaipur.

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