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.]
IN NUMBERS
Men on average earn Rs 4,000 more than women. Muslims earn Rs 7,000 less than non-Muslims and those at the bottom of the caste system, including Dalits and tribals, make Rs 5,000 less than others with the same educational qualifications and experience.
Source: Oxfam’s India Discrimination Report, 2022
Read more about the report here.
STORIES YOU MIGHT HAVE MISSED
Update: Hijab hearings in the Supreme Court
Credit: PTI
A two-judge bench of Justices Hemant Gupta and Sudhanshu Dhulia remarked that it was not equipped to interpret the Quran. Meanwhile, lawyers representing 23 petitioners challenged an earlier Karnataka high court order that upheld the ban on hijab, or a head scarf.
The ban is a violation of individual rights and of privacy said senior advocate Kapil Sibal who urged the judges to refer the matter to a larger Constitution bench since it involved the personal dignity of individuals and is a cultural right protected by Article 29.
On the fifth day of hearings, senior advocate Colin Gonsalves called the Constitution a living document and asked for hijab to be given the same protection as Sikh turbans and kirpans. “The wrong equation of hijab with a law and order problem is a shocking formulation,” he said.
Putting forward a just-released PUCL report on how the hijab ban had impacted Muslim girls from attending schools and colleges, another senior advocate, Aditya Sondhi said the girls were being forced to make a choice between education and the wearing of a head scarf. “A citizen must not be burdened with choosing between two rights,” he said.
Senior advocate Yusuf Mucchala agreed that the rights of Muslim girls is affected because their cultural and religious rights were not being accepted.
UP’s rape horror story continues
Six men have been arrested , one after an encounter with police left him with a bullet injury on his leg while he was trying to evade arrest, in connection with the death of two minor Dalit girls who were found hanging from a tree in Nighasan in Uttar Pradesh’s Lakhimpur Kheri district. Police officials said two of the men, Sohail and Hafeezul Rehaman raped and murdered the girls while Chottu Gautam, a local villager facilitated the crime. The others helped in disposing off the bodies.
National Crime Records Bureau data shows a 45% increase in the reported rapes of Dalit women from 2015 to 2020.
Bringing in a law for ‘honour’ killings’
Credit: Pexels
The Dalit Human Rights Defender Network, a coalition of anti-caste activists and organisations has, reports The News Minute, put together a draft bill that recognises so-called ‘honour’ killings or, more accurately, the caste-based murder of kin by their own families because they marry outside caste and faith. Despite a Law Commission recommendation, there is no law in India that specifically deals with these killings.
AND NOW FOR THE GOOD NEWS
The simple intervention of lidocaine, a local anaesthesia that costs less than Rs 100, just before breast cancer surgery significantly lowers the risk of death and recurrence of the cancer. The decade-long study by doctors at the Tata Memorial Centre, Mumbai said the treatment will now be used as standard protocol for the treatment of all breast cancer patients at their centres.
India has an estimated 150,000 new breast cancer patients every year, of which 90,000 to 100,000 are eligible for surgery.
BOOKSHELF
What happens to three couples who break barriers by falling in love? Journalist Mansi Choksi documents three cases: One which crossed the religious divide; another that had to pretend to be sisters just to live together; and a third that runs away from their families because they belong to different castes.
Mansi Choksi’s The Newly Weds: Rearranging marriage in modern India has been published to rave reviews. In the Financial Times, Nilanjana Roy called it “compelling, and sometimes heartbreaking”. The Times calls it a “staggeringly good work of literary journalism”.
AROUND THE WORLD
In Iowa, a teenage human trafficking victim who was initially charged with first-degree murder after she stabbed her accused rapist to death has been sentenced to five years of closely supervised probation. But, under state law, she will also have to pay $150,000 to the man’s family, reports Associated Press. Donations through GoFundMe have been pouring in for the teenager and stand at twice the amount she has been ordered to pay.
In Sweden, the country’s first woman prime minister Magdalena Andersson accepted defeat to a four-party right-wing opposition bloc in a close-fought election and has resigned, reports EuroNews.
In Chicago, , a jury has found R&B singer R Kelly guilty of multiple charges of child pornography and luring underage girls to have sex with him, reports CNN. Earlier in June, Kelly was sentenced to 30 years in prison by a New York court on charges of racketeering and prostitution. The singer still faces charges in Illinois and Minnesota.
In the UK, civil liberties campaigners have expressed alarm about the police crackdown on anti-monarchy protestors, including the arrest of a man in Edinburgh for apparently heckling Prince Andrew who remains under a cloud of allegations for sex with underage trafficked girls.
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