A product of colonization, the medicalization of childbirth in India was the beginning of the process of re-imagining childbirth in the country. The term ‘medicalization’ suggests looking at certain aspects of the human condition as ‘medical conditions’, and thus, childbirth started to be looked at as a ‘condition’ that affected humans and needed medical intervention.[i] However, in recent times, several issues have surfaced regarding the injustices that plague how hospitals view and treat childbirth. This article will analyze and highlight the loopholes that render maternal healthcare provided in hospitals in India ineffective. It will also attempt to bring to focus the oppressive, profit-driven nature of hospitals and suggest reforms to prevent the issues that exist, in order to humanize the way in which hospitals treat childbirth.
First, an analysis of the traditional treatment of childbirth is required to highlight the need for medical intervention in pre-colonial India. The traditional treatment of childbirth in India involved the role of a low caste woman (dai), who were responsible for conducting the delivery and were generally regarded as being ‘untouchable’. The process of delivery was seen as an ‘unclean’ event because of the lack of hygiene. The recruitment process for a dai was based on heredity rather than on skill or merit.[ii] As a result, the traditional treatment of childbirth in India was a grim reminder of the oppressive class system that existsed here. There was also a lack of skilled assistance to facilitate the delivery process. The necessary medical intervention took place in the 1800s, when the Dufferin Fund was founded by Lord Dufferin, Queen Victoria and Elizabeth Bielby. They created the fund out of their own terrible experiences of maternal healthcare in India, where they were subjected to a poor environment and no cleanliness.
The purpose of this fund was to provide medical tuition, medical relief and train private nurses to work in hospitals.[iii] The immediate result was an improvement in the quality of maternal healthcare in India. The effects of this fund were felt post-Independence as well. The Infant mortality rate which was about 193 (deaths per 1000 live births) in the 1950s, went down to 112 by 1980; 65 by 2000 and 36 by 2015.[iv]
The positive effects of medical intervention are
evident in the growing number of people choosing hospital births and the
ever-increasing number of hospitals. The Indian healthcare sector stood as the
4th largest employer in FY17, employing 319,780 people. From
2000 to 2014, there has been a 370% increase in government healthcare expenditure.[v] However,
in the same time period, a lot of issues have cropped up in the field raising questions
regarding the nature of medical institutions as being profit driven rather than
one of healthcare service.
A major practice driving this perception is that of overbilling. Private hospitals like Fortis, Max, Medanta, have constantly been sued for bills up to 17 Lakhs for treatments of diseases like dengue. Instances have also been recorded where needles, that are originally acquired for Rs. 5 are sold at Rs. 106 or more. As of February 2018, hospitals in India make a profit of over 1,737% on drugs, consumables and diagnostics.[vi]
Several instances of sexual, verbal and emotional abuse have also been recorded, wherein women have been harassed by the medical professionals for not acting compliant and quiet. In May 2015, two women in Kolkata, were psychologically and physically abused in the maternity ward while they were in labor. Another instance of labor room abuse was recorded from a hospital in Delhi, wherein the nurses threatened to slap a pregnant woman if she screamed, and handed her the unwashed body of her stillborn baby in a polythene bag.[vii]
Furthermore, unnecessary and expensive treatments and procedures are performed on women during the delivery. Procedures like C- Sections and episiotomies, which are solely for the purpose of complicated deliveries and reducing maternal mortality rate, are increasingly being performed on women. A caesarean section is a major abdominal surgery used for the delivery of an infant through an incision in the mother’s abdomen and uterus.[viii] WHO permits only 10-15% [ix] of the deliveries to be c-sections, yet in the past few years, India’s number has gone up to as much as 41% in Kerala, 58% in Tamil Nadu and 51.2% in Haryana.[x] This rise in unnecessary treatments is purely on the basis of monetary benefits and the physician’s convenience. These procedures are expensive because of their complicated mechanisms and hence, they churn out more profits for the hospitals as compared to natural or vaginal deliveries. The charges for a C-section including the procedure, hospital stay and anesthesia can range from about Rs 5,000 in a government hospital to upwards of Rs 40,000.[xi]
The initiatives taken by the government so far have failed to resolve or decrease the intensity of this issue. A Governmental scheme, Janani Suraksha Yojana, pays pregnant women to give birth in hospitals in an effort to discourage home births. The implementation of this program has been a success. The number of women who are now able to access maternal health care in hospitals has increased from 40% to 80%[xii], yet this scheme still failed to ensure a quality healthcare for women. Reports show that three infants died in Uttar Pradesh’s Balia district “after their mothers were forced to deliver on the floor even though beds were available at the primary health center,” because the attendants didn’t want to deal with the soiled sheets.
The problems that plague this field aren’t hidden from the public eye. Several initiatives have been taken in the past to overcome these issues and make medical interference a better and safe experience. For instance, in Mumbai, an NGO called Centre for Enquiry into Health and Allied Themes (CEHAT) introduced a course for medical students on humanizing childbirth to sensitize students about the issues that exist in institutionalized maternal healthcare and how to deal with them.[xiii] A few healthcare institutions, such as The Birthplace (a Hyderabad-based maternity center) and Tulip Women’s Healthcare Centre (in Mumbai) have started to charge an equal flat fee for C-section and vaginal births and are thus pioneers in the field of humanizing childbirth.[xiv]
These institutions set
examples of reforms that have been taken, but it is also important to note that
these are isolated initiatives. If we put these initiatives in the context of
the entire country, they cater to a very small section of people. The need of
the hour is to incorporate such reforms into the national healthcare system,
chiefly the lack of information available for women. A possible solution is to set up a
consultative body, independent of the doctors consulted for delivery, primarily
with the purpose of educating women about the different medical procedures
involved, and the risks involved with opting or not opting for them. Moreover,
a regulatory body, that aims at increasing the accountability of doctors, medical staff and other
professionals in hospitals as well as deciding on nationwide, standardized
costs of procedures, equipments and other medical services to prevent financial
exploitation of people.
[i] Antonio Maruto, Medicalization: Current Concept and Future Directions in a Bionic Society (Bologna, Italy: Bologna University, 2012), 122-33, doi:10.4103/0973-1229.91587.
[ii] Supriya Guha, From Dias to Doctors: The Medicalization of Childbirth in Colonial India, (1998), 1-14, http://www.womenstudies.in/elib/others/ot_from_dias.pdf.
[iii] Supriya Guha, From Dias to Doctors: The Medicalization of Childbirth in Colonial India, (1998), 1-14, http://www.womenstudies.in/elib/others/ot_from_dias.pdf.
[iv] “India – Infant Mortality Rate.”, Knoema Corporation [US], Accessed November 20, 2018, https://knoema.com/atlas/India/topics/Demographics/Mortality/Infant-mortality-rate.
[vii] Reema Nagarajan, “The Labor Room Bullies – Times of India”, The Times of India Business, November 15, 2015, Accessed November 20, 2018, https://timesofindia.indiatimes.com/india/The-labour-room-bullies/articleshow/49791192.cms.
[viii] Sancheeta Ghosh, Medicalization of Maternal Health Care: An Analysis of Caesarean Section Delivery in West Bengal (2014), http://hdl.handle.net/10603/15931.
[ix] Luz Gibbons, José M. Belizán, Jeremy A Lauer, Ana P Betrán, Mario Merialdi, Fernando Althabe, The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage, (WHO, 2010), http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf.
[x] G Singh, E D Gupta, Rising Incidence Of Caesarean Section In Rural Area In Haryana India: A Retrospective Analysis, (2013), http://ispub.com/IJGO/17/2/2972.
[xi] G Singh, E D Gupta, Rising Incidence Of Caesarean Section In Rural Area In Haryana India: A Retrospective Analysis, (2013), http://ispub.com/IJGO/17/2/2972.
[xii]Malathy Iyer, “Campaign to End Abuse of Women During Childbirth,” Times of India, 2018, Accessed November 20, 2018, https://timesofindia.indiatimes.com/city/mumbai/Campaign-to-end-abuse-of-women-during-childbirth/articleshow/55735772.cms
[xiii] M.E. Khan, Avishek Hazra, and Isha Bhatnagar, IMPACT OF JANANI SURAKSHA YOJANA ON SELECTED FAMILY HEALTH BEHAVIORS IN RURAL UTTAR PRADESH, http://medind.nic.in/jah/t10/s1/jaht10s1p9.pdf.
[xiv] Malathy Iyer, “Campaign to End Abuse of Women During Childbirth,” Times of India, 2018, Accessed November 20, 2018, https://timesofindia.indiatimes.com/city/mumbai/Campaign-to-end-abuse-of-women-during-childbirth/articleshow/55735772.cms