Gloves Reveal Childbirth Story

Institutional deliveries have increased dramatically in a state like Rajasthan, but what’s the quality of these institutions?

New Media Fellows 2013

By Anindita Sengupta

May 26, 2013

Also published in Bangalore Mirror

A woman lies on a bed, wrenched in labour as a team of birth attendants hover over her. Some of them apply pressure on her abdomen. Others examine her vagina, sometimes with hands encased in dirty gloves. Through it all, the woman is vulnerable to the immense power that these men and women hold over her.

This could be any woman in parts of rural Rajasthan. It is many women in parts of rural Rajasthan. A study published in the Journal of Perinatalogy in 2008 revealed that childbirth practices in this northern state were still a far cry from modern standards of hygiene.

Dr Kirti Iyengar, senior co-ordinator of local NGO ARTH (Action Research and Training for Health), says things have changed since then but not enough. ARTH has been working in rural Rajasthan for fifteen years across a range of projects related to maternal health.

In these parts, women enjoy little autonomy. They are usually illiterate and married early. They are often not allowed to use contraception or let out to visit a health facility on their own. Many women have four or five children as young as 23. Son preference is strong so women typically bear children until they have a son.

Because the entire health system, by which one means doctors, Auxiliary Nurse Midwives (ANMs), etc. are deeply indoctrinated in a patriarchal system, the woman is not prioritised. She does not even have basic privacy. “When a woman asks for contraceptives, the health workers often tell her marital family about it,” says Dr Iyengar. This is disastrous in a set-up where the woman has few choices in terms of pregnancy and child-bearing.

The good news is that more women are opting for institutional delivery: almost 70% of the women that ARTH works with are now delivering in hospitals. Things have changed rapidly because of the government scheme called Janani Suraksha Yojana introduced in 2005. Under the scheme, women receive an incentive of 1400 when they go to the hospital to deliver.

“But in hospitals, they are not bothered,” says Iyengar. “There may be a dirty table with blood stains left over from another woman. Gloves may not be sterile. They may just wash and re-use gloves.”

The practice of injecting women with intramuscular oxytocin to induce labour pain is widespread and this causes complications, according to Iyengar. “Sometimes, there are strong contractions of the uterus and the baby may be stillborn,” she says. The reasons are manifold and mostly linked to a ceaseless commoditisation of health. Hospitals are under-staffed.

“Partly, the workers want to the delivery to be over as soon as possible so that their responsibility is over. Partly, it is that they want her to deliver before the duty ends so that they can get a gift from the family. If it happens during their shift, they can ask for the gift,” she says.

After delivery, the woman remains in the labour room for fifteen minutes or so, after which she is transferred to a general ward. Routine check-ups like blood pressure testing are foregone.

Instead, a nurse asks her how she is twice a day. All of this points to gross negligence.

A recent news report espoused optimism. The Annual Health Survey (AHS), conducted on nine states in May this year showed that Rajasthan had the highest decline (67 points) in maternal mortality rate (MMR). In 2011-2012, the MMR came down to 264 per 100,000 live births from 331 per 100,000 live births in 2010-11. This seems like good news but there may be more to it than meets the eye. Iyengar points out that the decline in maternal mortality has not been proportional to the increase in institutional delivery. “If quality of institutional delivery was higher, it would have increased,” she says.

We must be cautious then, in celebrating statistics. Statistics do not lie on soiled tables. Statistics are not warm, living bodies that can contract germs from dirty fingers. They cannot bleed. And mostly, they cannot speak. Better processes need to be put in place so that every death is reported and investigated, every act of callousness checked.

There is a thin line between neglect and cruelty. And clearly in some places, this line is breached much too often.

Anindita Sengupta writes about maternal and reproductive health with a fellowship from the International Reporting Project in Washington, D.C.

Reader Comments

  • simpedes said:

    A woman lies on a bed, wrenched in labour as a team of birth attendants hover over her. Some of them apply pressure on her abdomen. Others examine her vagina, sometimes with hands encased in dirty gloves. Through it all, the woman is vulnerable to the immense power that these men and women hold over her.

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