In India, childbirth has turned into a moneymaking racket, with caesarean sections pushed by unscrupulous medical practitioners in search of profit. Healthy young women who could easily have had normal, natural deliveries are lied to, told that they and their babies are at risk, and advised to have invasive surgery. Worried families feel helpless and afraid to refuse doctors’ orders. Thousands of women in even the smallest towns are put through this ordeal for no medical reason at all.
Until 2010, C-sections were limited to 8.5% of all deliveries in India, just under the recommended level of 10-15%, according to a World Health Organisation report. However, during the past decade the numbers have shot up. In Kerala, India’s most educated, aware state, 41% of deliveries are C-sections and Tamil Nadu, another relatively well-off state, has 58% of its deliveries by C-section, reports the ICMR School of Public Health. Major cities in particular have seen an exponential growth in C-sections in both private and public hospitals, while one study revealed a rise from 31% to 51% over just six years in rural Haryana.
As a result, many women are taking unnecessary risks and young couples ending up in debt they can ill-afford and suffering financially for years. Why hasn’t there been a huge noise from Indian women’s organisations and female politicians about this issue? That is the question my daughter asked after she heard about a friend of a friend who had died after a C-section.
“Why does the feminist movement shut up totally when it comes to women and childbirth,” she asked. “Everyone’s vocal about everything connected to a woman’s body before she gives birth. But the minute a woman decides to become a mother, the silence is deafening. Does she cease to be a feminist because she decided to have a child?”
I was nonplussed. I’d never thought about this, in spite of having borne three children, two under pretty tough circumstances. But suddenly three decades of suppressed anger against the medical negligence I’d endured returned. After being admitted into hospital when my waters broke, I was ignored. I didn’t scream – as was considered “normal” – because I had a higher pain threshold than other women.
Finally after 12 hours, at 5am, the nurse appeared armed with a drip to put me on Pitocin, a drug to induce labour. “This is my third child and that drug will harm the baby. I know I’m at the end of the labour, not the beginning,” I pleaded. Ignoring my words, the nurse advanced determinedly, muttering, “Nowadays these patients think they know everything.” Desperate, I screamed, “If you bring that thing near me I will kick you.” Furious, she stormed off to call the head nurse. The senior woman approached me, reprimand ready. “What’s your problem? Why don’t you just obey the nurse?” she scolded. On examining me, her tone changed. “Oh my God,” she shouted, “the baby’s almost out. Rush her into the delivery room.”
My son delivered himself. The gynaecologist whose fees I’d paid for nine months was nowhere in sight. The nurse cut me badly. She then stitched me up and triumphantly announced to her helper “my first delivery”! I honestly wished I’d kicked her hard when I’d had the chance. It would perhaps have saved me a lot of post-pregnancy problems. At the end of 12 hours I was exhausted and weak, both physically and emotionally.
In traditional systems, women are encouraged to squat, because that was the most normal way for the baby to be naturally pushed out. In one tribal community in southern India, the women have a strong rope, like a bell pull, to hold on to while they squat in the final stage.
The rise in C-sections is not restricted to poorer countries. But in India the figures are particularly stark. Meenakshi Gautham, India country coordinator for a maternal and newborn health programme at the London School of Hygiene and Tropical Medicine, accuses private hospitals of being the most “scalpel happy”. Gautham’s survey says that the charges for the procedure, hospital stay and anaesthesia can range from about Rs5,000 (less than $ 75) in a government hospital to upwards of Rs40,000 ($ 600) in a private hospital.
Hope lies in the fact that some gynaecologists are now calling for change. Mumbai obstetrician Sheetal Sabharwal is co-founder of the Tulip Women’s Health Care Centre. She has been in the forefront of the ethical practitioners’ movement demanding that doctors and clinics charge an equal, flat fee for caesarean and vaginal births.
The sharply rising rate of C-sections, though, is only one of many issues surrounding birthing practices and pre- and postnatal care. Perhaps the rights of pregnant women and mothers will find their way into the International Women’s Day debates. They certainly should do.
Why don’t India’s feminists call out doctors doing unnecessary C-sections? | Mari Marcel Thekaekara
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