“Just after delivery I was asked to sweep the place clean even though I told the nurses I was in no condition to do so,” recalls one woman. Another describes how she was compelled to part with ₹1,000 to provide sweets for the hospital staff despite the fact that the family was running out of funds for child care. They ultimately settled for ₹800. A third woman points towards the awfully dirty bathrooms that she had to use at the hospital, making her afraid that she would end up with a serious infection.
This is just a sprinkling of voices that emerge from the one-year-long survey on maternal care conducted in Assam among 92 women who had just delivered their babies in the five districts of Baksa, Darrang, Goalpara, Kamrup and Sonitpur. The purpose of the study was to find out maternity service delivery at the grassroots and record the experiences of mothers who were receiving it. The survey, conducted by Diya Foundation with support from the White Ribbon Alliance India and MacArthur Foundation, reached out to new mothers for their answers.
While it is true that in the past 10 to 12 years, there has been a decline in the Maternal Mortality Rate (MMR) in the country, still 15 per cent of maternal deaths around the world take place in India. And we have around 45,000 women dying of pregnancy-related causes every year. Even women who do receive institutional care, and have safe deliveries, are subjected to insensitivity by the delivery care system that tells the story of indifference and disrespect, sometimes bordering on gross abuse.
It is as pertinent that 70 years after Independence, as the survey shows, women face indignities in the most crucial and difficult hours of their lives — while giving birth.
During the survey, almost 34 per cent of the women reported that the hospital did not bother to use a curtain or screen while examining them. Even during labour and the actual delivery, privacy was breached, with the women being exposed to non-healthcare staff.
And if that is not bad enough, around 34 per cent of the women reported that, during their hospitalisation, health workers were far from sensitive. They shouted at them, insulted and threatened them with dire consequences if they failed to follow instructions. They were reprimanded if they called for help, blamed for negative pregnancy outcomes and shamed for reproductive choices.
Around 27 per cent of the women reported denial of care. They were left unattended during the labour hours and delivery, with no one answering calls for help. They were even asked to clean the floor or the labour bed immediately after delivery and denied help if informal payments were not made to the staff.
Sixteen per cent women said that their consent was not taken before medical procedures or examination. The birth companion was also denied access during labour and delivery. What is even worse is that almost 9 per cent reported physical abuse during their hour of utmost need. They were slapped, hit and their legs tied during labour and delivery. About 8 per cent of the women felt discriminated against due to their poor socio-economic status, illiteracy, religion and the number of children they had. And despite this treatment, 70 per cent of the women were asked for an informal payment by the health staff when they were being discharged.
The above micro study in Assam, along with a larger study last year across 24 States and Union Territories among 1,43,556 women about their expectations in terms of quality of maternity services, brought to light interesting findings.
Seeking to “amplify” women’s voices, the ‘Hamara Swasthya, Hamari Awaz’ (Our Health, Our Voices) campaign carried out by White Ribbon Alliance India reached out directly to women to find out what improvement they would like to see in reproductive and maternal healthcare.
On the aspect of being treated with dignity, a large number of the women in the study desired respectful behaviour from health personnel, no caste or religion-based bias, clean labour rooms and toilets, access to information about their case and complete privacy during examination, labour and delivery. Not such a tall order this.