When Syndey-born Ruth Malik had her first child, it was by caesarean section, on the insistence of a private facility’s experienced obstetrician. A re-examination of the sonogram after the delivery revealed that the operation was not required.
After her experience, Ms.. Malik co-founded Birth India in 2007, a non-profit organisation that works to provide mothers with their maternity rights, including the Right to Informed Consent, particularly by encouraging the services of midwives and doulas. The group is working in cooperation with HRiC to organise the India Conference.
Ms. Malik’s experience isn’t unusual. The fourth National Family Health Survey (NFHS) of India revealed earlier this year that a disproportionate number of caesarean sections were carried out over the past five years in private hospitals when compared to government hospitals.
The rise in C-section rates will be a centre of focus for the international organisation Human Rights in Childbirth’s (HRiC) 2017 India Conference in Mumbai. The event aims to be the first in the country to initiate a dialogue between medical professionals, activists, and lawmakers to recognise the implementation of fundamental birthing rights, in practice and in policy.
“Women need a lot more care and protection than they currently get when it comes to their maternity rights. A traumatic experience in childbirth can drastically increase the chances of post-partum depression, and even suicide,” says Ms. Malik.
The NFHS survey showed that the c-section rates in all surveyed states were higher in private health facilities than in public health facilities. In Telangana, 74.9% of births in private health facilities were delivered by C-section, in contrast to the 40.6% in public facilities. At the other extreme was Bihar, with just 2.6% of C-section births in public health facilities but 31% in private facilities. Maharashtra showed a similar trend, with 33.1% of C-section births in private facilities and 13.1% in public hospitals.
While the states exhibited a less significant reduction in infant mortality rates, a 2015 report by the World Health Organisation (WHO) concluded that c-section rates higher than 10% of a population were not associated with any reduction in maternal and newborn mortality rates. The organisation recommends the use of a caesarean section only when medically necessary.
These skewed statistics have led to suggestions that C-sections serve as a convenience to physicians, rather than a necessity to patients.
“The higher procedure costs and longer hospital stays contribute to a resulting increase in income for many institutions. C-sections are often simpler than vaginal deliveries, and a lot of doctors aren’t well-educated in non-surgical delivery methods,” says Ms. Malik, who now holds a post-graduate degree in International Health, “The lack of awareness, combined with the unquestioned faith we have in our doctors — who are only human — has led to India’s infant mortality rate surpassing that of many war-torn countries.”
WHO data from 2015 records India’s neonatal mortality rate as 27.7 deaths per 1,000 live births. In that same year, the rate was 18.4 in Iraq, and 7.0 in Syria.
Ms. Malik is quick to point out that the problem isn’t endemic to India. More than 40% of births in China and 30% of births in the United States of America are carried out by C-section, despite a maternal mortality rate of 13.3 per 100,000 C-section births against 3.6 for natural deliveries, documented by the American Congress of Obstetricians and Gynecologists.
Dr. Suchitra Pandit, former President of the Federation of Obstetric and Gynecological Societies of India, attributes the rise in urban C-sections to late pregnancies and lower pain thresholds: “Modern urban life rarely involves activity on the ground, such as sweeping. This leads to a reduction in the flexibility of the pelvic floor muscles, and it’s harder to push during normal delivery.”
Dr. Pandit finds that “preconceived anxiety” often plays a role as well. “When we find that there’s no indication for a C-section, we try to counsel them on the risks, but they have often already consulted their families and made a decision. Women don’t want to take any chances and with the rise in medical litigation, neither do doctors. In smaller nursing homes, people even pelt stones in the event of a baby’s death.” She says that “C-section-on-demand” figures need to be brought down.
While Dr. Pandit believes that there are few doctors who would risk the safety of their patients for a monetary incentive, she agrees that India has a long way to go before it can ensure fundamental rights in childbirth.
The writer is an intern atThe Hindu
WHO data from 2015 records India’s neonatal mortality rate as 27.7 deaths per 1,000 live births
