Representative image. Photo: PTI
- The absence of laboratory testing or diagnostic imaging means a lot of pregnant women need to be referred to higher centres to get the proper care they need.
- For women seeking care in rural primary health centres, the decision about whether they should be referred to a district hospital often lies with their husbands.
- Husbands often downplay their wives’ illnesses to avoid the hassle of visiting the district hospital – already crowded for being a dumping ground for referrals.
- The US Supreme Court’s recent decision to overturn its landmark Roe v. Wade judgment has brought attention worldwide to the issue of women’s reproductive rights.
- Laws in India regarding abortion are fairly liberal – but the challenges stand tallest in the face of ensuring women have the autonomy and the power to make decisions about their bodies.
Last year, in August, I was posted in a sub-district hospital in Haryana as a medical intern. A large chunk of my duties revolved around caring for pregnant women and newborns.
The first delivery I oversaw was a 24-year-old woman who had previously given birth to three girls. There was a grim silence, unusual for a labour room usually filled with the harsh cacophony of anguished cries of women struggling through labour. The woman was silent because she was familiar with the pain of childbirth. And we were silent because we knew she would keep getting pregnant until she gave birth to a boy.
The delivery was uneventful. The baby popped out without a fuss, breaking the silence with a hearty cry. The mother-in-law, who had been coaxing the mother and whispering words of comfort earlier, now only had eyes for the baby. As soon as she saw it was a girl, she whipped out her phone to call the husband and left, muttering angrily.
At that moment, the phone seemed like an anachronism, strangely out of place in that delivery room where an old system of subjugation was playing out. The mother lay alone on the delivery table, bleeding profusely from a uterus that refused to contract after suffering the trauma of giving birth four times in four years. (Excessive bleeding after childbirth is one of the leading causes of maternal deaths in India.)
We asked her if she wanted a copper-T, a form of postpartum contraception. We also told her about the risk of not spacing out her pregnancies. But she refused. She said, in quiet desperation, “Mummy ji ne mana kiya hai, jab tak ladka nahi ho jata” – Hindi for “my mother-in-law has prohibited me from using any form of contraception until I give birth to a boy.”
Seeing how little agency she had while making decisions about her own body was appalling. She couldn’t decide the number of children she wanted or when she could have them. Decisions about contraception and childbirth were taken by the mother-in-law or the husband.
In a separate instance, a belligerent husband threatened litigation against the hospital when his wife underwent an abortion without his consent. Indian laws about medical termination of pregnancy (MTP) don’t require the husband’s consent. But after the husband’s intimidation, the woman backtracked and denied that she had given consent in the first place.
After this incident, the hospital management called us into a large wood-panelled conference room and informed us of a new, unofficial hospital policy: to refer all such cases to the district hospital. The hospital, the managers said, didn’t have the resources to deal with frequent threats of violence and lawsuits, and shifting the responsibility to a higher centre was considered the safest course of action.
However, the district hospital – being the dumping ground for all kinds of referrals – was already overcrowded. It wasn’t easy to get an appointment with a doctor there. The absence of medical expertise meant women who needed an abortion would have to resort to unsafe methods. Around eight women die each day due to causes related to unsafe abortions. It is the third leading cause of maternal mortality in India.
My next posting at a primary health centre took me deeper into the underbelly of rural Haryana. My colleagues and I witnessed run-of-the-mill cases of khansi-zukam (cough and cold), ‘allergies’ (a term patients often used to describe itching), body aches and complaints of a general listlessness and disinclination to work.
We saw serious cases of hypertensive emergencies, myocardial infarctions and chronic obstructive pulmonary disease exacerbations – but mostly the poorly equipped emergency services were considered an extension of the OPD services, with patients walking in at 3 am with complaints of itching or bloating.
The absence of laboratory testing or diagnostic imaging meant a lot of patients needed to be referred to higher centres to get the proper care they needed. There was a single ambulance which was often not available, forcing patients to arrange their own transportation to reach the district hospital.
For women, the decision about whether a referral was needed wasn’t made by them or the treating doctor. It was made by their husbands – who would often downplay the severity of the women’s illness to avoid the hassle of going to the district hospital.
As one boisterous, young Haryanvi lad put it, “Jo ilaaj karna hai, yahin pe kardo. Aage nahi leke jaunga” – “Do whatever you can here only. I am not going to take her to a higher centre.” It wasn’t uncommon for a woman to sit quietly while her husband explained her symptoms and offered a diagnosis as well as a treatment plan. It was usually a shot of painkillers for everything.
The US Supreme Court’s recent decision to overturn its landmark Roe v. Wade judgment has brought attention worldwide to the issue of women’s reproductive rights. Laws in India regarding MTP are fairly liberal – but that’s not where the challenges lie. They stand tallest in the face of ensuring women have the right, the autonomy and the power to make decisions about their bodies. These challenges are just different and insidious.
Doctors can’t change how women are treated in their own homes. Laws, while useful, don’t suffice to effect changes in power structures that have persisted for generations. The long arm of the law ultimately fails to reach inside the houses where many women lead repressed lives, without the power to take decisions on issues that affect them directly.
Dr Gurasis Boparai did his MBBS from AIIMS, New Delhi. He enjoys reading, playing the guitar and exploring the city around him.