(Fictional News Report: This article has been written imagining a hypothetical situation where one government hospital has begun a project to eliminate disrespect and abuse of women from its obstetrics and gynaecology wards.)
In India, as in much of the world, being poor, sick, and female is the worst state you can be in. But what I realized over the years is that being poor and pregnant is equally awful.
These are the words of Dr Suman, Head of the Obstetrics and Gynaecology Department at the New Government Hospital. This month they started a unique project named ‘Mommy-Friendly Hospital Initiative’ to make maternity care more respectful and quality-driven.
“The Baby-Friendly Hospital Initiative is well-known, but it is strange that our system never gave serious thought to also making health centres mother-friendly. I myself have been part of this imperfect system for too long.”
I asked her what imperfections she was referring to.
“We have this pet phrase of ‘skilled birth attendance’. Politicians and bureaucrats naively believe that getting women give birth in hospitals instead of homes satisfies the ‘skilled birth attendance’ recommendation of the World Health Organization. But then, does assisting a woman become a mother require only clinical skills? No. Skills like compassion, empathy and humanity are equally essential, and glaringly lacking in our hospitals.
“Besides, by increasing the burden on hospitals without taking care of human resource development, even the hospital staff are not able to work at their best skill levels. Which is why I say that even if India has an 80-90% hospital deliveries rate, true skilled birth attendance is perhaps not even 50%.”
The first step in solving a problem is to acknowledge its existence. Having interviewed doctors previously and witnessed their denial mode when it comes to ‘obstetric violence’, I found Dr Suman’s take very progressive and refreshing.
But perhaps she was just another senior employee trying to ensure she did something fancy before her retirement. So, I asked her to tell me more about this Mommy-friendly initiative, especially to see if there was any long-term vision. She then called a junior doctor and asked him to give me a tour of the reinvented delivery room, which they now call ‘birthing area’ (“the terms ‘delivery room’ and ‘labour room’ reek of unduly medicalized maternity care”).
His name was Dr Sameer and he was a lecturer in Ob/Gyn, having finished his MS a year back. On reaching the birthing area I quickly realized the initiative was indeed being seriously implemented. On the main door and at several places inside, small placards saying ‘This birthing place respects women’ were pasted. It reminded me of how bus and taxi services around the country have similar placards that say ‘Our employees respect women’.
I saw three clean beds with thick green partitions between them. There wasn’t much space, but still the two labouring women were encouraged to also stand and move. In one corner of the room an old woman was seated on a stool. I asked Dr Sameer who she was.
“She’s the mother of the woman on bed number 2. Dr Suman wants to make it possible for women’s kin to be close by during the birth. Since we have little space presently, we allow the female relative of only one patient… I mean, woman.”
Although, he said as an afterthought, the main reason is it generally ensures that hospital employees don’t yell at birthing women.
I asked him what he thought of all these changes.
“I think this is really great. It is high time we did such things, no doubt. The whole world is talking about obstetric violence, and I am happy we are being pioneers here and showing the way forward.”
How did the residents and nurses take it, I asked. Govt employees are, after all, not known to take too kindly to change.
“Well, you must remember that no-one comes in the health sector to harm people — it is generally the system and culture that limit the scope of how much good they can do. Now that we partly have a good culture in place, everyone is slowly and happily coming on board. And then, I think Dr Suman conducted it all pretty well. She made us part of this whole endeavour right from the beginning.
“Around a year back she and two professors convened a meeting of all the nurses, residents and faculty in the department. They talked about the latest medical and public health research surrounding disrespect and abuse during pregnancy and labour. While she never mentioned this explicitly, we knew she wasn’t happy with the way we were treating women here. Later we were encouraged to air our own views on how things can be improved.
“Perhaps the most intense part was when we saw a video interview of a young woman from a neighbouring slum who had given birth here. She was asked about her experience, and shockingly for me, she remembered every word and every act we had said and done. Much of it was really not something we feel proud about. She also cried as she talked. It was quite an uncomfortable realization that we had ruined most of what could have been her happiest day.
“But now I think we have realized the importance and absolute necessity of being humane with patients whatever the workload or pressures be. I have myself studied extensively about human rights and reproductive rights since.”
Talking to Dr Sameer was like walking in an oasis of optimism surrounded by the harsh arid desert of Sarkari maternity care. What it generally takes to transform a badly functioning system is just one person willing to lead by example. I was amazed at how the humane leadership shown by Dr Suman was trickling down and having a positive effect on her juniors.
Not everyone was happy though. I met two faculty members who were sceptical, one even saying ‘this will be a short-lived fad and things will soon be back to usual’. But he couldn’t provide me any significant arguments other than the usual: government institutions are corrupt and inefficient.
I decided to have a final word with Dr Suman before leaving.
“To be honest, we are still not fully mommy-friendly,” she admitted. “What you just saw is work half done, and there will be constant improvements in the future. As a lot of women visit us, many births still occur in the old-fashioned labour room on the other side of the floor. One reason for this is that the primary health centres in neighbouring towns, which can easily handle many of these births, are not well-equipped or well-staffed. We have begun writing to administrators to remedy that.
“None of this was easy of course: we had to persist and persevere a lot with higher authorities both at the hospital and at the ministry. The last half year has drained me tremendously, but I still won’t stop working harder. I want this to continue even when I am gone, so my ultimate aim is to place a system here that will by itself put brakes on disrespect and abuse, without any need of ‘pressure’ from the senior level as is happening right now. After all, the alternative to all of this — letting the maternity system stay in the mess it is currently in — is completely unacceptable.”
It was remarkable to see the difference in the attitudes of the senior professor who dismissed the initiative as just a transient fad, and Dr Suman who was willing to take on every obstacle to not let that be. Perhaps that’s what the government systems in India direly need: dreamers and doers. People who know it is mighty difficult to create change, but who still dream of doing it and would work tirelessly for it.
Seriously hoping she receives ample support from those around her, I wished Dr Suman good luck and promised to return in some months.
(Research for this article was made possible through funding from Sitaram Bhartia Institute of Science and Research.)
by Dr Kiran Kumbhar