Fix maternity care before calling for more children

Every expectant mother deserves respectful and compassionate care throughout the maternity process.

Some elected representatives have called for women to have more children for a variety of reasons, none of which take into consideration women’s agency over their reproductive rights. Yet, when it comes to women’s right to safe and healthy pregnancies, a host of issues need addressing before these blanket calls are made. For example, while maternal mortality and morbidity rates have declined, there is an unevenness in this, with states like Assam registering 195 maternal deaths per lakh live births.

Every expectant mother has the right to be treated respectfully in the facility of her choosing and shown a degree of compassion. (Photo by Pratham Gokhale/Hindustan Times) (Pratham Gokhale/HT Photo)

In large parts of rural and peri-urban India, there have often been complaints about the lack of access to medication and provisions for institutional delivery. Many medical facilities lack clean water, uninterrupted electricity, and adequately trained medical service providers. There is a lack of beds, communication, and essentials. Not enough information, or relevant information, is imparted to women about postpartum care. The World Health Organization stipulates that communication and effective responses specific to the woman’s needs as well as qualified medical personnel are critical elements of Respectful Maternity Care (RMC). These factors are vital to both the physical and mental well-being of the mother and her newborn.

Every expectant mother has the right to be treated respectfully in the facility of her choosing and shown a degree of compassion. For this, health providers need to accord the woman dignity and communicate with her about her choices. Anjoo Agarwal, vice-dean of obstetrics and gynaecology at the Queen Mary Hospital, King George Medical University, Lucknow, says, “Respectful maternity care is the right of every woman and should be universal.”

The high caseload at health and wellness centres as well as district hospitals and tertiary care facilities precipitate a situation in which women’s needs are often overlooked, depriving them of quality care. So, there is all the more need to focus on RMC, especially in remote areas where women’s maternity needs often fall through the cracks. This means addressing a whole host of challenges, including communication gaps, lack of support structures, cultural disparities, and often bias or lack of awareness among health care professionals.

According to a 2022 research report — Prevalence of Disrespect and Abuse and its Determinants during Antenatal Care Services in Rural Uttar Pradesh — in the International Journal of Health and Science Research, about 60% of women in rural Uttar Pradesh did not receive antenatal care, faced discriminatory treatment and were insulted during treatment in maternity health facilities. About 18% reported that the behaviour of health providers was not civil towards them. Additionally, 1.5% reported that abusive language was used against them. This led to patchy treatment regimes with many women not getting adequate care as per protocols during and after pregnancy. Many reported not coming to health facilities for fear of being insulted by health workers. Seema, a 36-year-old resident of Lucknow, says she visited three different hospitals for health check-ups. She observed that while some hospitals provided adequate seating, drinking water, and toilet facilities, others lacked these basic amenities, forcing pregnant women to sit on the floor. She expressed concern about a government hospital where all staff members, regardless of gender, entered the room where pregnant women were being examined without any regard for privacy.

Every expectant mother deserves respectful and compassionate care throughout the maternity process. This is something that all government programmes for maternity care should ensure.

The views expressed are personal