A Challenged Healthcare System: The Mothers’ Perspective
A few months ago, I wrote about my first experience visiting hospitals in India. Having been born and raised in Europe, I naturally have a different view on healthcare matters, as the system is simply different. I knew the mortality and morbidity rate was high, but I was surprised about the lack of respectful care by providers, the poor quality of hospitals as well as the occurrence of preventable complications during birth.
Having lived in Mumbai for about 6 months now however, I have felt the need to tap myself on the fingers on a crucial point. My innumerable interactions with doctors and carers on the ground, thus far, have offered deeper insights into an issue that I now understand, is not just systemic, but also societal, and I’d like to share a couple of experiences to highlight this.
So yes, the mortality rate is high; yes, the morbidity rate is concerning, and needs attention and, yes, respectful care practices are not always observed. According to the WHO most maternal mortalities and morbidity cases are caused by severe bleeding during/after pregnancy, infections after pregnancy, hypertension, complications during pregnancy and unsafe abortions — all notably preventable causes.
Nevertheless, it is too one-sided to squarely blame a challenged healthcare system. What I found is that the healthcare providers are often left to fix health issues of mothers that could have been prevented via other routes than medical interventions.
Genetics & Environmental Influences
One aspect, that was explained to me, is that due to genetics and the environment, the pregnancy challenges that occur in India, are different, compared to other developed nations. Diabetes and high blood pressure are more prevalent in Indian women than, for example, in European women, just because of their genetic disposition and the environment they grow up in.
Consequently, gestational diabetes and hypertension, major contributors to pregnancy complications in India, are more likely to occur, irrespective of the quality of care of the hospital, or the socio-economic background of the pregnant woman. Gestational diabetes in turn, increases the risk of having a C-section or complications during the delivery, as well as influencing her healing after birth, e.g. in case of infections.
Add to this, poorer environmental conditions like air & food pollution, or financial barriers to healthy foods (or food at all), and it is but obvious, that pregnancies will go wrong more often in India.
Moreover, Indian women are, on an average, fertile for a shorter period of their lives than Caucasian women, due to environmental factors, especially in rural India. Consequently, as more and more women either delay conceiving or continue to give birth till later, in India, complications during pregnancy and hypertension also increase.
Hence, both these genetic and environmental factors are important determinants to consider, before laying the square blame of maternal deaths, on the healthcare system in India.
Knowledge vs. Societal Norms
By acknowledging that women in India are more prone to difficult pregnancies, something else becomes even more important in this context: Knowledge.
My conversations with mothers and doctors over the last few months, highlighted that the knowledge of young pregnant women, especially in the lower income segments, on their pregnancy journey — is very low. They often rely on their mother, their in-laws, friends or religious figures for information.
Consequently, many traditional “old-wives’ tales”, both harmless and harmful, define the pregnancy journey, across an alarming stratum of households. More alarming is the fact — that knowledge — on which vaccinations to take, which scans to book, or what the warning signs are — for problems like hypertension, haemorrhage or anaemia, is simply not existing. And worse? Status quo is revered. “New age” perspectives, scoffed on.
Another doctor gave me an interesting insight — she mentioned that especially in the lower income segments, the most persistent recommendations come from ‘well-wishing’ family members. Women are often recommended to eat ‘for two’, to stop doing housework, physical activity, or shopping, during pregnancy. They are recommended to change their diets, and encouraged to have more fatty and sweet foods or leave out ‘supposed’ bad foods completely. They are also asked to minimise travelling, work less in the first trimester and quit their job, early in the third trimester — all of which I found surprising and contrary to mainstream healthcare advice.
Especially in a country where diabetes and hypertension are more prevalent, eating more, and moving less can have very negative effects on a pregnant woman’s life. Besides the detrimental effect of lack of sports on overall well-being, the decreased physical movement outside of the house, including leaving the job earlier than necessary — can cause social isolation, at a time when support is most needed, and have spill-over mental effects.
Solution: Empowering women
It is concerning — but at the same time — a great relief, to know that much of maternal mortality and morbidity can be prevented by increasing the knowledge and awareness of young women.
By getting women moving and eating healthy before they get pregnant, as well as giving them enough information to keep their healthy habits up during pregnancy, will, for sure — have a positive effect on their pregnancy experience. We need to empower women with enough knowledge to be able to confidently explain to well-wishing family members what healthy habits look like during pregnancy, to teach them the early warning signs of possible problems and to quell myths and fears around childbirth. By tackling beliefs, behaviours and attitudes during pregnancy, therefore, we could potentially reduce the problems significantly, without having to go through the difficult, long and bureaucratically mired jungle gym of the Indian healthcare system.
This is a change that needs to be achieved with the mothers themselves. Maternal health outcomes in India, can be transformed, by shifting focus towards giving pregnant women the knowledge, the voice & the choices to impact their maternal health outcomes and experience positively.
A Challenged Healthcare System: The Mothers’ Perspective
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