Violence in the labor room

Gurpiya Singh looks at the challenges of care structures for women and the difficulties they encounter on a daily basis in accessing the same

For Ramrati, a 29-year-old woman from Patna, recounting her experience of the institutional delivery of her first child was quite painful. She became pregnant two months after the start of her marriage. She took good care of herself and took all the prenatal medications and tests on time. But Ramrati vividly remembers the four nights she spent in the hospital. “For four days, I continued to scream in pain. The nurse sometimes cursed or made humiliating remarks, she said, “when you were intimate with your husband you didn’t feel the pain, you come here and you scream.” Sometimes they would continue to make comments based on caste / religion, or ask us to donate money for an operation. The doctor and the residents did a finger test, I would have the impression that I was not there for the delivery but for them to observe and learn about my body, ”Ramrati explained.

A report from the YP Foundation, a youth-led and managed organization based in New Delhi, notes a similar experience of a finger test that a young person had during a mystery audit at a community health center in Lucknow . There are many such cases reported by women, where pregnancy detection options are not offered, and practitioners without informed consent regularly perform bimanual (internal) pelvic exams to assess the uterus.

Even though the act had been committed in good faith – in the interest of the patient’s well-being and the time available – the practitioner did not find it necessary to clarify or obtain the patient’s informed consent, if she would be comfortable with such an invasive procedure going on her body.

This is just one example of the indignity that women regularly experience in the labor room. Violence in the labor room is not unheard of – it ranges from physical and verbal abuse, neglect of quality infrastructure, lack of consent or informed choice, and financial exploitation.

As part of the Khud Se Pooche campaign, a movement led by women in Bihar, supported by several organizations in Patna, including Sakhi, Bihar Youth for Child Rights, Gaurav Grameen Mahila Vikas Manch, Population Foundation of India and Center for Social Equity and Inclusion, to gain recognition for dignified health care among women, many women reflected on various health care experiences.

As part of the campaign, a number of women spoke about the extreme judgment and shame they experienced when entering a health facility due to delayed / missed / painful menstrual cycles. Instead of medical diagnosis and treatment, the women were asked personal, out of context and uncomfortable questions, such as if they had a boyfriend, or if they had any intimate relationships or relationships. Certainly, before being heard, some women were told that they must be pregnant. All of these responses made women feel raped. Those in pain have been told to learn to be resilient or that it will get better after marriage or after the first child. Their pain was dismissed and personal comments were made. In all of these experiences there is a look of suspicion and shame that the women feel, further traumatizing and silencing the patients. The hesitations and barriers that young unmarried women sometimes overcome to access health services interrupt women’s access to services.

Due to the stigma associated with sexual and reproductive health, from adolescence onwards, women are unable to voice or share their concerns, and there is a reluctance to discuss breast asymmetry, problems related to breast cancer, vaginal discharge, menstrual hygiene issues or general curiosity about the body and psychological changes. Lack of adequate and dignified access to sexual and reproductive health services, which is often accompanied by hesitation, stigma and shame, impacts women’s mental health.

According to the latest National Family Health Survey-5 (NFHS-5), quality of care is measured by whether users have been made aware of the side effects of the current method of family planning. For example, in Patna, only 46.4 percent of women were told about this, and only 18.6 percent of women who did not have access to family planning services received counseling about it. With less than half of women not being told about side effects, even fewer have received counseling, while myths and misconceptions about family planning remain common. With just a 2% drop in unmet need among women, unmet need of 15% is high, as women want to use contraceptives to delay the next birth. These three factors are related to the lack of proper counseling, which leads to abandonment and dissatisfaction in women.

The other major aspect of the indignity that women have also suffered is discrimination, differential treatment and prejudice in treatment on the basis of age, caste, social class, religion, abilities, sexuality, gender, occupation, education, appearances and ease of communication.

Many women felt raped or embarrassed by the way the doctor, attendant or nurse touched them – some felt they had been touched inappropriately but did not know to whom tell or to whom to contact. They all resorted to silence.

In most cases, the women did not know who to contact, how or to whom to explain these experiences, there is always a fear that they will be told, at home or in a dispensary, that they seek help. Be careful, whether they overreact or be frivolous. In a CEHAT report on mistreatment of women in labor rooms, in similar situations, doctors, nurses and orderlies mentioned that it was women who misunderstood the situation and that there is nothing sexual about the doctor’s actions. .

Many women did not think they could share these experiences with their families for fear that they would be told to dress properly, behave in a clinic, or be refused access to a clinic in the near future. to come up. The medical fraternity holds great power, where agency, bodily autonomy and integrity are compromised for treatment and care.

Healthcare professionals and experts note that doctors and medical staff are part of the same society that standardizes these practices every day and simply these are reflected in healthcare, due to the lack of training / awareness of health professionals.

During the Khud Se Pooche workshops, women suggest setting up feedback boxes, gender awareness and sensitivity training, ethics training, helplines, counseling sessions. mental health counseling or committees that can take note of these experiences and help navigate the situation.

While experiences of unworthiness in healthcare are universally understood, an individual’s personal circumstances impact their health and well-being. This was clearly visible in the campaign to which most of the above anecdotes are attributed, that factors such as the quality of housing, family structure, violence or conflict, working conditions, education, fashion of everyday life, gender or sexuality, caste, religion or class, has played a huge role in how women have navigated access to health care.

The World Health Organization (WHO) notes that addressing the social determinants of health in appropriate ways is critical to improving health and well-being. These include early childhood and development, education, income and employment, housing, work-life balance and conditions and privacy, violence, among others to ensure that women seeking care are not seen as a homogeneous group, and that root and underlying causes are taken into account, in the treatment process.

(The author is the campaign leader of Khud Se Pooche, a movement led by women in Bihar.)