The Embarassing state of Kerala’s maternal health care: effect of the Kerala model


Health system in India has seen several incongruities since its independence. Public health expenditure, inspite of repeated promises in election manifestos as well as in policy documents towards raising it to 2.5 to 3 % of GDP, remains around 1 to 2 %. The the existing health care infrastructure is flawed and inadequate; the hospitals are under-staffed, under-financed compelling the rural population to visit private medical practitioners and hospitals.

India has one of the highest numbers of women dying in childbirth and under five mortality rates. Women’s human rights needs are at its crest around pregnancy and labor. Examinations, intercessions and systems that stance dangers to both the mother and child are routinely performed without informed consent, or through forced consistence by means of dangers or dread. The significant obstructions women experience is chartered across contraception, legal and safe abortion, obstetric violence, maternal mortality, assisted reproduction, and balancing work and reproductive life.

Obstetric violence/ Labour room bullying falls under the bigger ambit of violence against women, which itself is a public health concern. A vast segment of women that face obstetric violence have a place with poor economic conditions. They have to resort to public facilities for birth and expect such behavior, and therefore do not think it is abnormal, illegal or ethically wrong. But this normalization is an unacceptable reality that needs to enter the larger discourse.

Labour room bullying in Kerala

Labour room abuse has turned shockingly common in the Indian medical system. The horrifying reports from labour rooms in Kerala started attaining media attention recently. In Government hospital a nurse gagged woman in labour pain and showered abuses for not paying the demanded money.

A mother of two, narrated her painful childbirth experiences from a Medical College,

“Labour room resembles a jail’ – the nurses and even the sweepers consider it as their domain and behaves in such inhumane ways to every woman. The repeated pervaginal examination multiple times by umpteen numbers of medical students in the labour room was the worst pain of all”. For Remya, a native of Kottayam district had to to share her bed with another woman as there was not enough beds for all.

One doctor doing her P.G. in forensic medicine at a Medical College narrated the ‘sadistic relief’ that nurses enjoy in delivery rooms.  When a thirteen year old pregnant child was brought into the labour room, she was laughed at her skills of early pregnancy. In a similar case, when a child was brought to hospital by her parents for abortion, the health workers cooked up a story of the girl’s father molesting her.

The experience of a senior nurse from Govt. medical college, Thiruvananthapuram was quite astonishing. “I have worked in both government and private hospitals. This is quite common in delivery rooms. These ladies are pampered too much at home. If we try to comfort them, they won’t push well. Ceasarean would be the only option left then. They won’t have any strength left if they keep on crying. I have even attended hundred deliveries a day. The mental agony and tensions of each nurse inside the delivery room is way too much you can handle. When we lose control, shouting at them is the last resort”.

The abuses and and yelling are much severe if the woman looks pathetic and dark skinned. This disposition makes it troublesome for ladies to feel safe about their own wellbeing and strength of their kids with such sort of staff.

Experiences of women from a Taluk hospital reveals the innumerous caesarean deliveries. The doctor never waits for normal delivery and writes for caesarean. About five thousand rupees beforehand is given to doctor the day before delivery so the lady receives proper care.

The unfortunate outcomes of this denial of access to good quality medical care and the inhumane treatment are severe psychological distress, trauma and sometimes death from negligence. The psychiatric problems women face during their postpartum period are isolated into three classes: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. When women come out of childbirth with postpartum post-traumatic stress disorder (PTSD) from disrespect, abuse, or obstetric violence, the goal of a “healthy mother and healthy baby” has not been met.

Women in Kerala encounter higher degrees of mental pressure and tension and lower mental prosperity contrasted with men. The deep rooted patriarchal values that form the bed rock of Kerala have failed to cater to the hopes and aspirations of its educated soaring women.  There is likewise an expanding pattern in suicides among females between the ages 15-29 years. Lifestyle changes and job related concerns have brought about a spike in gynecological issues among women in Kerala. Gestational diabetes, endometriosis has gone up extensively. The instances of uterine fibroid are likewise high, incidentally as a result of the achievement in family planning. At the point when the number of childbirths descends, instances of fibroid, or non-dangerous tumor, go up. Absence of legitimate obstetric and midwifery care in public hospitals prompted the multiplication and reliance of everyday citizens towards private health areas in Kerala.

Different other research studies likewise have demonstrated that the mind-boggling expense of treatment and out-of pocket consumption in Kerala has added to individuals falling underneath the poverty line. Even though the public healthcare is free and done by experts, women prefer private hospitals due to issues such as lack of privacy while consulting the gyanecologist, status problems and obstetric violence.

Modernized and healthy maternity wards, proper sanitation facilities,adequate number of health workers, gender sensitizing programme specially targeting men and policy makers, strict implementation of labour room protocols, Informing and interpreting health information with gender perspective are the basic elements the government has to address. Women’s care is the responsibility of society. All things considered, “A woman’s health and wellbeing is a nation’s wealth”.

Bulbul Prakash, M.A Politics and International Relations, Mahatma Gandhi University, Kottayam

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