After learning about the different types of birthing rituals all over the world in week three, I became interested in the maternal mortality rates in different third world countries, based upon these birthing practices. Due to my familial roots in India and as a country with very high maternal mortality rates, I decided it would be appropriate to focus on this country for the semester. First, I wanted to focus on traditional India birthing practices and how or if these have been improved since previous decades. Moreover, after doing some initial research on the subject, I came across the fact that most maternal deaths in India could have been prevented by fixing the disparities between men and women in this country and educating women on sexual and reproductive health. In fact, the World Health Organization (WHO) reported that about 88-98% of the maternal deaths that occur could have been prevented with proper care and handling during the delivery process (Prakash, Swain, and Seth, 1991). Prakash, Swain, and Seth (1991) also believed that an effective strategy to reduce maternal mortality rates was to educate young girls on reproductive health and safe sexual practices. Women understand their own body and how it works and by being properly educated, they will finally be able to prioritize themselves by taking care of a female health issue rather than being the caregivers for mixed gendered diseases. I also decided to look at how different regions, in terms of poverty levels, in India fared when it came to maternal mortality, which is why I used the critical medical anthropological approach to understand this health issue better.
According to the material from week one, the critical anthropological approach describes that people with political, economic, and social power within a country can make important decisions that make a situation for different groups of people in that same country better or worse (Critical Medical Anthropological Theory, 2019). For example, a policy legalizing marriage for same sex couples would make people who identify as LGBTQ better off, but would not necessarily impact the lives of people within a different social group or with a different identity. This theory also shows how inequalities can be formed for different groups of people by a different number of these social, political, or behavioral factors (Singer and Erickson, 2011). Moreover, critical medical anthropologists asks questions about the people that benefit and the people that suffer based on these new policies being created (Critical Medical Anthropological Theory, 2019). For example, they discuss why some people in one area are dying more from a certain disease than people that live in a different areas; they discuss what social, political, and economic factors affect why these people are dying more than others. In terms of maternal mortality, they would definitely be interested in why that rates of death for mothers in rural areas of India were a lot higher than the deaths of mothers who lived in urban areas. Additionally, the critical medical anthropological theory states that policies can put people at risk, create political disparities, create an environment that emphasizes healthy living conditions, and allows harmful products to enter the city or country (Singer and Erickson, 2011).
Critical medical anthropology really focuses on the social aspect of different ideas. For example, Carroll (2014) wrote about structural violence and how it pertains to the critical medical anthropology theory in their article. They discussed how structural violence helps trace the social causes of a certain disease and that together societal arrangements of power and property and constraints and possibilities of our biology, based on our evolutionary history, form inequalities in society (Carroll, 2014). In other words, this can explain the fact that there are poorer health outcomes for those living in poverty and for people who live in different regions of the world. In fact, Kumar (2010) found that 80% of deaths during pregnancy occurred in families who lived in poverty and 61% of mothers that died were in the lower caste in society. Additionally, mothers in the lowest socioeconomic class were about two and a half times more likely to die during pregnancy than mothers in the higher classes (UNICEF). This can be accounted for by the fact that the amount of skilled attendants at birth in rural areas in India is about 43.3%, while the amount of skilled attendants at birth for urban areas is about 75.6% (UNICEF). Moreover, according to UNICEF, the maternal mortality ratio in India is about 210, while the maternal mortality ratio in the United States was only about 12.7. The difference in these numbers supports the fact that maternal mortality is an issue that reinforces inequality for those with a lower income status. Therefore, this can be applied to the critical medical anthropological theory because it supports how maternal mortality and the government’s policies regarding it can affect people in different social and economic groups.
One of the biggest reasons why rural maternal mortality rates are so much higher than urban maternal mortality rates is because there are more pregnancy in rural areas follows more traditional practices. In traditional Hindi practices, no one is allowed to accompany the woman when she is giving birth because there is a belief about the filthiness of the delivery process (English and Punjabi, n.d.). Additionally, the period of isolation lasts past the date of delivery up to about 40 days, depending on the region of India. This isolation stems from traditional Hindi culture in which the baby and mother are vulnerable to evil spirits and diseases directly after birth and must be kept in isolation for protection (English and Punjabi, n.d.). Moreover, another traditional belief about pregnancy in India is that it is a natural phenomenon and rarely requires hospital intervention (Punjabi and English, n.d.). This belief has also been reinforced by the fact that pregnant women in India are often treated very poorly, from the medical staff disregarding the patient’s privacy to using unsanitary techniques, which is why most women in rural areas feel more comfortable giving birth at home. There is also delay in the public health system that has been linked to women who die in childbirth. This delay occurs when a women is at a healthcare facility and is unable to been seen by a medical professional immediately (Kumar, 2010). For example, the time taken to receive transport to a hospital in some rural areas of India was about 4-5 hours, but a women who has a postpartum hemorrhage would only survive for 2 hours (Kumar, 2010). To try and compensate for these beliefs, India’s government is trying to do to reduce the mortality rate of women in childbirth is to reduce the number of home births in the country (Weber-Steinhaus and Wadhawan, 2019). Therefore, women living in poverty in India are now being given money as an incentive to give birth in a hospital, which may decrease maternal deaths in rural areas (Weber-Steinhaus and Wadhawan, 2019).
From a historical and cultural standpoint, maternal mortality in India is very important to address because of the many different inequalities for women exist in this country and how eliminating these inequalities can easily prevent the drastic mortality rates. While the Indian education system for doctors has the opportunity to focus can on prenatal and postnatal care for women, their resources are spent on other things that do not have to do with women health issues at all. Moreover, many large scale observation studies to are not often spent on antenatal, natal, and postnatal care in India to assess the quality of care in this area of medicine (Kumar, 2010). Additionally, there should be education to women on the use of contraceptives and practicing safe sexual and reproductive health. Education of women on the use of contraceptives and safe reproductive practices is crucial in eliminating a lot of maternal deaths in India. Goldie, Sweet, Carvalho, Natchu, and Hu (2010) found that by educating women on the topic of safe family planning and control of fertility choices would be as cost effective child immunizations in the United States. Moreover, with these changes, more than 150,000 maternal deaths would be avoided through the use of safe sexual practices in just five years. Critical medical anthropology think this theory works perfectly for maternal mortality in India because critical medical anthropology discusses the power differential between those who make the policy and those who live it (Horton, Abadía, Mulligan, and Thompson, 2014). For example, of India’s 48% female population, only 12% hold a seat in the national legislature (Bellinger, 2019). Therefore, due to the lack of women representatives in the Indian government, there are not very good policies or regulations in place for women giving birth. By giving the power to women by educating them, the maternal mortality rates in India can significantly decrease.
While there is still much that can be done to educate women and make resources available to all socioeconomic classes in India, overall the country has made progress for maternal deaths. For example, in 1990, India had an estimated maternal mortality rate of 437 deaths per 100,000 live births and a rate of 212 from the years 2007 to 2009, which is an overall decrease of 51% (Shrotri, 2014). It was found that these trends were on par with deliveries by skilled personnel, which increased from 33% to 53% in those same time periods (Shrotri, 2014). Additionally, the government is setting up a program in which health care facilities will provide essential obstetric care to all pregnant women. In this program, there will be early administration in the first trimester of pregnancy and a minimum of four antenatal checkups will be provided for the mothers. In these checkups, prophylaxis and therapy for nutritional deficiency anemia, immunization against tetanus, tracking of severely anemic women for special care, detection and treatment of hypertension and preeclampsia are being provided (Shrotri, 2014). Moreover, all of the community health centers and primary health centers will be able to provide delivery services at every hour and there will be skilled birth attendance for each delivery (Shrotri, 2014). Finally, the government wants to have a training program on basic emergency obstetric care for midwives and doctors(Shrotri, 2014). Despite all of these efforts, communities still need to come together to follow these procedures in order for them to work and for every mother’s life to be saved.
In conclusion, I got to learn a lot about the culture and health care system in India and how it can be improved to decrease maternal mortality rates throughout the country. I discovered plenty of information on the traditional birthing ideologies of Hindi culture and that some rural regions in India still use these practices, which may be why the maternal mortality rates in these areas is higher than in others. I also figured out that women are not being educated properly on safe sexual and reproductive health strategies and that this may be because there are not enough women with roles in leadership in India. Additionally, I learned that the critical medical anthropological theory was an acceptable principle to use because maternal mortality deals with how different people with political, social, or economic power create policies regarding the subject affect different groups of people. For example, because there are not enough women with roles of leadership in India, this may be contributing to not as many policies to try and fix female-related problems in society. Most importantly I got to learn more about the place that my family came from this semester and how this problem could have impacted my family members. My aunt was actually born in India and the fact that maternal mortality rates were so high when she was born could have meant that my grandmother could have died while going into labor with her. This would have been very unfortunate for me because my mom was born after my aunt in the United States. Therefore, I am thankful that it all worked out for my family and I really hope that more mothers in India can have just as successful births as my grandmother did.
Works Cited
Bellinger, N. (2019). India has a sexual assault problem that only women can fix. Retrieved from https://theconversation.com/india-has-a-sexual-assault-problem-that-only-women-can-fix-101366
Carroll, J. J. (2014). Key theories from critical medical anthropology for public health research. part II: Medicine in the social system, medicine as a social system.Tobacco Control and Public Health in Eastern Europe, 4(1), 41-48. doi:10.6084/m9.figshare.1041599
English, H., & Punjabi, T. (n.d.). INDIAN ETHNICITY AND BACKGROUND Communication.
Goldie, S. J., Sweet, S., Carvalho, N., Natchu, U. C. M., & Hu, D. (2010). Alternative strategies to reduce maternal mortality in india: A cost-effectiveness analysis.PLoS Medicine, 7(4), e1000264-e1000264. doi:10.1371/journal.pmed.1000264
Horton, S., Abadía, C., Mulligan, J., & Thompson, J. J. (2014). Critical anthropology of global health “takes a stand” statement: A critical medical anthropological approach to the U.S.’s affordable care act.Medical Anthropology Quarterly, 28(1), 1-22. doi:10.1111/maq.12065
Introducing Theory 3: Critical Medical Anthropological Theory. (2019, May 23). Retrieved from http://anthropology.msu.edu/anp270-us19/lecture-videos/critical-medical-anthropological-theory/
Kumar, S. (2010). Reducing maternal mortality in India: Policy, equity, and quality issues. Indian Journal of Public Health, 54(2), 57.
Maternal Health. (n.d.). Retrieved from http://unicef.in/whatwedo/1/maternal-health
Prakash, A., Swain, S., & Seth, A. (1991). Maternal mortality in India: Current status and strategies for reduction. Indian Pediatrics, 28(12), 1395-1400.
Shrotri, A. (2014). Towards reducing maternal mortality in india.Journal of Krishna Institute of Medical Sciences University, 3(1), 1-5.
Singer, M., & Erickson, P. I. (2011). A companion to medical anthropology. Chichester, West Sussex: Wiley-Blackwell.
Weber-Steinhaus, F., & Wadhawan, J. (2019). Giving Birth in India: ‘The Women Here Are Afraid’ – SPIEGEL ONLINE – International. Retrieved from https://www.spiegel.de/international/globalsocieties/india-turning-toward-midwives-to-reduce-maternal-mortality-a-1265427.html