Safe motherhood means ensuring that a woman receives the care she needs throughout pregnancy and childbirth. Ishita Malhotra does a reality check
Motherhood starts as early as when a woman conceives. She then enters that phase of life when she requires much affection and care, with every member of the family, especially the husband, pitching in. Yet life often doles out a very different set of experience for the mother. Gone are the days when a woman was relegated to the house and kitchen. Today men and women are equal partners at work, earning to run the house. Balancing home and office, pregnant women and young mothers bear a bigger brunt of responsibilities.
“Women, especially expecting mothers, need to have a support system provided by their families, so as to help them tackle with the pressure and accept the changes and demands of their bodies,” said Dr Bhavana Chaudhary, a maternity specialist at Max Hospital, Gurgaon.
“A mother goes through a lot of physiological, psychological and emotional changes apart from hormonal changes, for which she needs a lot of support from the spouse. A little help might just work wonders and sometimes acts as encouragement and raises confidence as well,” she said.
While government has set out several programmes to support expecting mothers, including increasing the maternity leave up to 26 weeks, most of them remain out of reach, especially in the rural areas. It is also no surprise that institutional child-birth, or birth in a hospital or medical centre, is fairly low in the rural and remote areas despite several incentives offered by government. Consequently, maternal mortality rates are also high, especially in these regions.
Nearly 45,000 mothers die due to causes related to childbirth every year in India which accounts for 17 per cent of such deaths globally, according to World Health Organisation (WHO). It said the major cause of maternal deaths is Post-Partum Haemorrhage (PPH), which is defined as the loss of more than 500-1,000 ml of blood within the first 24 hours following childbirth. The global health body has said 88-98 per cent of all maternal deaths could probably have been prevented with proper handling.
As part of their campaigns, several organisations have stressed on a woman’s right for safe abortions. Among the various rights enshrined in our Constitution for empowerment of women, is the right to abort that is covered under provisions to safeguard the health and dignity of a woman. Not many are aware of the existence of these laws, which anyway are poorly implemented. Women’s rights activists have also been clamouring for a woman to be allowed to decide whether or not to continue with a pregnancy. A woman’s health and the number of children she has are very strong factors in determining her right to safe abortion, which is often denied to her.
The government has supported expecting mothers by increasing maternity leave up to 26 weeks, thus allowing them to take care of themselves, including proper nutrition, health check-ups and exercise. Various programmes have been introduced too, such as regular exercise that helps in development of a healthy child and also prepares the mother for a normal delivery.
Dr Chaudhary also advises, “All young girls who have started their puberty, should take good care of themselves. Apart from healthy eating habits, it is very necessary to monitor menstrual cycles. Girls should get a health check up done every three months and in case they experience anything unusual like break-out of excessive acne, facial hair growth, blemishes and irregular cycles it is highly recommended to visit a family doctor or a gynaecologist. This could help them prevent any future complications or conception failures.”
Dr Mahima Bakshi, a maternity expert, model and actor, understands and explains very beautifully, the need for a mother to indulge herself in programmes that ensure good care of her and her child.
“Life is full of stress from work and relationships these days. To provide a child with a healthy environment is a very important task for parents and a woman must have a healthy body to give birth to a healthy child.” said Dr Bakshi, adding, “I would highly recommend young girls to pursue at least one sport so that they have a good metabolic rate and enough physical exercise thus preventing various diseases.”
There are numerous programmes that provide women and mothers extensive care under authorised supervision of certified doctors. One such programme, called Preggo, helps women tackle the gestation period through exercises that help one maintain the body hormones, release stress and ensure good health of the mother so that the pregnancy and delivery of the child is without any complications and the newborn baby is healthy.
“I understand how stressful lives have become,” noted Dr Bakshi.
“With chemicals found even in vegetables and fruits, the quality of food intake has declined. Diseases and complications in pregnant women are on the rise and have become very common these days. I believe in preventing rather than curing and hence, we have introduced this programme (Preggo), that provides mothers a healthy lifestyle, supervised by certified doctors. We also welcome mothers-in-law to be a part of the exercise session, which allows them as well to follow a fitness regime,” Dr Bakshi added.
Sometimes, pregnant women who do not want to continue their pregnancy visitunrecognized facilities seeking an abortion, which may not be successful. Women only come to know of this later when they suffer chronic ailments, conception failure, infections and/or, in the worst case, face life-threatening situations.
Studies carried out by Ipas Development Foundation point to the fact that close to 80% women in our country are not aware of the law in India – the Medical Termination of Pregnancy (MTP) Act, 1971 which allows for abortion for a broad range of conditions. Even though abortion has been legal in the country for over four decades, there is an urgent need for strengthening the implementation of the law for making abortion services available and for generating awareness about the same.
Above all, activists point out, a woman is the ultimate entity to decide, whether to continue her pregnancy or not. The reasons may vary from a health-related issue to a financial one, but a woman above the age of 18, according to the MTP Act, is allowed to consent to the termination of her pregnancy based on the four conditions – if the continuation of pregnancy is a risk to her physical and mental health; if the pregnancy is a result of rape or incest; if the foetus is expected to have severe abnormalities incompatible with life; or if the pregnancy is due to contraception failure (this clause applies only to married women). However, in case of a minor or a woman who is mentally ill, consent of a guardian is required for termination.
During pregnancy, a woman’s body transforms not just physically but also physiologically. Apart from these the mother goes through emotional stress wherein she feels delighted, anxious, exhilarated and exhausted ~ sometimes all at once. Regular or routine health checkups are advised. A healthy mother will give birth to a healthy child.
Postpartum depression usually manifests a few weeks after childbirth. The birth of a baby triggers numerous emotions in the mother, from zest and joy to fear and anxiety. Some may experience “postpartum baby blues” along with physiological and hormonal changes that last up to two weeks after delivery. When these blues, along with physiological symptoms, continue beyond two weeks and manifest in more severe signs, it usually requires medical help. The mother in such a case experiences severe mood swings and, in extreme cases, thoughts of harming oneself or the new born child. Freak cases where a depressed mother has killed her own child have been reported in the US and the UK. In India, such instances go unreported or misreported.
Many Indian families practise outdated post-delivery rituals and traditions. Some of them may do more harm than good to the mother. In many areas in the northern and western parts of India, for instance, the mother and baby stay isolated from the family and community for 40 days after delivery. While this may be done to protect them from infection, the effective isolation makes the mother lonesome and vulnerable.
According to WHO, maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Nearly five women die every hour in India from complications developed during childbirth, with heavy blood loss caused by haemorrhage being a major factor, WHO has said. Nearly 45,000 mothers die due to causes related to childbirth every year in India which accounts for 17 per cent of such deaths globally, according to the global health body.
The National Centre for Biotechnology Information (NCBI) presented an abstract on the causes of maternal mortality in India and strategies for reducing maternal mortality. An Indian hospital study found Maternal mortality rates (MMR) to be 4.21/1000 live births and that 50-98 per cent of maternal deaths are caused by direct obstetric causes. MMR in India has not declined significantly in the past 15 years. Effective strategies to reduce MMR are being demanded to assure every women the right to safe motherhood.
Happy and healthy
Lifestyle modification is the only thing that can help one lead a happy and healthy long life. Mandira Bedi in a recent Herbal Science Summit emphasised on the need for an exercise regimen and a balanced meal in one’s life. She said, “I am in my 40s and am experiencing motherhood. My child needs my attention and work, my presence. For me, meditation always acts as a way to peace and puts me off stress. I follow a very sustainable way of eating and avoid junk. During my pregnancy, I was 74 kg and now I’m back to 52 kg in exactly six months’ time. It was all because of healthy eating habits, a balanced biological clock and 4-5 hours of gym in a week.”
Dr Dolly Marya underlined the relevance of grandmother’s advice for nutrition. She explained how the variation in calorie and nutrient content in body can lead to disastrous psychological and physiological problems. Focusing on women’s health in all stages of life, especially motherhood, she says, “The intake of right herbs at the right time, can solve various chronic problems and, more than that, can reduce the probability of one to face it. Herbs like pepper, coriander, ginger, garlic, turmeric, to name a few, are what we normally find in the kitchen. Using them in appropriate quantities helps us heal ourselves and makes our immune system stronger.”