Child birth

Childbirth practices in India are shaped by the prevalence of religious customs^[1] and joint-family living, India’s young average population, the lower national average age at marriage, and disparities in social status and literacy between men and women. Inadequate maternal health care services in India are a result of poor organization, the huge rural-urban divide, and large interstate disparities coupled with stringent social-economic and cultural constraints.^[2]

The joint-family system is one of the basic features of Hindu social organization. Therefore, since Hinduism is the primary practiced religion in India, the joint-family system constitutes the majority of family structures in India.^[3] The joint-family system is described as follows: “In structure, it comprises a married man, his father, his grandfather and his collaterals within three generations. The different kinsmen along with their spouses and children occupy the same dwelling, eat and worship together, and enjoy property in common. They cooperate in economic activity and, even if the members are differentiated occupationally, pool their earnings. The joint-family provides nursing care for the sick and afflicted, social security for the unemployed, and support for the aged”^[3] “They share the various routines, problems, and joys of social living, have strong feelings of mutual obligation during crises, and regard self-interest as being identical with family welfare. Their respect for the wisdom and justice of the eldest male permits him and his spouse to render decisions which affect each and every member of the unit”^[3]

“The median ages at marriage for women and men in Central India are slightly lower than the national averages. Early age at marriage is especially rampant in the villages, and among couples belonging to the Hindu and Buddhist faiths”.^[3] Moreover, the age at which males and females get married in India have remained constant for several decades. In the 1960s, it was reported that the median ages at marriage in India are 16.4 years for urban women, 14.6 years for rural women, 23.0 years for urban men, and 20.2 years for rural men.^[3]

The literacy rate in India has improved considerably over time. The rate has increased from 43.56 percent in 1981 to 52.11 percent in 1991.^[4] Literacy rates vary significantly among different regions of the nation. For example, the literacy rate is higher in south India than in the north. Also, a significant literacy gap exists between men and women. In 1991, the male literacy rate reached 62.86 percent and the female literacy rate was only 39.42 percent.^[4]

In preparing for birth, Indian women who live with their husbands generally seek counsel from their mothers-in-law. The advice of maternal figures is highly valued, and expectant mothers will follow the childbearing rituals passed down to them by their mother-in-law. Sleep positions, eating habits, and level of activity are all influenced by the views of older women of the family. Aside from what is told to them, women receive very little knowledge regarding birth itself. Often, women are very fearful for their birth, as they have only been told of the pain from others.^[6]

The maternal figures of the family, especially the mothers-in-law, pass on customs regarding nutrition, hygiene, and daily activities during pregnancy. Frequently, “cold” foods such as fruit are avoided during pregnancy for fear of causing sickness or stillbirth. In some traditions, women may only drink hot tea and rice milk.^[6]

The older women of the family determine each expectant mother’s activity level and sleep habits, following family tradition. Some women are told to increase their activity levels in order to prepare the body for the hard work of labor, while other rest throughout pregnancy to save energy. Sleeping may also be regulated, and some women never sleep on their back or turn over during pregnancy.^[6]

Pain is expected during labor and is seen as part of the natural labor process. There is little knowledge about options such as epidurals in some communities.^[7] Depending on birth location, some women receive pain relief from warm water and massage, while other receive little support or even human touch. In hospital births, private hospitals have a higher rate of pain relief. One study found the rate for private hospitals to be 9.9 percent while the public hospitals had a rate of 0.9 percent.^[8]

During labour, the mother and child both need adequate monitoring. Inadequate monitoring during labour can increase the chances of the baby going into distress which can potentially lead to the death of child before birth. It is also known as stillbirth. It is an unfortunate scenario that the largest number of stillbirths, more than 330,000 every year, happen only in India.^[9]

Female relatives and neighbors may support the mother by serving tea, heating water, and helping with wrapping the newborn after birth.^[10]

Birth location often determines the amount and type of supportive behavior. Women who give birth in hospitals are generally supported by nurses, although the extent of this support varies. Some express dissatisfaction with the lack of physical touch and comfort in the hospital. At home, women are supported by the “wise women” of the family with massage and warm water, although this also varies by family.^[6]

On average, 83.1 percent of births are attended by skilled health personnel. However, this varies greatly by region. Traditional birth assistants (TBAs) attend 37 percent of home births in India. These TBAs often lack knowledge and literacy regarding safe birthing practices, but could have a large influence in reducing maternal mortality if properly trained. If educated properly on birthing positions, sanitary practices, weighing of the baby, maintaining adequate newborn body temperature, and handling postpartum hemorrhage, maternal and infant health in India could improve dramatically.^[11] The other 63 percent of home births are unattended, and women who deliver in a health facility or hospital are cared for by nurses and doctors.

The majority of TBAs, who attend 37 percent of home births in India, are married and have not been to school. They may be trained or untrained, but the trained TBAs are generally younger with less work experience, and are paid for their services. The untrained TBAs are older, more experienced, and are generally unpaid.^[11] Most TBAs entered the field after either attending several family births, birthing their own child, or following the footsteps of a family member.

Some women experience disrespect by hospital staff during childbirth.^[12]

After the placenta is delivered, the cord is cut and an herbal oil, face powder, or ash mixture is rubbed on the cut section. The placenta is buried near the home, or in some communities burned. Nine days after birth, a ceremony is conducted at the placental burial site to announce the name of the baby.^[6] At home births, the baby is sometimes not caught after being delivered and remains lying on the floor until the placenta is delivered.^[10]

The cesarean section rate in India was 8.2 percent in 2008, which is below the WHO’s recommended 10-15 percent. However, this number is higher in some private hospitals. The use of interventions such as episiotomies, induction, and cesarean section varies between private and public hospitals. A study of women in Delhi found that the cesarean rate in private hospitals was 53.8 percent while the rate at public hospitals was 23.7 percent. The same study reported that the episiotomy rate in private hospitals was 74.9 percent compared to the public hospital rate of 57.8 percent. The rates of induction of labor were found to be 30.8 percent and 20.6 percent.^[8]

Female and male relationships