Financial constraints and rise in caesarean deliveries push poor women in Delhi to give birth at home

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Intifada P Basheer-

A tiny maternity clinic in Zakir Nagar, is packed with women. With all the waiting chairs occupied, the
men accompanying the women, stand up and make space for other women. One of them, Poonam
Gujjar, is talking with the receptionist after her appointment with the local gynecologist. Gujjar is
currently six months pregnant with her second child. Coming all the way from Govind Puri, Gujjar
prefers to have her checkup here in this clinic instead of going to any government or private hospital.
Her reason- the doctor here promises a normal delivery just like she did with Gujjar’s first daughter.
“I went to a hospital for my first delivery, but in the beginning itself, that doctor was like you have this
problem, that problem etc. Even if I had a swelling in my leg, she used to exaggerate it. She said it will
have to be a cesarean delivery”, says Gujjar.

She also says that it came to a point where they started troubling her with what kind of room she would
take, a deluxe room or a normal room and so on, when all she wanted was to deliver her baby. “I
couldn’t afford all that. That’s why I left that hospital and came to this clinic here. My daughter was born
through a normal delivery”, says Gujjar.

However, not all women are as lucky as Gujjar. The rise in cesarean deliveries in India is tremendous.
According to the fourth National Family Health Survey (2015-2016), 17.2% of registered births in India,
took place through cesarean section. This is twice compared to the previous National Family Health
Survey (2005-2006), where the percentage was almost half at 8.5%.

Even though the numbers are higher in urban areas than compared to rural areas, it is the poor who are
getting more affected. While under the Janani Shishu Suraksha Karyakaram scheme, a normal delivery
or a cesarean delivery has to be free of cost in government hospitals throughout India, the NITI Ayog’s
Healthy States Progressive Report tells another story. The out of pocket expenditure per delivery in a
public health facility in the national capital costs 8719 rupees. And so, unable to afford such exorbitant
prices, these days many women are going back to home deliveries.
For instance, Neetu Devi (30), a household cleaner says that she gave birth to all her three children at
home. “We are poor and we were scared of going to the hospital. In the hospitals they just end up
operating on you. There’s also the risk of children getting switched, so that’s why we chose to have our
children delivered in our home itself, with the help of a dai (midwife). They were all born sound and
healthy and did not fall prey to any disease as soon as they were born.” Neetu says its common in
households like hers for women to deliver at home without going to a hospital. “Even my elder sister
Mala (35) and my sister-in- law gave birth to all their children at home through a midwife”, she says.
Also, it is interesting to note that, despite daily advancement in technology, more and more women are
preferring to deliver their children, the old way, i.e. at home. Renu (40), who has been working as a
midwife for the past 15 years says that there has been a steady rise in people opting to deliver at home.

 

“These days the doctors charge for everything. Right from taking a scan to see if the child is in the
correct position or not, to delivering the child. Those who have money they can afford all this, those
“who don’t, they prefer to deliver at home”, she says. “I have delivered 20-25 children in the last 15
years, and all of them were born healthy”, she says.

However, not all such home deliveries are safe or successful.Slutana Begum, who also chose to deliver at home lost her son in 2005. While her first two children were born and delivered safely by a midwife, her third child died soon after being born. “Everyone at our place delivered at home and so did I, but something went wrong and my son died within a week after he was born”, she says. Such tragedies are bound to occur while giving birth at home, claims gynecologist, Dr. Charu Latha.

“Many problems and complications can arise both in the mother as well as the child. Fetal problems like
malformation in the babies and big size babies can occur while the mother may miss out on being
diagnosed for anemia, pre-eclampsia and diabetes. Even multiple pregnancies and various conditions of
the heart could be missed,” she says.

With the persisting exorbitantly high out of pocket expenditure figures in public health facilities, and the
outrageous cost of delivering a child in private hospitals, one can expect this trend of the poor reverting
to delivering at home to continue.

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