Twenty-four-year-old Hannath died at her house in Malappuram’s Manjeri on August 4, while giving birth to her baby. Her delivery was handled by a midwife, locally known as ‘othachi’. According to media reports, Hannath’s husband, Muhammed Yunus had allegedly refused to take her to a hospital on religious grounds.
Speaking to TNM, District Medical Officer (DMO) Dr K Sakeena said that Hannath’s death was due to the negligence of her family and their orthodox beliefs.
“The incident happened in Payyanad, an area where deliveries by midwives are very popular. Health officials visit pregnant woman regularly and impart awareness on consulting a doctor. Officials did meet this woman and requested her to have a hospital delivery but they did not listen,” she says.
Following Hannath’s death, Dr Sakeena says that the Health Department had taken the midwife’s statement. Dr Sakeena alleges that Hannath died due to excessive bleeding following an error by the midwife. The placenta, she alleges, did not come out, which led to complications. “But when we asked the midwife, she said she had decades of experience and had not made any mistakes,” said the DTO. She, however, admits that authorities can’t take any legal action for the death and can only provide awareness about the risks involved in home births.
Hannath is the second mother to die in Malappuram district between April to August 2017, according to official records from the Health Department. While the last four months have seen 72 home births in Malappuram district alone, official stats reveal that there were 208 cases of home births between April 2016 to March 2017. On an average, the DMO says that two to three women died from such deliveries every year.
So, why is Malappuram seeing an increase in home births, despite the risks? The two major factors are religious and a movement against child births in hospitals.
Religious reasons
Religious reasons play a major factor for families to opt for home births. Some orthodox Muslim families believe revealing one’s nudity to a doctor even at the time of delivery is wrong. They believe that a woman cannot reveal herself to anyone except her husband.
In her Facebook post published on August 21, Dr Shimna Azeez, a doctor from Malappuram laments about how many Muslim women still continue to undergo home deliveries because of religious reasons. In her post that has since gone viral, Dr Shimna says that during the time of childbirth, it was not a woman's nudity that a doctor would see, but a mother who is giving birth to a child. She notes, it is not the woman's organ that a doctor- be a man or a woman- would see, but the doctor's efforts will be to keep both the mother and the child safe.
Explaining why many Muslim families opt for home birth, Dr Shimna tells TNM, "The frequency or popularity of home delivery among Muslims is not increasing per se. What is happening is that there is a section of families who have been practicing it and are unable or not willing to think beyond it. It is not that they are stubborn, but for them, it is part of a belief they have been practicing for ages. And deviating from it for them is a sin."
The doctor from Malappuram also suggests that choice for home births also stems from a lack of trust with modern medicine. Dr Shimna says, “As far as Muslims are concerned, they have always been resistant to anything English, say English education or modern medicine. The choice of home delivery for them, is because they don't trust or believe in modern medicine. Then, there is this belief that a woman's naked body shouldn't be seen by a man other than her husband. This is one reason women opt for home deliveries.” She adds that those who opt for home deliveries are usually vulnerable, gullible and ordinary people.
Dr Shimna, however, admits that it is extremely challenging to reach out to conservative Muslim families and educate them about seeking help. She argues that health volunteers on the ground are often met with resistance.
“In one way, it is also our fault, since doctors in government hospitals just don’t get the time to talk in detail and convince a woman that she should not opt for a home delivery. Common people go to government hospitals and the doctors are helpless and can't talk to them in detail due to time constraints,” she says. Dr Shimna also notes that the cost of medical care at private hospitals is also another factor for many families choosing home births with untrained midwives.
Movement against child births in hospitals
But DMO Dr Sakeena points out that religion is not the only reason women opt for such home births.
“There is a huge parallel campaign taking places across Kerala against child births in hospitals. This is similar to the anti-vaccination campaign,” the medical officer claims.
“There are campaigns spreading messages claiming that doctors will go for caesareans even if it was not necessary. They also cite a number of health hazards to convince people against institutional births,” says the DMO. And while she says that health officials do go from house-to-house to spread awareness, the campaign against modern medicine is gaining attention with messages often going viral on social media.
The DMO notes that the stigma against institutional delivery is gaining popularity in north Kerala and it was not just in Malappuram.
Another reason why home births are becoming popular is because families are choosing naturopathy, an alternative medicine that prides itself in being “non-invasive”, and “natural”.
But while many are now opting for water birth, deliveries at home using midwives, Dr Sakeena draws attention to several risks that these new choices pose. “Who will ensure the security and hygiene here? What will happen if the mother has got excess bleeding?” asks Dr Sakeena.
Dr Shimna also raises questions about the risks involved in naturopathy, stating, "While naturopathy is being promoted and is definitely gaining popularity, what we are not talking about, is the risks involved in them. For instance, in this (Hannath) case, when the placenta doesn't come out, it could be fatal to the mother.”
It’s not just Muslim families, who are opting for naturopathy during child birth, with Dr Shimna pointing out that people from different religions, and educational backgrounds choosing this alternate medicine.
But a few mothers, who opted for naturopathy during child birth explain that their rationale for choosing such a home birth was due to the higher maternal mortality rate at hospitals.
Soniya* a 26-year-old woman, who opted for a water birth at an institution in Kochi says, “My child and I are healthy, I did not have unnecessary medicines or injections. Hundreds of people opt for this kind of delivery at the centre. I have heard that many women face complex health problems after getting delivered in hospitals, but I was felling perfectly fine. Also, the pain was not unbearable during delivery. Moreover, how many women die during child birth in hospitals, how can they explain that?”
Twenty-eight-year-old Rekha*, who opted for a home birth with a 73-year-old mid-wife in Kannur district says, “She has been a Vayattatti (mid-wife) for the last 50 years, and in very few cases the mother or the child have lost their life. If it were in hospital, the number would have been more. I felt that she was very much experienced and I felt more comfortable with her than at the hospital. Above all I had a normal delivery. Though I had some complications, I believe that it was because of her ability. I just had some Ayurveda medicines instead of allopathic tablets.”