Ala Hospital, 4-15-19/10, 5 lane Bharathpet, Amaravathi Road, Guntur 522002, Andhra Pradesh, IndiaIndia
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The practice of obstetrics and gynaecology (OB/GYN) has historically been dominated by men and was brought into existence as a replacement for midwifery, a woman-centered model of care, by women, which was deemed unscientific. Instead of improving on this model, they built their own as they considered women weak, naïve, and irrational to understand the ‘complex science’.
OpenJournal PUBLISHERS Editorial Pitfalls of Sexual and Reproductive Healthcare of Women in India * Srivarsha Ala, MBBS* th Ala Hospital, 4-15-19/10, 5th lane Bharathpet, Amaravathi Road, Guntur 522002, Andhra Pradesh, India * *Corresponding author Srivarsha Ala, MBBS th Assistant Doctor, Ala Hospital, 4-15-19/10,5th Lane Bharathpet, Amaravathi Road, Guntur 522002, Andhra Pradesh, India; E-mail: varshaalaxz@gmail.com Article information th th th th Received: June 15 , 2022; Revised: July 11 , 2022; Accepted: July 19 , 2022; Published: July 19 , 2022 Cite this article Ala S. Pitfalls of sexual and reproductive healthcare of women in India. Gynecol Obstet Res Open J. 2022; 8(1): e1-e3. doi: 10.17140/GOROJ-8-e007 he practice of obstetrics and gynaecology (OB/GYN) has Accessing abortion as an unmarried woman is a night- historically been dominated by men and was brought into ex- mare in India. In most hospitals, she is asked to bring along her T istence as a replacement for midwifery, a woman-centered model parents despite not being a minor. In government hospitals, ob- of care, by women, which was deemed unscientific. Instead of stetricians performed dilatation and curettage (D&C) without an- improving on this model, they built their own as they considered esthesia as a form of punishment.9 When asked about their ex- women weak, naïve, and irrational to understand the ‘complex sci- periences with obstetrical care, pregnant women with disabilities ence’.1 They called midwifery unscientific while conducting unethi- reported that they were asked why they had sex in the first place, cal experiments on enslaved women without anaesthesia and prac- were denied an intrauterine device (IUD) unfairly, and were ver- ticing eugenics.2 The practice has deep patriarchal origins. They bally abused.10 viewed woman as a machine to be repaired. Over time, women started to re-enter the field only to work in the same technocratic It does not get any easier for a married, abled woman. 3-5 and misogynistic model.3-5 The husband speaks over her during the appointments about her concerns. Obstetrical care, instead of advocating for the patient, Looking at the current practice of OB/GYN in India, is depriving her of dignity and privacy, particularly in a teaching not much has improved and it remains the same for women of hospital where women of lower-income and marginalized com- 6 11 marginalized communities. The quality of care remains poor.6 The munities seek care.11 Obstetric violence is routinely seen there. The increasing number of women in OB/GYN is not helping in im- doctors do not explain most procedures or obtain consent before proving the treatment of female patients proportionately. Women conducting them. Every medical student is free to insert his or her face many barriers in accessing healthcare. When they finally do get fingers into her privates to check for dilatation of her cervix. They 7,8 access to it, their right to health is being denied (Table 1).7,8 are sometimes examined without the blinds drawn. The patients are yelled at and beaten for not pushing hard enough in the labour 7,8,12
Non-dignified Care cleaned after surgery, naked, without proper covering. Studies have Shouting/scolding from staff 36 43.4 shown how obstetrical abuse derails a woman’s psychological, Threat to withhold treatment during childbirth 34 41.0 13 7 physical and socioeconomic health. Acharya et al conducted a Discriminatory racial commnets 73 88.0 study in the Bargarh and Sambalpur districts of Odisha, India to Refusing of providing medicine 49 59.0 determine the extent of obstetric violence in India. They classified Waiting for a longtime to get medical care 53 64.0 it and assessed how it impacts the lives of women who experienced Physical Abuses it. Following is the table from the study detailing the various kinds Hitting, slapping, pinching and pushing from staff 23 28.0 of obstetric violence and the number of women who experienced Inappropriate physical touches 31 37.3 it.
Forcefully pressed abdomen 34 41.0 Forceful vaginal examination 11 13.2 Rape is significantly underreported and those who mus- Sexual abuse 07 8.4 ter the strength to report it experience humiliation from healthcare workers. They are subjected to invasive, unnecessary swab collec- cc Copyright 2022 by Ala S. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows Gynecol Obstet Res Open J. 2022 8(1): e1-e3. doi: 10.17140/GOROJ-8-e007 tion, questions on their previous sexual experiences and the valid- 2. Sowemimo A. The racist and unethical origins of modern Gy- ity of their claim. The ‘two-finger test’, a barbaric method, is used necology. How the past affects present day obstetrics. Clue. 2021. to gauge if the person has had sex in the past. Despite the health Website. https://helloclue.com/articles/culture/the-racist-and- ministry’s guidelines being direct about not commenting on sexual unethical-origins-of-modern-gynecology. Accessed June 10, 2022. history, the officials in many states still document it.14 Trauma-in- formed care is unheard of at most hospitals.15 There is minimal 3. Academics call for greater research into Endometriosis and the literature on intimate partner violence (IPV) in Indian medical edu- treatments available to patients. University news. Birmingham city cation. Post-coital tears are only treated with the husband’s con- University. 2017. Website. https://www.bcu.ac.uk/news-events/ sent. In a country where marital rape is not yet criminalized, OB/ news/academics-call-for-greater-research-into-endometriosis-and- GYN care, instead of helping the victim, is enabling the abuser. the-treatments-available-to-patients#. Accessed June 10, 2022. Though women who can afford private healthcare are 4. Seegert L. Women more often misdiagnosed because of gaps in not traumatized to the same level as those who cannot, it is not trust and knowledge. Association of healthcare journalists. 2018. a cakewalk for them either. Many women have expressed on so- Website. https://healthjournalism.org/blog/2018/11/women- cial media under the hashtag #obgyntales, how they were body- more-often-misdiagnosed-because-of-gaps-in-trust-and-knowl- shamed for being overweight and how gynecological care made edge/. Accessed June 10, 2022.
them feel invalidated, how every problem they had was attributed to their weight and that their concerns were only addressed if they 5. Kiesel L. Women and pain: Disparities in experience and treat- were related to child bearing.16 One in every five adolescent girls ment. Harvard health publishing. 2017. Website. https://www. in India suffers from polycystic ovarian syndrome (PCOS).17 Ado- health.harvard.edu/blog/women-and-pain-disparities-in-experi- lescents are highly impressionable. They are bombarded every day ence-and-treatment-2017100912562. Accessed June 10, 2022. with views of what the ideal body type is. Unnecessary surgeries to achieve it are becoming the norm and body dysmorphic disorder is 6. Sharma G, Powell-Jackson T, Haldar K, Bradley J, Filippi V. on the rise.18 So, the gynaecologist needs to have a weight-loss con- Quality of routine essential care during childbirth: Clinical obser- versation with them without imparting lifelong body image issues. vations of uncomplicated births in Uttar Pradesh, India. Bull World PCOS is hard on a woman. Facial hair, acne, the lack of regular pe- Health Organ. 2017; 95(6): 419-429. doi: 10.2471/BLT.16.179291 riods, overweight, acanthosis nigricans-every aspect of the disease is stigmatized. Social media pages like ‘uteropedia’ are educating 7. Acharya AK, Sarangi R, Behera SS. Experiences and impacts of girls on advocating for themselves in a medical setting.16 Isn’t it Obstetric violence on Indian women within the Public healthcare the gynecologist’s job to stand in their corner? Why should girls as system. Journal of Feminist, Gender and Women Studies. 2022; 11: 37- young as fifteen be looking at how to advocate for themselves? 45. doi: 10.15366/jfgws2021.11.005 So, the question arises, why is the practice of obstetrics 8. Sharma G, Penn-Kekana L, Halder K, Filippi V. An investiga- and gynaecology failing women despite being women dominated? tion into mistreatment of women during labour and childbirth in The branch of health that is supposed to be about the female body maternity care facilities in Uttar Pradesh, India: A mixed meth- does not respect it enough. The supposed safe havens are becom- ods study. Reprod Health. 2019; 16(1): 7. doi: 10.1186/s12978-019- ing the cause of their depression.19 The current practice where 0668-y women are expected to be grateful for the bare minimum while being dehumanized should be uprooted. To establish a new, wom- 9. Dr Dalvie S. Being a feminist gynaecologist in the patriarchal en-oriented practice, doctors, right from their undergraduate stage world of medicine|#MyGynaecStory. Feminism in India. 2019. should be taught humanities and soft skills, to re-examine their Website. https://feminisminindia.com/2019/11/19/feminist- biases and to view the patient as a person with emotion, feelings gynaecologist-patriarchal-medicine/. Accessed June 10, 2022. and a social life rather than a problem to be solved. The inequalities in power, information and wealth are responsible for poor care. 10. Dean L, Tolhurst R, Khanna R, Jehan K. ‘You’re disabled, why The lack of knowledge of their rights among women must be ad- did you have sex in the first place?’ An intersectional analysis of ex- dressed. Sexual and reproductive rights violation units must be set periences of disabled women with regard to their sexual and repro- up at the district level. Every woman has the right to health and ductive health and rights in Gujarat State, India. Global Health Action. dignity and it is the duty of the healthcare personnel to provide it. 2017; 10 (Sup 2): 1290316. doi: 10.1080/16549716.2017.1290316 FUNDING 11. Khubchandani J, Soni A, Fahey N, et al. Caste matters: Per- ceived discrimination among women in rural India. Arch Womens No.
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