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ABSENCE OF MATERNAL HEALTH AWARENESS TURNING KASHMIR INTO  HUB OF C-SECTIONS?

By | Syed Safa Chishti

The World Health Organization (WHO) revealed the ideal rate for Cesarean to be between 10-15%. Since then, Cesarean has become increasingly common in both developed and developing countries. According to International Cesarean Awareness Network (ICAN), the overall C-section rate is expected to increase with almost one-third (29%) of all births occurring with cesarean section by 2030. However, J&K was recorded amongst the top five states showing higher C-section deliveries including Kerala (42.4%), Andhra Pradesh (42.4%), Lakshadweep (31.3%), and Goa (39.5%). 

In a conversation with Gynaecologist and Obstetrician, Dr. Humaira Tabbasum states that Cesareans have become elective procedures based on “convenience instead of medical necessity”. “It is indeed being performed recklessly in Valley despite the cost being higher than the fee for a natural birth, lack of awareness being the major cause of this issue”, Dr. Tabbasum highlighted. 

She pointed out that the need for “proper counseling of patients and attendants” is to avoid the rising rate.

However, when it comes to the preferences of the patients, Dr. Tabbasum stresses how a patient’s choice has played a major role in the abrupt rise of C-sections in the valley, in some hospitals. “They believe it to be safer for the baby since it is a painless mode of delivery and less tedious. While C-sections are necessary to save lives, they are also linked to increased complications. So women must be encouraged to consider try natural birth if conditions allow”.

Dr. Tabbasum elaborates on some major causes of Cesarean existing like “fear of Normal Vaginal Delivery (NVD), pain and the prenatal outcome”. She highlights the complications like placenta previa (central), vaginal obstruction, cephalopelvic obstruction, advanced carcinoma cervix, fetal distress, no progress of labour, malposition/malpresentation, co-morbidities, hypertension, etc., too enforce the decision of Cesareans.

She further informs that causes like “late marriages, safety concerns related to health risk, fear of childbirth, negative experience of previous childbirth, sedentary lifestyle, improved socio-economic status, reliance on science and surgery, access to biased information, the low doctor-patient ratio” too have decelerated the rate of NVD in the valley.

In some cases, the complications enforcing the implementation of C-sections, like in the case of a 32-year-old Qurat-ul-Ain, who delivered her twins three years ago shares her experience stating that even though the process being “most appropriate” in her case, would not have been her personal preference. “My babies were in breach and transverse position so there was no better option than this. But it was like the worst nightmare because the back pain and the scar remain with you throughout your life. One is not able to sleep for months afterwards as the pain with this deep cut is unimaginable”, she added.

For Barooja Altaf (name changed), a middle-aged teacher currently expecting her second child being seven months pregnant reveals how despite the conditions in her first pregnancy revealed showed no signs of complications for cesareans, she highly preferred cesarean over natural delivery. “I understand that natural delivery is a healthier option specifically considering the post-delivery benefits compared to C-sections but I just cannot imagine the pain I would have to suffer at the time of natural birth. Besides it is common these days for cesareans to be opted”

Comparing the cases of urban and rural lifestyles coming from a background with low education to some cases who despite being familiar with the causes and implications of cesareans still opted for the same, it becomes evident that the requirement of awareness in both rural and urban lifestyles is needed for immediate implementation of large numbers in possible humanised births. 

The National Rural Health Mission (NRHM) aims to address the health needs of the rural population; especially the vulnerable sections of society by the Govt. of India through a band of community-based functionaries, named Accredited Social Health Activist (ASHA) to fill this void. In 2019, the Press Information Bureau, Ministry of Health and Family Welfare reported a total of 1047324 ASHAs engaged under NHM in India where about 12356 ASHAs are present in J&K. 

Amongst the many core guidelines, ASHA takes steps to create awareness and provide information to counsel women on birth preparedness, the importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception, and prevention of common infections and care of the young child.

Further, emphasizing the need for awareness of maternal health information, Dr. Tabbasum advices that “strengthening the facilities at the grass root level” is necessary in order to decrease the load on the tertiary care centres. “There should be a proper implementation of the various Govt. programmes like JSSK, LaQshya to facilitate vaginal delivery. Counselling regarding antenatal visits, and lifestyle modifications in order to prevent diseases like hypertension, and diabetes should be done. Moreover, the mother should be made aware regarding the complications of c-sections like incisional hernia, scar rupture, etc”, Dr. Tabbasum added.

NFHS-5 reveals more than half of the deliveries in urban Jammu & Kashmir take place through Cesareans. About 54.7% of C-section deliveries take place in urban Jammu and Kashmir with a literacy rate of about 77.12% compared to 37.8% C-sections in the rural areas with a literacy rate of about 63.18%. With the numbers in normal forms of births dropping to an alarming level, the need for a proper framework of an efficient work plan focused on the in-depth awareness and guidance of people belonging to both rural and urban areas in Kashmir, the results can not only revert to the previous statistical records of safe C-sections data but also aid in long term safe health benefits for pregnant women and children due to access to their own health information from awareness campaigns.