What About Safe Motherhood and Human Rights?
Concepts of the human body and its place in the world or cosmos are central to any culture. Likewise, care of the body, the health behavior which the mother, family or community inculcates into the child as a part of socialization, are intrinsically cultural orientations. Unfortunately the powerful language of human rights that is used in CEDAW (Convention on the Elimination of All Forms of Discrimination Against Women) and Safe Motherhood literature seems to ignore the existence of indigenous systems of health, healing and medicine in the effort to guarantee access to modern medical facilities to women and prevent economic and gender based discrimination. Most human rights NGOs have chosen not to address economic, social and cultural rights, in part because of the near total absence of any methodology to monitor enforcement or define violations of them.
CEDPAW was adopted in 1976 by the UN General Assembly and as of 1996 has been ratified by 152 member states. Part III, Article 11, 2 provides for maternity leave, social support for combining family obligations with work responsibilities and special protection for women during pregnancy. Article 14, 1 "States Parties shall take into account the particular problems faced by rural women and the significant roles which rural women play in the economic survival of their families including their work in the non-monetarized sectors of the economy, and shall take all appropriate measures to ensure the application of the provisions of this convention to women in rural areas"-which may be a rubric for inclusion of indigenous midwives.
Increasingly the language of women's human rights to health care includes 'accessibility' of that care. In other words, not just physical proximity but also social accessibility. This acknowledges the importance of health care providers’ attitudes which is compatible with women's beliefs and respectful of her cultural practices. Poor quality of interaction with health care personnel prevents access to modern medicine and health care facilities. Women are will not use health services because they perceive providers to be rude, patronising and insensitive to the context in which they live. Interactions with providers can be threatening and humiliating, and women often feel pressured to make choices that conflict with their own health and fertility goals.
Naming the human rights of women to choose, as practitioners and as users, indigenous health modalities and specialists is an important step in enumerating rights. The language of choice should not only extend to birth control techniques and family planning or obstetrically managed births. MATRIKA’s position (quite literally) is that a woman should be able to choose to squat, rather than lie down on a delivery table (or perform a ritual or be accompanied by a loved one), as she births her baby-and still avail herself of the advantages of bio-medical services.
Hanuman transporting the Sanjeevni (medicinal herbs) from Mount Goberdan—this image displays the sacred context in which healing and plant knowledge has been understood.
Why have Indigenous Systems of Medicine not been a part of Reproductive Health?
Due to the colonial past early health commissions, such as the Bore Commission, had never included indigenous health practices or practitioners. Some suggest that only in the 1980's, when it was obvious that the state could not cope with the need for health services, the GOI began to call on indigenous systems-calls for plurality to abet privatisation.
After the International Conference on Population and Development in 1994 and the Beijing Women's Conference in 1995 donors, especially the UNFPA and Ford Foundation, supported initiatives taken by Indian women's groups for dialogue among themselves on their health needs and women-sensitive population programmes. It was not a priority to perceive or reclaim indigenous women's health knowledge within the context of feminist activism critiquing patriarchal attitudes, structures and the excesses of GOI's family planning schemes
Government policies, which encourage dais as partners in reproductive health schemes, benefit dais, families and communities that have been marginalised by modern public health and bio-medical institutional processes. Dai work is labour intensive, rather than capital intensive as are hospitals and doctors, and thus contributes to its sustainability.
However even today powerful public health voices from abroad define Safe Motherhood goals in terms which make invisible indigenous knowledge, skills and practitioners. Theories emerge from universities in New York and London which may be statistically accurate, but do not lend themselves to coherent health policies in resource-strapped nations. For example Maine and Rosenfield advocate high technology and resource intensive solutions to the problems of maternal mortality and morbidity with the ‘all pregnant women are at risk’ assertion.
The best strategy is to assume that all pregnant women are at risk for serious complications and to focus efforts on improving the quality of, access to, and utilisation of emergency care services.
In many developing countries, there is a growing trend towards the medicalisation of maternal health care through specialised, generally technology-based models. Such practices as shaving the pubic area, giving enemas, routine electronic foetal monitoring routine episiotomy, and induction of labour contribute to over medicalisation. The overuse of invasive procedures may not be appropriate for many women, and can create barriers between clients and providers that discourage women from using health services.
HealthWatch Report on RCH states that in many of the areas reviewed the mainstay of the program serving the pregnant woman continues to be Tetanus Toxoid injections and iron tablets (which is congruent with MATRIKA findings). Yet in the Andhra, Bengal and Karnataka districts reviewed, care at birth continued to be handled by dais in as many as 75% of deliveries. Thus it appears that there exist precious few 'bridges' between public health and indigenous systems.