[Reader-list] hospital's labour room as a space for unheard voices: study abstract

[kuldeep kaur]

hello
sory for being late. i don't have any excuse for this delay. here i am sending my abstract of the study. i am looking forward for your comments on the abstract.
with regards
Kuldeep kaur

LABOUR ROOM AS A SPACE FOR UNHEARD VOICES

The study was an effort to understand the various pressures and to assess information level of would be mothers. Every case unfolded new pressures. The study resulted in exploration of various myths, misconceptions and fears of would be mothers about their reproduction health. This exploration was a good exercise to understand the social-psychological pressures women carry while admission in the labour room. One aspect of the study was based on observations of the mothers and their attendants before and after the declaration of sex of the new born. While mothers were considered main respondents the attendants’ comments were noted in the margins of the same questionnaire.  
Labour room in any organize city, as Chandigarh becomes a space for interaction and communication with each and every section of women. In the initial stages of the study I was expecting to get my respondents from the urban business families and rich farmers of Punjab and Haryana. I was surprised to get large number of respondents from migrant labour from Uttar Pradesh and Bihar. The second big segment was from agriculture labour. Moreover, most of them were ‘acute emergencies’ with life threatening conditions. Regularly supervised cases were with proper health records they were admitted, delivered and discharged in routine but these acute emergencies were brought in labour room to save the lives of mother and child so these were complicated cases. 
The study of labour room explored the attitude and psychological pressures on would be mothers. They are admitted for childbirth, which is a big event in the family and social life. Primary gravidas are more concerned about the well being of their child than sex of the unborn. Most of them enter the institution of marriage with unstated promise of reproduction within two to three years. Failure results in experiments with their bodies. These experiments vary from taking unidentified medicines and visiting Deras or religious places for treatment to prove their fertility. Respondents who don’t conceive within first year of their marriage were getting infertility treatments. Husbands are expected to consult a doctor only after final reports of wives with ‘nothing wrong’ remarks are received. Primary Gravidas decides avoid use of contraceptives on basis of advises by elderly women of the family. ‘No Contraceptive before the birth of first child’ is precious lesson for them with the logic of ‘avoidance of permanent infertility’. Most of my respondents (Primary Gravida) were following this safe path to motherhood. Reproduction is as natural as respiration for a married woman is the lesson they have learnt. Pooja (a girl with polio-affected lower limbs), Meena (a girl with phychosis) Poonam (a girl with mental retardation) have to produce children although they never get their due share in other spheres of life. 
For most respondents of this study age of marriage is directly related to school- going years. The respondents who discontinued their studies after fifth to eighth standards got married till the age below eighteen. Those with tenth or plus two are married by the age of twenty. The respondents who are working with professional degrees were married in their late twenties. An important finding of this study was ‘economic dependence’ of respondents. Most of the respondents are dependent on their in-laws for basic requirements of life. They may be in government service or working, as labourer but still their earning or income is considered secondary. None of the respondent was sole ‘bread-earner’ of her family. If their in-laws own a house or property, their share is negligible or they are unaware of it. Many respondents prefer motherhood after marriage. Most of the workingwomen especially in private sectors choose to leave their jobs for brought-up of children. Even the ‘place of delivery’ is largely decided by cost, distance and preference of husbands. The choice of pregnant lady or the availability of health facilities is not the consideration. Some of the respondents follow the traditional custom to shift with their parents during first delivery.
>From the study it is revealed that ‘traditional dais’ are still providing their services to a big chuck of population. In this study, most of the mothers, who have migrated from U.P., Bihar for labour depend upon dais for antenatal care and ‘delivery services’. The rural Chandigarh (villages attached with U.T) and slum areas in Chandigarh have untrained dais. The respondents with multigravida preferred their services (living in these area) during antenatal period and at the time of delivery. Antenatal Care health schedule is totally ignored e.g. no urine pregnancy test for confirmation of pregnancy, no ultrasounds for fetal well being and congenital malformations, no investigations for pregnancy induced complications, even regular pressure monitoring is not done although pre-eclampsia is a major life-threatening condition in pregnancy. Anemia is never diagnosed (in my respondents under dai referred cases most are with Hb 6gm-8gm. This HB is diagnosed at their arrival in the labour room when most of them are about to deliver. The reports are received after the delivery which means that this major variable remain unknown to the health staff. Without this report the patients cannot be blood-transfused, which may turn out to be fatal in certain cases.) Home deliveries are preferred due to cost effectiveness and faith on traditional dais.
The respondents who are primary gravida are worried about well being of their womb-child. In case of multi-gravidas these worries multiply. The respondents with one or two female offsprings are under tremendous pressures. Primary-gravidas repeatedly speak of well-being of their un-born child but multi-gravidas are with series of abortions or tales of ‘how they feel being mother of female child/ern’. They visit ‘son-giving’ gurus, they are being harassed from the in-law and they get more physical complications e.g. one respondent Anita was explained in written during time of previous L.S.C.S. (lower segment caesarian section) that her uterus is unable to bear another child and it can rupture during third pregnancy but she ignored under family pressures. The pressure of ‘being a mother of a son’ made her ignore medical science. Her life is at stake. Family glorifies her ‘sacrifice’ to become mother. As her mother-In-law said, “she is with marvelous will-power. God has to bless her with son now”.
The study explores how religious institution and religion shapes attitude/psychology of a woman to fit into social machine as a ‘production-unit’. Fate, will of God and helplessness before nature are widely used words by my respondents. How many children they are planning to give birth to; whom do you visit for/after conception; are questions, which brings out their religious socialization that is beyond reason. One of the interesting part of this phenomena is how they accept ‘mal-treatments’ and ‘exploitations’ after they fail to produce male-offspring. This was clear from large number of respondents who opt for ‘miracle-treatments’ after having female child/ern despite being Sikhs. Most of the Sikhs women with male-offspring show their disbelief in Tantar-mantar. This is clear from the study that reproduction related exploitation is directly related to sex of the child.
Maintenance of hierarchy is another pressure on woman. If you are single daughter-in-law you are suppose to produce owner of the property or business. Primary-gravida mentions this with hesitation but multi-gravidas are more open about this. 
Information level of ‘would be’ mother about contraceptives, menstrual cycle, labour process and process of pregnancy is full of misconceptions and misinformation. Source of information are mothers or mother-in-law. Most of the respondents who adopted contraceptives are mothers of sons. After first delivery they follow the advise of the health staff. Those who do not use any contraceptives were instructed but they ignored to produce a son as early as possible. On this issue they simply emphasized on to complete the family that is ‘a girl and a son’. It can be ‘one son and second son’ but it is never as ‘one daughter and second daughter’. Many respondents were willing for permanent sterilization only if they attain ‘norm of complete family’ otherwise they choose to try again.
Menstruation cycle came as a threat for emotional integrity of the respondents. Some respondents have to leave the school as soon as they got menarche. Some were restricted in their daily activities. For most of the respondents, the mother was the fundamental source of information. Information is full of fears, confusions and with ethical instructions for women. ‘Impure blood’ is the term used by most of the respondents. ‘It is necessary’ is the explanation by them while responding to ‘how it happens’ and ‘why it happens’? Most of the respondents got actual information about delivery process with their own experience of delivering child. Multi-gravidas are with fears of labour pains. Primary-gravidas are uncertain about how the whole process will happen. Somehow they were unanimous on the point that labour process is the most difficult phase of womanhood. Education and ability to purchase information materials was utilized by some respondents to purchase magazines like Femina, Meri Sehali, Grahshoba etc. They refer to them as authentic source of information.
The social and economic status of women is expressed in their responses to the question about their responsibilities in case of particular sex of the new born. On this question most of the respondents responded from their existing conditions. As labourer woman said that both have to earn their livelihood, so parents have equal responsibilities, as Hindus women from business families said that dowry, difficultly during marriage and social security are deciding determinant factors about responsibilities of son or daughters. This attitude retains its social legitimacy through female agents of patriarchy. The elderly women gave voice to this phenomenon as ‘teacher’ of coming generation.
Some of the respondents realize that girl is a burden. Son is a future investment who is going to provide care and security in old age.  He is considered valuable from economic, emotional point of view and expanding the family tree. Some respondents are with the view that girls are constant emotional responsibility for family even after their marriage. Respondents were also united on the concept that son is compulsion for continuation of family tree and for the care of family heritage. The ‘institute of marriage’ comes under questions, as girl is born to get married, produce children and live with other family (of husband). All her contribution to the families of parents and in-law lacks any recognition and reciprocation.
One segment of the study was focused on observation of the attendants and their responses after delivery. Post-natal attitude of women and their families menifest the pressures they have entered the labour room with. The silences, pauses, blank looks, heavy walks of attendants and complains of pains (of psychosomatic origin) by the mother after the birth of baby girl tells the story. On the other hand exchange of enthusiastic wishes, distribution of sweets, making immediate calls to relatives and friends in laud voices, tips to sweepers and ward helpers, gifts and over-care of baby and mother, over-thankfulness to health staff and arrival of relatives in large number are clear expressions of sense of achievement at the birth of a male child. Respondents, who delivered son, were getting ‘shaguns’ at the bedsides; sweets were distributed. These respondents complained no problems about breast-feeding and insisted upon early discharge. They were getting attention of their mothers or female attendants. Most of the respondents who delivered daughters were received with unwelcome gestures. Some try to get relief by weeping. Primary-gravidas were hopeful for next time. Multi-gravidas were complaining about ‘no breast milk’ for baby. Even some of the patient’s attendants refuse to have clothing’s for the newborn. No sweets, no smiles, no shoguns. Respondents who were friendly with me show special thanks to me if they produce son, otherwise I have to go to their bed and ask, “How are you? Answer is well written on their faces. Worst of them are respondents with stillbirths. Newly-mothers refused to share their beds with them if there is any emergency.
This study can be helpful to define the contours of research that can take place with labour room as point of reference. These researches can be of multiple help to the policy makers, social scientists, women organizations and society at large to understand the pressures on women while entering the labour room. The studies of backward and forward linkages of these pressures can help to understand women in a better way.
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