Maternity Services and Surrogacy in India

Abstract

This article majorly looks at three different works concerning women’s health and the taboos related to it, which includes the maternity services offered by dais in different parts of India and surrogacy. The three works are: Can Maternity Services open up to the Indigenous Traditions of Midwifery by Mira sadgopal, The Surrogacy (Regulation) Bill, 2019 and two Bollywood films, Doosri Dulhan (1983) and Chori Chori Chupke Chupke (2001). Both the films depict sex workers as surrogate mothers and talks about the changes in their life and the societal reactions after their decision of becoming surrogate mothers. The academic article by Mira Sadgopal talks about the lives of midwives. Let’s look at how these important professions without which many lives would become difficult are looked down upon by the society and needed at the same time.

Critical analysis of the Surrogacy Bill

The surrogacy (regulation) bill 2019 was passed by Lok sabha. Within a span of one week, the bill received a lot of backlash as it excludes single persons, divorcees, live-in couples, widows, widowers and gay couples. The condition laid in the bill is that only hetrosexual married couples can opt for surrogacy. Yet another condition is that couples should have been married for five years and must be certified 'infertile' in order to be able to hire surrogates. It also says that under altruistic surrogacy no monetary benefits should be involved other than the medical expenses and insurance.

Parenthood can not be limited to gender, sexuality and sexual preferences. Discrimination for availing surrogacy on the same basis is a violation of Human Rights.

Reproductive rights entails bodily autonomy, sexual health, access to maternal healthcare, freedom from sexual violence, and torture, access to to contraception and birth control, and access to safe and hygienic abortion services. With the rise of commercial surrogacy, came the rise in the industry of fertility tourism. This boom in the industry resulted in the ban of commercial surrogacy in 2015.

Although the bill wanted to prevent exploitation, the clause of allowing just altruistic surrogacy limits the possibility of surrogacy to a large extent. Stigma is attached to adoption and surrogacy even today but the desire for ‘true’ heir (read: male) increases in the process of surrogacy. The idea of ‘altruistic surrogacy’ limits the potential for both, surrogate mothers as well as children. Another problem with this is that many times couples are unable to find relatives willing to be surrogate mothers for them, in which case the only way out left for them is adoption. It would have been appreciated if the bill was to encourage adoption and not stick with the idea of biological children but the laws for adoption in India are also very rigid. Therefore, there needs to be a streamlining for adoption process.

After the boom in the surrogacy industry, a lot of women were dependent on the same. Hence, the women who survive on the business of surrogacy will be left unemployed, keeping in mind the ‘one time pregnancy’ clause in the bill. The drafters of the bill also forget to consider ‘consent’ as a concept. The prerequisite of a willingly consenting woman becoming a surrogate mother should be a safe delivery and the child should be assured of a safe home. All these terms stated, why should she be limited to only one surrogacy? Surrogacy laws ought to be set out so that there is full assent of the lady being referred to. Here, rather than directing the ways and approaches in which a lady's misuse is counteracted, what the bill has done is dispense with the thought totally.

Mainstream Bollywood and it’s interpretation of Surrogacy

The surrogacy debate is being much talked about after the Surrogacy Bill 2019. The clauses in the Bill have received much criticism as discussed above. Let’s look at the cinema’s interpretation of Surrogacy. The first Bollywood cinema to recognise surrogacy was ‘Doosri Dulhan’ (1983). Later, Chori Chori Chupke Chupke (2001) and Filhaal (2002) came out on the same theme.The plot of the film created certain harmful assumptions regarding Surrogacy. These films failed to do justice to the topic of Surrogacy.

Since then we do not have even a handful of film depicting the more sensitised representation of Surrogacy or the actual portrayal of it in the popular media. In these movies, the infertility of the couple becomes a reason for them to hire a sex worker to carry their children for them. The plot lines depicts commercial Surrogacy, which is banned in the bill. The selection of sex workers as Surrogate mothers works on the “good woman” versus “bad woman” principle. The selfless nurturer and carer image of a good mothers tends to question the unpious image of a sex worker, who use their bodies to earn their livelihood. The two images are meant to be opposites of each other.

Surrogacy is more a profession but to keep the ‘good mother’ and ‘bad mother’ categorization alive, the government has banned commercial Surrogacy and only altruistic Surrogacy is legal.

Both surrogacy and sex work are tinted with moral judgements i.e., commodification of body via morality. The societal norms of India, understand these professions as exploitative which in many cases are untrue because there are many women which take up these professions out of free will and choice. While it is true that many times, women from low income background are prone to get exploited in these professions, however, both these movies reinforce that only women who are stuck in financial crisis undertake Surrogacy. This assumption takes away the agency of choice from the woman.

There is another line of similarity between the two movies, where Shabana Azmi and Preity Zinta decide to give up sex work and earn livelihood through other ‘respectable jobs’. Again, not considering the agency of choice. We also need to understand surrogacy and Motherhood as two different things. Very evidently in the two movies, the “bad mother” image of a woman is replaced by that of a “good mother” when she gives away her child as she is sacrificing her motherhood. Sacrifice is seen as an essential trait of motherhood.

“Commodified motherhood” or “Glorification of motherhood” are the two arguments around which Surrogacy revolves, in the contemporary scenario. Both these arguments are presented in a problematic manner. Commodified motherhood portrays motherhood as a commodity to be sold, which makes the Surrogate a bad mother. Glorified motherhood reveres the surrogate mother because she’s seen to be sacrificing her motherhood for someone else. Surrogacy is a choice, be it altruistic or commodified, to just carry the baby and Motherhood deals with raising the baby into a complete being. Therefore, Surrogacy and motherhood should be seen as two different things, negating the ‘commodified motherhood’ and ‘glorification of motherhood’ argument.

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Another question that pops in our head after watching these films is whether Surrogacy is a choice or exploitation. In both movies, the surrogate mothers were uncomfortable at the time of separation from the child after the delivery. At this stage, the surrogate mothers felt exploited as they had a feeling that they were being exploited by renting their wombs for money. This feeling of discomfort, sometimes misinterpret the surrogate mothers within a contract, who know that they are bearing the child for someone else.

Another problematic component within these movies were the idea of pitting two females against each other and the reward being the male protagonist. There was a feeling of insecurity among the wives from the surrogate mothers, this seems like an unnecessary attempt to ignite an element of competitiveness. In the real scenario, the commercial surrogate mothers stay at their own homes or clinics unlike the movies in which surrogate mothers put up with the couples. Also, portraying the untrue and harmful stereotype of a ‘jealous and illogical’ character of a women only seems to satisfy the nerves of patriarchy as opting for surrogacy is a conscious choice of the couple and thus will not make the wife insecure.

All the fine details of the film make me understand that morality needs to be detached from surrogacy. Motherhood and surrogacy needs to be seen as two different concepts. Everyone should have the right over their bodies, so does the surrogate mother and their decision must be respected. Though we understand that sometimes, women’s bodies can be exploited in the name of surrogacy but negating the element of choice and merely viewing surrogacy is exploitative would be unfair to the profession as well as to the females who decide to take up this profession.

Surrogacy comes up as an important achievement of technology, especially for childless couples who want to have children. In a patriarchal setting, a married couple who cannot bear a child are often seen hatefully and the female is blamed for it. So, rather than banning surrogacy, let’s accept it as a profession and raise our voices to bring reforms within the bill.

Traditions of midwifery: local and institutional level

The National Rural Health Mission’s Janani Suraksha Yojana (JSY) aims at making the expectant mothers aware to go for ‘Institutional delivery’. Home births is a form of local health traditions and the NHRM is working towards incorporating the dais, who work at the local level, into the government structure. Mira Sadgopal in her paper largely deals with maternity care by involving the inputs of dais in the institutional structure. The maternity care has always been hospital centered which is why the government tend to exclude the dais from the category of “skilled birth attendants”. The health governance wants to keep the dais out of the structure because they are not trained with the technological and managerial solutions.

The dai training aims to reduce maternal deaths and focuses on hygiene. The Bhore committee report (1946) recommended integrating trained traditional dais into the health system but the organised structure eliminates and undermines them by calling them ‘dangerous’. In contrast to this, the institutionalised structure believes in the reversal of dais rather than restructuring. The debate of “whether dai training was helpful or not” in reducing neonatal and maternal mortality, does not evaluate the oblivious nature of training. The health administrators instructed these dais to unfollow certain age old and effective methods of maternity services and trained them to wash hands and adopt the “five cleans”. As a result, the maternal mortality did not fall and the dais were tagged as “ineffective” ands were thrown out of the system.

The paper also acknowledges, caste, class, gender, power hierarchies within the dai system. There were two kinds of dais who performed different kinds of maternity services during the time of delivery. One are the ‘cord cutters’ and the second are the ‘baby deliverers’. The cord cutting was seen as a sinful activity and the women who performed this activity generally belonged to the dalit adivasi community.

Several traditional childbirth practices have found scientific validity. Among them are, squatting and movement during labour, continuous emotional or physical support during labour, perineal massage or vulva oiling. One method that has made heads turn, is the practice of heating the placenta if the child does not cry. The doctors discredited this practice of delayed cord-cutting, by labelling it as a practice of “illiterate uncouth women”. There is an excerpt in the paper which narrates the story of a sikh dai who revived a distressed newborn by heating the placenta on a tawa. Various reports show that indigenous midwives have developed a technique for saving newborns that is virtually unknown to medical science. The system of health services in India lies at the two ends of the same spectrum. On one hand, the dai tradition believes in the reductionist tendency of western thought, on the other hand, the institution is the staunch ideology of power hierarchy as understood by Mira Sadgopal. The reductionist approach has given medical a chance to pay attention to the mechanisms of body functions, similar is the concern of dais, stressing attention on food, rest, relief whereas the doctors tend to believe that technology is the ultimate solution.

There are various unrecognised flaws in the institution. The malpractices take place because of the lack of accountability. For example: allopathy promotes the dangerous use of Oxytocin, which reduces pain but causes severe damage to the mother and the baby. The partnership of local health traditions and health services at the institution level will minimise the chances of such tragic distortions. Privatisation of public health is ignoring the age old home remedies used by the local communities which has resolved issues of health and illness.

Some organisations, which are working towards the dai training and their integration in the health services are as follows: The Matrika project works towards the representation of dais and working in different ways to promote dai’s knowledge, skills and worldview. Other community based health organisations include, The Gujarat Dai Sangathan, Jeeva Project, Jharkhand Women's Health Network, Tamil Nadu Village health nurses Association are taking steps to ensure more inclusive possibilities within the maternity services.

There is a challenge to introduce a dynamic and integrated pluralism into the existing public health system. Dufferin’s fund and Victoria Memorial Fund is associated with the improvement of conditions of childbirth in India and is dedicated to improving women’s healthcare conditions in India. This fund provides scholarships to women who aspire to educate themselves in the medical field as doctors, hospital assistants, nurses and midwives.

Last year, a World Summit Awards (WSA) took place, which celebrated the work of local innovators using digital platform. MedHealth TV was chosen under the category of Health and Well Being. It is a web portal which offers medical advice on maternal health, pregnancy, women’s health, postnatal care in regional languages. It was founded in 2015 by Dr. Padma Rammoorthy. The mass internet connectivity opened a new channel of communication for this portal to address the health education problem. “Women’s health issues have always been considered taboo and health information is something that is typically passed on from mother to daughter” Dr. Padma Rammoorthy told FII in an interview.

A country’s development can be seen through the development of it’s women and the maternal mortality rate is one of the major factors of women’s development. It is sad to witness a scenario where 80% of deaths take place because of bad healthcare conditions. Socio-economic factors and health related complications and the common causes behind maternal deaths. Janani Shishu Suraksha Yojana (JSSK), provided free delivery, free blood, drugs and diagnostics, free transportation to and from the hospital, and free food services during delivery to pregnant mothers, who were unable to bear the cost of delivery. The health centres in the rural areas are understaffed whereas three-fourths of the health infrastructure is concentrated in urban areas, where one fourth of India's population lives. The deplorable state of healthcare in India compel the expecting mothers to skip necessary injections and medications, compromising the “Full antenatal care”. The intersectionality of caste and religion makes it even more difficult for the women from marginalised section to access these services. Adding to it are the socio-economic barriers, such as lack of awareness which keep these women from availing health care. All these indicators lead to the problem of maternal mortality. The political leadership has turned a blind eye to this issue, which continues to make women second class citizens. There is a dire need to address this tradegy as “the fastest growing economy in the world” lacks in something as basic as healthcare for it’s women.