A grave concern

I want to begin this piece by raising an important question. How is it that almost every woman that gives birth these days in Kashmir does so through a cesarean section? Cesarean section births are recommended only when the life of the mother or the baby would be endangered by normal delivery. It has to be medically proven to be the safest option and only under such circumstances must the operation be conducted. The World Health Organisation (WHO) has put an upper limit of 10-15% on the cesarean sections i.e. in a population, the number of cesarean births should be between 10-15%, at the most. Shockingly, in Srinagar, according to the National Health Survey data from 2016, the number is a staggering 74.7%. The overall average in Kashmir is 41%, it is diminished because the numbers from rural and far-flung areas are lower, however, this is still nearly 3 times the global upper limit. Also, this is the combined data from both Government and private hospitals. If one looks only at private hospitals, then it is a whopping 94.6% for Srinagar i.e. 94.6% of the times Kashmiri doctors in private hospitals have knifed the women. One would be stupid to believe that all those 94.6% cases would be medically justified. The numbers for Shupyan, Pulwom, Baramulla are 90%, 89.6%, and 86%, respectively.

Considering Srinagar, if we take out the 15% (as, let’s say, medically justified cases), it still means that the remaining nearly 80% women were cut open un-necessarily, risking the life of the women and the child. There are various scientific and medical reports that establish an increased risk of respiratory distress, surfactant deficiency and pulmonary hypertensions among the children born via Cesarean sections. In addition, the Lancet, the premier medical research journal published a series of papers last year that indicated increased risks of morbidity among women following un-necessary cesarean sections. To quote one such paper by top-notch doctors and researchers, “The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose–response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology’’. Such reports are indicative of the alarming muck that this uninhabited malpractice must have unleashed on our society’s overall health.

Further interesting is the fact that over the past decade or so we have seen a constant mushrooming up of private hospitals that provide facilities for child birth and concurrently there has been a sharp increase in the C-sections. From nearly 13% in 2006 to 41% in 2016, the trend indicates that there might be a further increase in the overall numbers since 2016. It is criminal that in Srinagar, there is nearly a 100% chance that any women to give birth would be going through a C-section.

This blatant crime has been happening because doctors lay their eyes on the extra money they make on C-sections. It is a kind of a cartel run by doctors and hospitals which allows this misuse wherein no medical justification is sought to put a person under the blade. It seems C-sections are a money minting machine that both the doctors and the hospitals have abused at the expense of general well-being of people. Also, the authorities which should have regulated this procedure seem to be completely oblivious to the fact that nearly each time a woman enters labour, she is directly operated upon without a need for it. As per some sources, some of the private hospitals in Srinagar don’t even have Labour rooms, therefore, their doctors lay sight directly on C-sections. Some doctors in public hospitals force women to deliver in private hospitals where they can use the blade and earn a few more thousands of that cash. These actions, mind you, would be considered CRIME in other parts of the world. A doctor medically unjustifiably and without an informed consent of the patient, when goes for a C-section would not only lose his job but face criminal charges. But in Kashmir, and particularly in Srinagar, the situation is such that there seems to be no issue at all and this seems to be the norm. No authoritative over-watch and more importantly no moral and ethical constrains from the doctors.

And when any woman loses her life after or during this procedure, the first question that must be asked is- was it medically justified? If not, the doctor must be held accountable. For long we have held the doctors at a higher pedestal, where questioning seems to be questioning the decree of the God. Like other professionals, some doctors are chin-deep into greed for money and would give a toss to morals and ethics. When a doctor is found negligent or criminally motivated he/she must face the law. The muck that is widespread in our health care system needs to be cleaned. The authorities must wake up from their slumber and question the hospitals that allow this mal-practise and curbs could be brought about by imposing the law.

Ikram Ullah is a researcher at the University of Marburg, Germany. He tweets at @ullahi_