In Conversation With Dr Janhavi Nilekani On Why Women Need Respectful Maternal Care

Dr Janhavi Nilekani calls herself an entrepreneur by accident. Entrepreneurship is not what she tried to achieve but that became the centre of what she is doing. She started Aastrika Midwifery Centre because she was unhappy with her pregnancy experience in India. She could not find any high-quality birthing centre in Bangalore that she was satisfied with.

Janhavi Nilekani, a Harvard researcher, prefers to call herself a development economist, working on health policy on the ground and in the private sector. Acknowledging the gratitude we owe to our society is integral to her world. The daughter of Infosys co-founder Nandan Nilekani and philanthropist Rohini Nilekani, she works via the Aastrika Foundation on upskilling midwives, nurses and ASHA workers.

Aastrika Midwifery Centre aims to reduce infant and maternal mortality rates, reduce caesarean rates and other excessive interventions, eliminate and stamp out disrespect in the labour rooms, and ensure that every mother has a right to high-quality and respectful maternal care across the country and at any income group.

SheThePeople got a chance to catch up with Dr Janhavi Nilekani.

Personal Passion

In 2021 she founded the Aastrika Midwifery Centre in the private sector, a passion project for Janhavi. She believes we can't only work with the lower income groups in the government sector; the middle class and the wealthy also need access to good healthcare.

People try to copy the rich

Nine million births and 70 per cent of the general healthcare happens in the private sector. So to make a change, it is important to work in the private and government sectors. She feels that the private sector is aspirational. It sets the tone for the whole country. When the country's wealthiest, richest and most educated women are going to hospitals where informed consent is not the norm, where some extent of abuse and disrespect is happening, caesarean rates are high and not in the best interest of the mother that spirals to the entire market. It matters inherently that urban metropolitan women do not have such bad experiences.

Janhavi wants to showcase what healthcare should look like for every Indian woman. 

Breaking The Myth around Midwifery 

In general public, a professional midwife often gets muddled with a dai or a birth attendant. Still, Janhavi clarifies that "in modern language, the public health community does not look at a midwife as the traditional birth attendant as understood in India. A professional midwife in India is a nurse who has finished 3-4 years of nursing, then has 1.5 to 2 years of master's level specialised training in midwifery, which is the art of child delivery." 

To disentangle this muddled understanding, many advocacy efforts are being led, but Janhavi shares that it will take time to create awareness. As per research, midwives can provide 87% of essential care for mothers and infants when trained and regulated as per international standards.

Destigmatising conversations around pregnancy and birthing

In India, the family takes the decision when it comes to childbirth in the family. The problem is that the choice often does not lie with the woman or the couple. It is the family, especially the parents, who take the decisions. Janhavi expresses her surprise at how much urban, elite, educated women accept allowing their families to take decisions on their behalf. She says, "Birth is considered a family decision. The norm is you go to the family-approved doctor and then sit and listen quietly. Often it is the girl's parents who decide on her behalf." She adds, "Cultural change and progress are slow in our country. Liberalness is not what everybody wants, so change can't be quick."

Postpartum seclusion about time we question It

She points out the practice of postpartum seclusion observed in many parts of the country, even today. The 40-day seclusion period is often followed rigidly in many progressive families. Families continue to impose unscientific and unhealthy postpartum restrictions on women even today.

Digital training in medical care reduces the burden on the system 

Digital training allows people to be trained at a time they could otherwise not. While hands-on, clinical or simulation training is essential, digital training can supplement on-the-ground efforts. Janhavi says, "It is not possible for the nurses in geographically dispersed obscure locations to constantly go to the district hospital for physical training once a month. Digitals allow all healthcare workers to upskill in a self-paced way. Thus, digital allows more upskilling and in-service low-dose high-frequency training." She believes fundamentally if your healthcare providers are better trained it will impact women.

Her support system

On the personal front, talking about her husband, Shray Chandra, she credits him for the support which allows her to work odd hours. She admits theirs is an egalitarian marriage and acknowledges the male support, her father, brother, husband and father-in-law she has always got.

Talking about women and sisterhood, she says women share a relationship with others based on shared experience and lived experience, which is not replicable. She acknowledges her vibrant set of women friends and women colleagues, and mentors. She says, however, during her pregnancy experience, it was her sisterhood of women who were failing her. She says she strived to find a doctor in Bangalore who would first agree to work hard for a vaginal birth. She confirms that hers was a completely low-risk pregnancy. While she did find a few doctors in Bangalore who agreed to normal birthing, none agreed to perform it without a routine episiotomy. (Episiotomy is a cut to the vagina to expand it during childbirth.) She finally had her delivery in Hyderabad. Women around her she felt had normalised episiotomy, and many asked her to accept that vaginal tear. But for her, "the cut to my vagina over my body autonomy was not something to be normalised". Adding, "it hurt me how much women in my life had normalised that everybody gets cut, put up and shut up."

An episiotomy is usually not needed in a healthy birth without any complications. Experts and health organisations such as ACOG and the World Health Organization (WHO) only recommend an episiotomy if it is medically necessary. However, it remains common in India, often overruling the birthing mother's wish not to undergo it.

Janhavi is very conscious of her privileges and attributes that sense was taught in her by her mother, Rohini Nilekani, a well-known philanthropist, journalist and author. She feels having daughters makes men more supportive of women. 

Janhavi signs off by saying, "I would encourage women to strive for their ambition even if they do not have a supportive family. Unless some of us strike out, there won't be wide-scale change."

Suggested Reading: Living In Patriarchal Homes, Is It Possible To Call Yourself An Absolute Feminist?