Rethinking pregnancy and post-partum care

Hindustan Times

3 days ago

Traditional norms often assign specific roles to male and females within the household as well as in society. While women are typically expected to handle household chores and caregiving responsibilities, men are seen as breadwinners and primary decision-makers. In such normative settings, power structure dictates that women oversee care during pregnancy and the post-partum phase, leaving the rest of the household members as spectators, particularly male members. Dialogues around pregnancy and childcare are often confined to female members only, except in situations that require urgent clinical attention. This selected silence around pregnancy within the household makes it difficult to create an inclusive environment and have an open conversation around pregnancy care. As a result, the focus of the family remains on the future child, often neglecting the maternal needs during pregnancy and postpartum. Pregnancy. (Pexels)
The journey from pregnancy to postpartum brings physical, emotional, and social changes in the women that require significant care and support, making pregnancy care a shared household responsibility for both male and female members. This can be done by creating pregnancy responsive households, where each household member takes part not just in childcare but also maternal care right from the beginning of pregnancy to post-partum. Without responsive and supportive household environments, institutional care alone cannot ensure positive outcomes for mother and child, further stressing the need for comprehensive care.
The first step towards comprehensive care is mapping the vulnerabilities of women during pregnancy. In India, according to NFHS-5, 18.7% of women aged 15--49 have a BMI below normal, while 24% are overweight, and 52.2% of pregnant women are anaemic. These are the predominant risk factors contributing to maternal morbidity and mortality. Deliveries through C-section have also increased to 21.5%, requiring additional care. Another study reveals that 22% of mothers suffer from postpartum depression, which is often overlooked and rarely addressed from the perspective of the new mother. Hence, women located at socio-economic marginal positions across caste, class, religion, specially-abled are more vulnerable to being at risk of receiving poor maternal care. These evidences reveal the need for family support in dietary care, encouraging rest, access to clinical care in pregnancy and the post-partum phase that prioritises women's physical and mental well-being.
Building pregnancy-responsive households demands interventions that encourage the conversation around pregnancy within the household and at the community level, involving both men and women. Drawing from Moser's Gender Framework, this can be done by distinguishing between practical gender needs (PGNs) and strategic gender needs (SGNs), which are fundamental in creating a pregnancy-responsive household. PGNs address immediate and material conditions, while SGNs focus on systemic changes and long-term gender equity. In this case, practical gender needs would include the nutritional requirements, clinical care, hygiene and sanitation, and financial assistance. In contrast, strategic gender needs involve support from household members, protection from gender-based violence, access to information and education, and decision-making. These indicators are not mutually exclusive but are interrelated depending on the socio-cultural characteristics of the household. This article aims to define pregnancy care and post-partum care in a way that balances practical gender needs with strategic gender needs.
When we express the need for comprehensive care in pregnancy and postpartum, we must understand the cultural context through a gendered lens. Commonly in many parts of India, pregnant women move back to their maternal home (maika) during pregnancy. This completely dissociates the husband/in-laws from participating in any pregnancy care activities, which continues even when the women return after delivery. Another concerning practice is that many families intentionally restrict the women's diet to prevent the foetus from gaining weight to avoid caesarean deliveries. Additionally, women who give birth to boys often gain higher status and security in the household as opposed to those who give birth to girls. They may face pressure to produce a male child, resulting in low birth spacing. These issues, dictated by the longstanding cultural beliefs, can only be addressed by fostering an environment that enhances favourable knowledge, attitudes and practices (KAP). The KAP approach is not restricted to women alone but also to the other household members, both male and female.
Several central and state government schemes aim at improving maternal health outcomes. The government's Pradhan Mantri Matru Vandana Yojana provides financial support, conditional upon timely registration for antenatal checkups (ANC), completion of full ANC and institutional delivery. While existing cash incentive schemes play a critical role in addressing the PGNs such as ANC care, nutritional requirement, financial assistance and access to institutional delivery services, they fall short of addressing SGNs that defy deep-rooted social norms, which inhibit a woman's ability to benefit from schemes. Incorporating the KAP approach is necessary to shift the attitudes and practices within the household around pregnancy and post-partum care.
Prioritising SGNs requires the use of social and behavioral change (SBC) techniques to educate all key stakeholders to take shared responsibilities during pregnancy and after childbirth. An innovative programme in Rajasthan used this approach to create positive behavioral changes within households and communities through interpersonal counselling and nutrition-focused events. Targeted messages for improved knowledge, attitudes, and practices of mothers and family members were developed and delivered through multiple platforms. Trained frontline workers engaged with mothers to improve knowledge and awareness about health outcomes during pregnancy, like diversified diet, ANC checkups, proper rest, and appropriate gestational weight gain. They also played a major role in debunking myths related to food consumption. This approach not only improved better utilisation of financial schemes but also enabled households to prioritize maternal nutrition and health. It encouraged family members to accompany women to ANC checkups, ensure access to nutritious food and proper rest. These efforts have resulted in 81% mothers having adequate knowledge of nutrition and care during pregnancy, 48% improvement in dietary diversity during pregnancy, 43% increase in husbands' awareness of their role and support during and post pregnancy, and 57% increase in the utilisation of cash incentives for the purchase of nutritious food.
Rethinking pregnancy and post-partum care in India require positioning it in the long-lived socio-cultural fabrics. Creating pregnancy-responsive households would mean having a nuanced understanding of the physical, emotional and clinical needs of women in terms of pregnancy and post-partum care. The engagement of all family members in an open conversation around pregnancy (particularly, decision-makers, i.e., husband, father-in-law, mother-in-law), can lead to breaking the cycle of taboos, bringing them from the sidelines to the centre of pregnancy and post-partum care. This would catalyse a fine balance between the practical and strategic gender needs, leaving a sustained effect in terms of women's decision-making, health and overall well-being.
This article is authored by Amana Raoof, MEL analyst, Kashish Saran, associate and Anshita Sharma, associate manager, social economic empowerment, IPE Global.