Indu, our friend and DWP employee, became a mother for the first time on July 2, 2013 in Mumbai, India. Her beautiful daughter Agya was born prematurely (two months early) weighing just 1.75 kilograms (2.2 lbs.). Indu and I sat down one day and I peppered her with questions about what it was like to be pregnant with little to no pre-natal care and no family to nurture her through her pregnancy or see her though the birth process. Indu lives with her husband, Akhilesh (both in their 20′s) in a room in a chawl* neighbourhood in Marol, a suburb in the northern part of Mumbai, near Saki Naka. Akhilesh is learning to be a carpenter. The following is a Q & A about Indu’s journey to motherhood and the birth of Agya at K.E.M. Municipal Hospital in Mumbai.
When did you know you were pregnant? Did you have a test done?
Indu: I was not feeling well so I bought a pregnancy test for 50 rupees (just under $1 CAD) to find out. The test said I was pregnant.
Did you go to a doctor after your took the pregnancy test?
Indu: After four months I went to a doctor.
Why did you go to the doctor after 4 months and not before?
Indu: If I want to have my baby in a hospital I have to register before the baby is born so that is why I finally went.
What happens at the hospital when you register? What is the process?
Indu: I registered at Marol Municipal Hospital because it is only 15 minute walk from my house. I lined up with at least a few hundred other pregnant women to register for the birth. They asked for my name and for my husband’s name. They asked if I have a bank account because after birth of a baby the government will give all mothers 600 rupees ($10.34 CAD) when their baby is three months old. I don’t have a bank account so I would have to go back to K.E.M. Hospital (where Agya was finally born) with photo ID and the baby’s birth papers to collect the money. The rickshaw money to go back to K.E.M. Hospital would be more than 600 rupees back and forth and I would have to line-up all day in very long lines while holding Agya to collect the 600 rupees. I have not gone.
How was your pregnancy? Did you feel healthy or were there problems?
Indu: Everything was normal. At four months pregnant I started going to Marol Hospital where I registered for a check-up. They weighed me and checked my blood pressure every time and felt my stomach and asked if I was having problems. It takes a whole day to wait in line-ups. Up to 70 women wait in line every day for a check-up. They gave me an injection and didn’t tell me what it was for. They didn’t give me any information about blood pressure or other issues to watch out for. The whole appointment takes about 5 minutes. They gave me pills the first time I went for my check-up. I didn’t know what they were for. After that I had to buy the pills for 425 rupees ($7.32 CAD) a month. They gave me a type of protein powder that I had to mix with milk and then drink.
Did they ever measure your stomach to see if the baby was growing?
Indu: No, they just felt my stomach each time.
What happened when you were in your seventh month of pregnancy?
Indu: I went to the hospital for my monthly check-up. The doctor looked at my file quickly, didn’t examine me physically and said everything was fine and I could go. Two days later I was getting ready to go to my job (Indu worked at an office job at the time) and I realized the baby hadn’t been moving. I waited for an hour and still felt no movement. I walked to Marol Hospital and told them. The nurse said it was normal, that babies sleep in the womb. I told them this not normal for me, that my baby moves all the time. A doctor gave me an internal physical check-up and said everything was fine, but if I was worried I should go to a clinic and have a sonogram. I left the hospital and walked about 40 minutes to Saki Naka to get a sonogram. I waited two hours for the results and was in some pain after the physical exam at the hospital. Then I walked back (40 minutes) to show my sonogram to the doctor at Marol Hospital. The doctor said the sonogram was fine. I still hadn’t felt the baby move. They said I could be admitted to hospital if I wanted. I said no because the doctor told me everything was fine so I went back to work. (My husband was not working at this time because he had a broken his hand, so we needed the money). I walked home after work to tried to relax and I started having pains about every 5 minutes. My back started to have pain. I ate some food and tried to sleep.
Walking anywhere in Mumbai is a test of agility and nerves. Chaotic traffic, no footpaths, crumbling pavement, open sewers, food vendors, chunks of cement to step over, muck and mud, buses belching purple exhaust and motorcyclists driving the wrong way make walking anywhere a test of agility and nerves. Crossing the roadways puts faith into perspective.
Did you think you were in labour even though the doctor said everything was fine?
Indu: I wasn’t sure but I was worried. After about an hour (at around 2 am) my water broke and I told my husband to get up. I tried calling a taxi to take me to the hospital. I knew I was in labour. No one answered my calls so my husband and I walked to the hospital. There was no doctor at the hospital. The nurses checked me and my water was still coming out. They said they didn’t have an incubator and because I was only seven months pregnant they wouldn’t admit me because they knew there might be complications with the baby.
You were having labour pains, your water had broke and they turned you away without a way to get to another hospital. What did you do next?
Indu: The nurse gave me the names of three different hospitals to try. I left Marol Hospital with my water still coming out and my husband and I walked home and then called a taxi which took twenty minutes to arrive. My husband, a neighbour and one of the people I worked with came with us and we went to Sion Hospital, the first hospital on the list the nurse gave me. The trip took one hour. When I got there I was directed to different buildings by different people and we wandered between them to find someone to help me. When I found someone to finally help me, I was told the maternity ward was full. Then I went to J.J. Hospital by taxi (another half-hour). I am in labour and in much pain. At J.J. Hospital, two doctors were there. They had to consult with a surgeon. They called the surgeon and waited for a return call. There was no call back. I had waited another hour at this hospital and then they said I couldn’t give birth there because they also didn’t have an incubator. Then we got back in the taxi (who waited for us) and went to K.E.M. Hospital. When we arrived there we searched many buildings to find where to go. A nurse finally checked me and said the baby’s birth would be very soon. I waited about half-an-hour until they admitted me and my husband had to sign paperwork before they would do anything. Three or four other women were also giving birth in a large room with 5 or 6 doctors in attendance. The air-conditioning was on and I was very cold. They gave me two pills without telling me what the pills were for. I was shivering. I couldn’t straighten my leg for some reason. I had five or six labour pains and finally the doctors snipped me and my baby girl was finally delivered at 7 am. They showed me my baby. They stitched me up without anesthetic which took about fifteen minutes. A half-hour later I was taken to a ward. They asked if I could walk to the ward. When I said no, they gave me a wheel chair. They took my baby to PICU (paediatric intensive care unit) in an incubator. We were both labelled. I slept until 10 am until someone woke me to tell me my baby was crying. I went to PICU and she was in the incubator. She weighed 1.75 kg. They checked her over and gave her a whole body x-ray, took blood samples and told me she was healthy. They gave her an injection when she was born, but didn’t tell me what it was for. For the next five days I slept in a chair beside Agya’s incubator, afraid that no one would call me if she cried. The doctor gave me some milk and I spoon-fed her. After two days I extracted milk from my breast and spoon-fed her that. Everyday they checked her weight. Once she could suck properly I breast-fed her. After five days the doctor declared Agya was fine to leave the PICU and she came to the ward with me. The doctors gave me pills twice a day for blood pressure. I was told my blood pressure was very high and that’s why I gave birth early. The doctors are so busy with hundreds of patients that each patient gets very little time and attention. The doctor who looked after me was very nice and caring. Her name was Tejhashree.
When you were in labour how did your husband react?
Indu: He was very scared for me and also worried that the neighbours and our relatives would blame him for any problems if the baby died. He always took good care of me. My husband spent four days coming and going to the hospital and made me food to eat.
How many beds were in your room on the ward?
Indu: About 100 beds full with new mothers.
We have spent time with patients at BMC hospitals and noticed the beds are rusted and the sheets are stained and often ripped, sometimes actually in shreds. Was this what the ward was like at Kem Hospital?
Indu: Yes, my bed had stained, dirty sheets.
How many babies were in ICU when Agya was there?
Indu: About 30.
When you are a patient in a BMC hospital do they feed you?
Indu: They do give some food. Not tasty or nutritious, but it was food. The dal was very watery. They did give milk. My husband brought me food to eat.
What were the total hospital fees to have your baby?
Indu: 700 rupees ($12 CAD) for blood tests. 500 rupees ($8.62 CAD) charged for a woman to clean up the afterbirth. I had to buy pampers and medicine during the hospital stay. The total cost for the birth was about 4000 rupees ($69 CAD). We also donated a small amount of rupees for a kit (baby socks, pampers and a bowl and spoon for feeding babies milk) for mother’s who can’t afford to buy their babies basic items. We took a taxi home from the hospital after the birth which cost 450 rupees ($7.75 CAD).
When you got home were you confident about how to care for the baby?
Indu: No, I was worried because she was so small. The nurses at the hospital gave me some instructions about how to care for the baby. I didn’t sleep for the first three months because she cried so much.
What are normal baby care rituals each day for mothers in your community?
Indu: Some people have a bai who comes every day to massage the baby with mustard oil and then bathe the baby. After the massage and the bath, the husk of a coconut is burned and then garlic husk and some kind of seed is sprinkled onto the smoking coconut husk. The naked baby is flipped and turned upside down over the smoke for about ten minutes. Then the baby is wrapped tightly in a blanket and sleeps for about 3 hours. The reason to put the baby into the smoke is it is believed to keep the baby from getting colds and from getting ill. This massage, bath and burning coconut ritual happens every day for at least one month or whatever the mother can afford. The bai charges 1500 rupees ($26 CAD) per month. The bai will also give the mother a complete body massage/coconut smoke ritual and bath. For that service she charges 2000 rupees ($35 CAD). Black bracelets or white plastic bracelets are put on the baby’s wrists for protection. Metal bracelets woven with seven strands of different metal (copper, silver, brass) are also worn by the baby for protection. Agya is wearing one thin white plastic bracelet on each arm. I put a disposable diaper on Agya when I go out for all day, but usually only use one a day. When we are at home she doesn’t wear diapers.
Children in slum communities defecate on the street or in lane ways and are often unclothed from the waste down until they are old enough to make the trek to the public toilet (shared among hundreds) themselves.
What rituals do you perform on Agya every day?
Indu: Everyday I dip my finger in kajal (black powder mixed with mustard oil) and press my finger in the space just above her her nose between her eyes (giving her a third eye) for protection against bad spirits and evil people. I also line Agya’s eyes in kajal. This keeps the dust out of her eyes and helps her eyes grow bigger. I dot the bottom of each foot as well. After I bathe her I put baby powder on her body and face and mustard oil on her head. At night I give Agya a massage with mustard oil. Mustard oil rubbed on the baby’s skin is good for bones.
Do you take Agya for regular check-ups?
Indu: Municipal (BMC) hospitals ask mothers to bring their babies for monthly check-ups but I can’t afford to go because of the cost of transportation (250 rupees ($4.30 CAD). I take her back to K.E.M. Hospital for immunizations and I can also take her to immunization clinics in my neighbourhood.
I accompanied Indu to K.E.M Hospital for Agya’s first immunization shots. We waited a very long time in a very long line-up. We were finally shown into a room. There were numerous medical staff sitting around a broken wooden table. One man was removing pills with his bare hands out of large white plastic container and wrapping two pills in small packets made out of scrap paper. Agya was laid on a gurney covered in grimy vinyl with no barrier between her and the vinyl. A nurse (without gloves) injected her with the immunization and Agya was picked up by Indu and another baby took her place on the vinyl gurney. The vinyl was never cleaned between babies. Indu was handed a packet of pills and instructed to give them to Agya for pain. No instructions were given about how one would give a tiny baby a pill. As for Agya’s monthly check-ups, DWP pays the transportation cost (1000 rupees ($17 CAD)) for Indu to go to take Agya to The Foundation for Mother/Child Health clinic. We try to have up to two other mothers and children join us for the monthly trip (which takes almost two hours by taxi to get there in Mumbai traffic) provided the mothers agree to continue to attend the clinic every month. This foundation provides the best possible care for babies with personal one-on-one sessions with doctors, health-care workers and nutritionists. They require children come on a monthly basis so they can track their growth. The children are measured, weighed and excellent records are kept giving the staff at the foundation the necessary information to assess what the mother needs to do to prevent malnutrition in her child before it stunts the child’s growth and intellect. Besides great advice in a loving environment the clinic provides free supplements and protein snacks to the parents to give to their children. Most children who live in slum communities or come from poor families are malnourished and have many other health problems due to low birth weight, overcrowded living conditions and poor hygiene. The doctors at the clinic are always excited by Agya’s weight gain and overall healthy progress.
How does the community participate in a new baby’s life?
Indu: When a friend or family member sees the baby for the first time they are expected to give a gift of money or clothing. Babies are named when they are 12 days old. A naming celebration might happen if the parents can afford to have a party. The baby’s name is chosen by the parents or the grandparents. At a naming celebration there is music, dancing, food and gifts. The guests attending the celebration bring money or silver bracelets or anklets and put the gift on the baby’s blanket.
Are boy babies more celebrated than girl babies?
Indu: No. Everyone loves new babies.
Although all babies are adored by the community and the parents, female babies are a cause for concern especially amongst the poor. Boys don’t require a dowry payment and their duty is to their parents. They will live with the parents and take care of them in old age. A girl (though loved) will cost the family a dowry and she will go to live with her in-laws once she is married providing no money or care to her parents. There is a saying in India that having a girl is like watering someone else’s garden. In Mumbai it is illegal to determine the sex of a fetus. Every hospital and clinic posts signage in Hindi, Marathi and English outlining this law. Some pregnant women from slum communities go back to their native village to end their pregnancies if they are worried about whether they can afford to have a girl. No paperwork is required and the fetus is disposed of.
Many babies in chawls or slum communities are born at home. Do you think it is important to give birth in a hospital?
Indu: Yes, because babies born at home usually don’t get identification or birth records.
Many people in slum communities don’t have birth certificates and do not know their own age or the age of some of their children. Illiteracy is high amongst the parents and they don’t recognize the need for paperwork despite the problems they have faced by not having identification.
Do husbands take part in the daily care of their babies?
Indu: My husband will hold Agya when he is at home, but he doesn’t bathe her, change her, or feed her.
Most fathers here don’t take part in the daily care of their children. Many women of certain castes don’t ever speak their husband’s names. Indu calls her husband, “Agya’s father”. When we asked her why, she said it would be very disrespectful of her to call him by his name.
Are Agya’s grandparents involved with her care?
Indu: My father and my brother have never met Agya. They are angry that I have a love marriage. At first my father and brother approved of my marriage but after I was married they refused to see me.They have only met my husband, Akhilesh, once. (Indu’s mother is deceased). My father-in-law lives in Kandivili (one-and-a-half hours by bus). He loves Agya and sees her when he can. If a family lives with the grandparents, the grandparents have the power in the relationship. The parents must obey what they say regarding school, discipline and sometimes baby naming.
Indu, with Agya bundled in her arms, accompanies us where ever we go day or night, six days a week, which includes slum homes, hospitals, clinics, schools and shops, helping us with translation and cultural issues and decision making on behalf of DWP. She often breastfeeds, expertly covering herself with a dupatta (scarf) while walking through rubble, loose electrical wires, broken cement and insane vehicle traffic. We spend hours in small homes sitting cross-legged on floors or in rickshaws transversing the city to meet people who require assistance from DWP. Agya loves being on the move in rickshaws, is always the centre of attention for us and for the children and parents we visit. Indu leaves her home every day with nothing but Agya wearing a tiny dress, a disposable diaper and a bonnet, bundled in a small blanket. There is no baby bag packed with extra clothing or diapers or toys and astonishingly, Agya doesn’t need any of that stuff. She is content, happy, nourished and loved. She has gained weight steadily, is very healthy and active and obviously bright. With enormous amounts of love and attention from Indu and Akilesh (and us), Agya has flourished. She is 6 months old and she weighs almost 5 kilograms (11 lbs.). She is a beautiful child coveted by two loving parents who will strive to keep her nourished and educated enabling Agya to gain access to the “new India” that promises her so much more than her parents can imagine.
*Chawls are one to four storey blocks of homes – a home being one or two rooms maximum usually shared by numerous people in an extended family. Chawls are legal residences in Mumbai.