This week, 35-year-old Asma lost her life hours after giving birth without medical supervision in her house in Kerala, the state with the lowest maternal and infant mortality rates in the country. Her husband, a self-styled conservative cleric, allegedly did not take her to the hospital despite her critical condition. It was her fifth delivery, of which three were home births. The police have arrested the husband on grounds of negligence and deliberate denial of medical care.
The trend of home births has been growing in Kerala, especially in Malabar and particularly among the Muslim community. The state recorded 2,94,058 births between April last year and February this year, of which 382 occurred at home. There were 17 stillbirths and 12 neonatal deaths among the babies born at home. Two mothers died this year because of the practice. Those who insist on home birth without medical support—though a small share of the population—threaten Kerala’s hard-won success in maternal and infant health. While India’s maternal mortality rate stands at 97 per 1 lakh live births, Kerala has reduced it to 19.
Medical experts have been demanding that home births without medical assistance be considered a ‘criminal practice’. But the government is unable to do much as they are very much legal, and it may be constitutionally seen as an infringement on free will if action is taken against those who opt for them. However, it is heartening to see the state government’s directive to district medical officers to file charges of culpable homicide against families if a woman dies from complications at home birth. One hopes it would serve as a deterrent.
A combination of religious orthodoxy and patriarchy is behind the increasing number of home births. A parent cannot unilaterally decide on home birth if it puts anyone’s life at risk. The mother and the baby are entitled to proper medical care—even at home. Families should not choose to avoid medical supervision even when they do not want to opt for institutional delivery. The health department must carry out campaigns to highlight the risks of unsafe childbirth practices and rope in religious leaders to support the messaging. The government and community leaders have a responsibility to protect lives.