Obstetric violence and complications of childbirth in healthcare facilities in Uttar Pradesh, India: contextualizing institutional birth experiences and practices towards dignity

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dc.contributor.authorAttawar, Dhiwya Suphal
dc.contributor.examiningcommitteeVarley, Emma (Community Health Sciences)
dc.contributor.examiningcommitteeLorway, Robert (Community Health Sciences)
dc.contributor.examiningcommitteePinto, Sarah (Tufts University)
dc.contributor.supervisorBlanchard, James
dc.date.accessioned2024-01-09T14:23:38Z
dc.date.available2024-01-09T14:23:38Z
dc.date.issued2024-01-08
dc.date.submitted2024-01-08T21:22:41Zen_US
dc.degree.disciplineCommunity Health Sciencesen_US
dc.degree.levelDoctor of Philosophy (Ph.D.)
dc.description.abstractMaternal, newborn, and child mortality and morbidity are declining globally with persisting regional disparities in survival. India accounts for a high burden of maternal and child deaths with the highest perinatal and early child mortality rates in Uttar Pradesh (UP). Decreasing mortality rates in India have been largely attributed to increased facility-based delivery. The rapid rise of facility deliveries worldwide, however, has revealed poor quality of care and widespread mistreatment of women during childbirth, particularly among marginalized, subaltern women. Obstetric violence is significantly associated with maternal complications, suffering, and trauma. Using a critical theory lens and ethnographic approach, this study examined the structural context and dynamics of obstetric violence and complications of childbirth – postpartum haemorrhage, birth asphyxia, and anemia – in public hospitals and community health centres in two districts in UP. The study drew on datasets from a larger hospital ethnography evaluation of a maternal and newborn initiative in UP. Multistage analyses of direct patient case observations, interviews, and hospital records data were centred on birth stories of twenty-two women patients to understand experiences and interactions of institutional actors. Obstetric and epistemic violence were pervasive across the continuum of intrapartum and immediate postpartum care including: physical/verbal abuse; neglect; erasure; non-consented interventions; and substandard care. Obstetric violence and birth complications were deeply entangled in complex assemblages of birth. Social and biomedical processes underlying obstetric care within contexts of scarcity contributed to systems of dysfunction and precarity. Violence emerged as relational and structured harms, mediated by biomedicalized, gendered, classed relations of power, synergistic with caste, religion, and age. Violence functioned as reproductive governance through routine disciplining, force, and coercion that were normalized within institutional cultures. Birthing women and healthcare providers negotiated hierarchical, hegemonic systems of institutional birth, facing various forms of othering and inhumane conditions of birth. Study findings point to a pressing need to reform the structural and relational contexts in which institutional birth violence and inadequate maternal and newborn care thrive. Actionable change requires: attention to robust governance and accountability structures; ethical engagement with frontline providers; and inclusion of birthing women’s knowledge towards birth justice and dignity.
dc.description.noteFebruary 2024
dc.identifier.urihttp://hdl.handle.net/1993/37957
dc.language.isoeng
dc.rightsopen accessen_US
dc.subjectdisrespect and abuse
dc.subjectmistreatment
dc.subjectrespectful maternity care
dc.subjectepistemic violence
dc.subjecterasure
dc.subjectsilencing
dc.subjectstructural violence
dc.subjectreproductive, maternal, newborn, child health
dc.subjectglobal public health
dc.subjectcritical ethnography
dc.subjectpostcolonial feminist theory
dc.subjectnew feminist materialism
dc.subjecthierarchy
dc.subjectpower relations
dc.subjectgender
dc.subjectcaste
dc.subjectcasteism
dc.subjectclass
dc.subjectdiscrimination
dc.subjectmarginality
dc.subjectsubaltern
dc.subjecthegemony
dc.subjectbiomedicalization
dc.subjectbiomedicine
dc.subjectassemblage
dc.subjectrelationality
dc.subjectprecarity
dc.subjectaccountability
dc.subjectreproductive justice
dc.subjectbirth justice
dc.subjecthuman rights
dc.subjectpostpartum haemorrhage
dc.subjectbirth asphyxia
dc.subjectanemia
dc.subjectsafe motherhood
dc.subjectskilled birth attendance
dc.titleObstetric violence and complications of childbirth in healthcare facilities in Uttar Pradesh, India: contextualizing institutional birth experiences and practices towards dignity
dc.typedoctoral thesisen_US
local.subject.manitobano
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