Respect, companionship, and active labour support throughout the birthing process
Required & Recommended
Interventions based on clinical evidence, if and when needed
Informed & Collaborative
Awareness of rights, choices, and quality of care
Too much, too soon, or too little, too late
Today, India's birthing process demands transformative change.
India suffers from a dehumanised maternal care system. Unnecessary medical interventions have become increasingly common, and women frequently go home regretful, disillusioned and in pain. On the other extreme, millions of women still have insufficient access to basic, yet required, medicines, protocols, and evidence-based interventions that save lives.
Population-level caesarean rates should be between
10-15%Boerma, Ties, Carine Ronsmans, Dessalegn Y Melesse, Aluisio J D Barros, Fernando C Barros, Liang Juan, Ann-Beth Moller, et al. 2018. “Global epidemiology of use of and disparities in caesarean sections.” The Lancet 392 (10155): 1341–48. https://doi.org/10.1016/S0140-6736(18)31928-7.
but in India, caesareans are increasingly overused.
Nationally, the richest quintile of women have a 35.9%Boerma, Ties, and Carine Ronsmans. 2019. “Global epidemiology of use of and disparities in caesarean sections – Authors’ reply.” The Lancet 394 (10192): 25. https://doi.org/10.1016/S0140-6736(19)30698-1. caesarean rate.
On the other extreme, the rate among the poor is only 4.4%Boerma, Ties, and Carine Ronsmans. 2019. “Global epidemiology of use of and disparities in caesarean sections – Authors’ reply.” The Lancet 394 (10192): 25. https://doi.org/10.1016/S0140-6736(19)30698-1., indicating insufficient access to life-saving surgery.
India’s growing caesarean epidemic is highly visible in state-level caesarean rates, which are now as high as
61%IIPS, International Institute for Population Sciences. 2020. “Fact Sheets: Key Indicators, National Family Health Survey (NFHS-5) 2019-2020.” http://rchiips.org/NFHS/NFHS-5_FCTS/NFHS-5 State Factsheet Compendium_Phase-I.pdf%0A.
Overuse of caesareans is particularly acute in private hospitals. State-level c-section rates in the private sector are now more than 80%IIPS, International Institute for Population Sciences. 2020. “Fact Sheets: Key Indicators, National Family Health Survey (NFHS-5) 2019-2020.” http://rchiips.org/NFHS/NFHS-5_FCTS/NFHS-5 State Factsheet Compendium_Phase-I.pdf%0A. in Jammu & Kashmir, Telangana, and West Bengal.
In India, episiotomies are the norm and are cut for
85%Singh, Shalini, Tushita Thakur, Nomita Chandhiok, and Balwan Singh Dhillon. 2016. “Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India.” Indian Journal of Medical Research 143 (4): 474–80. https://doi.org/10.4103/0971-5916.184304.
of first time mothers, as per a study in 18 tertiary care Indian hospitals.
This is despite WHO guidelines, which recommend that episiotomies are restrictedWHO, World Health Organization. 2018. WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=F0122F15C7E3B553540C8128FC6A1F13?sequence=1 and used only when medically needed.
A restricted episiotomy policy results in 30%Jiang, Hong, Xu Qian, Guillermo Carroli, and Paul Garner. 2017. “Selective versus routine use of episiotomy for vaginal birth.” Cochrane Database of Systematic Reviews 2 (February). https://doi.org/10.1002/14651858.CD000081.pub3. fewer women with severe perineal trauma.
EXPECTING MOTHERS ARE AS IMPORTANT AS THEIR NEWBORN BABY!
Together, we can ensure that every pregnant woman receives the right treatment at the right time.JOIN THE MOVEMENT
OUR FOCUS AREAS
At Aastrika, we believe that midwifery is key to resolving the dual challenge of ‘too much, too soon’ or ‘too little, too late’. Across our initiatives, our efforts and resources are channelled towards establishing professional midwives as an essential cadre in India. Our goal is to ensure that midwifery becomes mainstream and every woman has the choice of midwifery care, the knowledge to make a choice, and the agency to select for herself.
We host Aastrika Sphere, a collaborative digital platform to support capacity building of maternal healthcare workers and improve maternal health outcomes across India. Implemented through alliances with like-minded partners and development sector experts, this is an instance of Societal Platform thinking, a way to address societal challenges at scale, with speed, sustainably. A key focus of this initiative is to ensure respectful maternity care for all birthing women.
CENTER OF EXCELLENCE
Aastrika Midwifery Centre, a Bangalore based centre of excellence for maternal care, launches at Vasavi Hospital in September 2021. Aastrika Midwifery Centre will adhere to ethical, evidence-based clinical guidelines and practices, setting the benchmark of expectations for pregnant women. The centre will focus on achieving optimal clinical outcomes, and ensure that every mother is treated with respect before, during, and after delivery.
We strive to increase awareness and knowledge of quality maternal care in India. As an organisation dedicated to the empowerment of women, we work towards educating expecting women about their basic human rights in childbirth, hoping to inspire change at a larger societal level, and urging people to question unethical practices.
As a part of the larger ecosystem of Nilekani Philanthropies, the inspiration for Aastrika comes from Janhavi's personal experience, under the mentorship of a reputed, socially minded family.
Dr. Janhavi Nilekani
FOUNDER AND CHAIRPERSON
“I spent part of my pregnancy in the US, and the rest, including childbirth, in India. As an expecting mother, I was appalled at the quality of care that is considered ‘adequate’ and ‘acceptable’ in our country. My sheer dismay and frustration kindled a desire to champion change, to empower women. In India, we accept that the price of becoming a mother is either a cut to the uterus or a cut to the vagina. Dissatisfaction with this ‘new normal’ led me to do further research, and learn more about a process that leaves women disempowered, yet seems to rarely trigger complaints.
Our system is rampant with abuse, poor clinical quality, and disappointingly low aspirations. As a mother and more importantly, an Indian woman, I feel strongly about the widespread lack of respect and dignity in maternal care. My personal experience, and my overall discontent with the desensitised system, inspired Aastrika. I hope, through this initiative, we can help transform maternity care so that every woman has a positive birthing experience.”