Why don’t India’s feminists call out doctors doing unnecessary C-sections? | Mari Marcel Thekaekara

In India, childbirth has turned into a moneymaking racket, with caesarean sections pushed by unscrupulous medical practitioners in search of profit. Healthy young women who could easily have had normal, natural deliveries are lied to, told that they and their babies are at risk, and advised to have invasive surgery. Worried families feel helpless and afraid to refuse doctors’ orders. Thousands of women in even the smallest towns are put through this ordeal for no medical reason at all.

Until 2010, C-sections were limited to 8.5% of all deliveries in India, just under the recommended level of 10-15%, according to a World Health Organisation report. However, during the past decade the numbers have shot up. In Kerala, India’s most educated, aware state, 41% of deliveries are C-sections and Tamil Nadu, another relatively well-off state, has 58% of its deliveries by C-section, reports the ICMR School of Public Health. Major cities in particular have seen an exponential growth in C-sections in both private and public hospitals, while one study revealed a rise from 31% to 51% over just six years in rural Haryana.

As a result, many women are taking unnecessary risks and young couples ending up in debt they can ill-afford and suffering financially for years. Why hasn’t there been a huge noise from Indian women’s organisations and female politicians about this issue? That is the question my daughter asked after she heard about a friend of a friend who had died after a C-section.

“Why does the feminist movement shut up totally when it comes to women and childbirth,” she asked. “Everyone’s vocal about everything connected to a woman’s body before she gives birth. But the minute a woman decides to become a mother, the silence is deafening. Does she cease to be a feminist because she decided to have a child?”

I was nonplussed. I’d never thought about this, in spite of having borne three children, two under pretty tough circumstances. But suddenly three decades of suppressed anger against the medical negligence I’d endured returned. After being admitted into hospital when my waters broke, I was ignored. I didn’t scream – as was considered “normal” – because I had a higher pain threshold than other women.

Finally after 12 hours, at 5am, the nurse appeared armed with a drip to put me on Pitocin, a drug to induce labour. “This is my third child and that drug will harm the baby. I know I’m at the end of the labour, not the beginning,” I pleaded. Ignoring my words, the nurse advanced determinedly, muttering, “Nowadays these patients think they know everything.” Desperate, I screamed, “If you bring that thing near me I will kick you.” Furious, she stormed off to call the head nurse. The senior woman approached me, reprimand ready. “What’s your problem? Why don’t you just obey the nurse?” she scolded. On examining me, her tone changed. “Oh my God,” she shouted, “the baby’s almost out. Rush her into the delivery room.”

My son delivered himself. The gynaecologist whose fees I’d paid for nine months was nowhere in sight. The nurse cut me badly. She then stitched me up and triumphantly announced to her helper “my first delivery”! I honestly wished I’d kicked her hard when I’d had the chance. It would perhaps have saved me a lot of post-pregnancy problems. At the end of 12 hours I was exhausted and weak, both physically and emotionally.

In traditional systems, women are encouraged to squat, because that was the most normal way for the baby to be naturally pushed out. In one tribal community in southern India, the women have a strong rope, like a bell pull, to hold on to while they squat in the final stage.

The rise in C-sections is not restricted to poorer countries. But in India the figures are particularly stark. Meenakshi Gautham, India country coordinator for a maternal and newborn health programme at the London School of Hygiene and Tropical Medicine, accuses private hospitals of being the most “scalpel happy”. Gautham’s survey says that the charges for the procedure, hospital stay and anaesthesia can range from about Rs5,000 (less than $ 75) in a government hospital to upwards of Rs40,000 ($ 600) in a private hospital.

Hope lies in the fact that some gynaecologists are now calling for change. Mumbai obstetrician Sheetal Sabharwal is co-founder of the Tulip Women’s Health Care Centre. She has been in the forefront of the ethical practitioners’ movement demanding that doctors and clinics charge an equal, flat fee for caesarean and vaginal births.

The sharply rising rate of C-sections, though, is only one of many issues surrounding birthing practices and pre- and postnatal care. Perhaps the rights of pregnant women and mothers will find their way into the International Women’s Day debates. They certainly should do.

Why don’t India’s feminists call out doctors doing unnecessary C-sections? | Mari Marcel Thekaekara

Can we stop talking about our bushes now? Feminists are needed elsewhere | Rhiannon Lucy Cosslett

How political are your pubes? It’s not a question most of us spend much time worrying about, yet when you’re a woman, how you choose to cultivate your lady garden sprouts up as a topic with tedious regularity. In its latest incarnation, the arbiters at Tatler magazine have declared the “freedom bush” back in fashion (those who sneer at the notion of the pudenda being subject to changing aesthetic trends would do well to remember that dark mid-noughties period: the “vajazzle years”). If even the conservative, conventional Sloane is cultivating a full bush then, it’s worth noting, that could indeed hint at a seismic shift in societal norms regarding pubic grooming. But equally, after years and years of the same “debate”, is it not time that feminist coverage in the media was directed elsewhere? In other words, magazine editors, enough already.

We are just emerging from a period that has seen a new generation embrace feminism in a way that the capitalist post-feminists of the 1990s could scarcely have imagined. Much of this has been powerful and positive: the conversation about the importance of sexual consent, for instance, and how it operates within a culture that continues to trivialise rape, has never been louder and more energetic. The fightback against street harassment has been equally inspirational. But at the same time a strand of feminism in the media has spent the last few years concerning itself with issues that many would dismiss as trivial, including pubes, and footwear, and 50 Shades of Grey, not to mention that perennial question that birthed a million op-eds: is Beyoncé a feminist or not?

As a writer, I have been guilty of entering into some of these debates. With an internet media run on opinion, feminist polemic can feel like one of the few journalistic avenues open to the young, aspiring woman writer (critiquing media sexism is how I began my own career, and I am grateful to it, but I have said my piece on women’s magazines). For a long while, talking about the more trivial aspects of the feminist debate – as opposed to, for instance, boring old domestic violence – was the only way to get feminism covered in the mainstream media.

But as time has gone on, the focus on the fluffy – so often to the point where it appears to be given equal billing to more urgent and distressing issues affecting women – has irked me, and other feminists writers, more and more. Perhaps it is because I have been in this game for a while now, and have thus seen the same topics recycled several times over with very little new being said (my friend and colleague Emer O’Toole wrote the definitive piece on female body hair several years ago – what could be left to say about it?). Or perhaps it is because I have grown up a tad in the past five years. But more than either of those two things, I would reason that this is a time when the need for feminism is making itself acutely obvious in all manner of ways. There is so very little to laugh about, to the point where even the notion of a “freedom foof” fails to raise a smile.

Donald Trump, a man with so much obvious contempt for women that it feels almost unbelievable – like watching a fictional dystopia play out on our TV screens – is running for president. Analysis has shown that, if women were excluded and only US men were eligible to vote, Trump would win the election. It is abundantly clear that there are millions of people who would rather have a fascist than a female as leader. We are told that women can achieve anything in this day and age – “so what are you whining about?” being the inevitable subtext. “Look at Hillary,” we are told, to which the inevitable rebuttal is: “Yes, look at Hillary. Look at what she is up against.”

Domestic violence shelters are closing due to funding cuts. Photograph: Murdo Macleod for the Guardian

There are other concerns, of course. The way the previous sexual behaviour of the complainant in the Ched Evans case was pored over during his successful appeal and in court this month has caused widespread dismay. Then there’s the closure of domestic violence shelters – 17% have closed due to funding cuts, 32 of which were specialist services for black and ethnic minority women, and 48% of 167 domestic violence services in England said they were running services without any funding. Two women a week are murdered by their partners or ex-partners, and vulnerable women such as female asylum seekers continue to be abused. There were 99 pregnant women held in Yarl’s Wood immigration removal centre last year. Three Serco workers are currently in court over the alleged rape of a Yarl’s Wood detainee. As a recent report noted, the harassment and abuse of young girls in schools is endemic.

I took part in a feminist debate this month, during which the broadcaster Jenni Murray recounted being turned down for a mortgage in the 1970s for no other reason than her gender; another speaker spoke about the murder of her friend at 18 by a boyfriend; and the DJ Clara Amfo expressed her frustration at being unable to articulate her anger about female oppression without being labelled an “angry black woman”. I returned home depressed and tearful. Faced with these sobering facts, is it any wonder, really, that so many people seek refuge in arguing instead about bikini waxes?

I’ve been to enough schools to talk to young women about feminism to know that feminist “fluff” can be an easy way to open a discussion – a “gateway drug” if you will, for those unfamiliar with the topic, or put off or intimidated by the stereotypes surrounding it. It’s important that teenage girls particularly question why it is they feel pressured into certain sexual behaviours. That issue does not go away once you declare that the “full bush” is back. The impact of pornography on the way young people conduct relationships goes way beyond a few wax strips, taking in issues of consent, coercion and abuse, objectification, grooming and revenge porn. It’s all cheerful stuff.

The personal is political, the feminists of the 1970s told us, and this has morphed into a strange kind of choice feminism where women are encouraged to examine their clothing, their footwear, their grooming, their behaviour, every little choice that they make, in order to assess whether it matches up. But the big picture is now so alarmingly vivid that it obscures these trivial questions. Freedom is never so easy to imagine as when it might be taken away. Most women know that our bushes have very little to do with it.

Can we stop talking about our bushes now? Feminists are needed elsewhere | Rhiannon Lucy Cosslett