For pregnant women gender injustice is THE obstacle to wellness.

#genderinequality #maternalhealth #storytelling #digitaldivide

United Nations Population Fund (UNFPA) has released its "State of World Population Report 2020" highlighting the scale and pervasiveness of gender injustice and stereotyping in the world today. The statistics are appalling and makes me at times wonder in despair why we continue to be stuck in medieval attitudes, beliefs and practices in the 21st century.

UNFPA advocates for a world where every woman and girl should be free to chart her own future. That’s a no brainer and why not! Yet, as the report highlights the reality is quite different. Causative factors are detailed in the report, and some of these are that we experience in Kushal day to day and work towards. For example, when we speak to family members of pregnant women, we are often told,

“Why does she have to learn what happens to her body in pregnancy? My mother and aunt live with us. They tell her what to do. They are who should make decisions for her and for us as a couple.”

It’s easy to get upset and react angrily. But to change mindsets of those who hold power and deny bodily autonomy demands patience. It can’t be done by sermonising, which is why we rely on story-telling, an effective tool for social change and by engaging male members of the family.

The report also presents data from 57 countries, stating that only 55 per cent of women aged 15 to 49 years who are married or in a union make their own decisions about sexual relations and the use of contraceptives and reproductive health services (UNFPA, 2020). We have some preliminary data to this affect as well, and continue to monitor so that we can come up with innovative ways and approaches to address gender related barriers.

For those who would like to know more about gender-biased sex selection, Female Genital Cutting and child marriage the report is a good read. However, I would have liked for the report to articulate strongly enough how and why it is essential to also address the digital divide in today’s world. To make a better case for leveraging technology effectively in order to facilitate autonomy, decision making and wellness in women.

You can also read Prof. Maya Unnithan's commentary who heads Centre for Cultures of Reproduction, Technologies and Health (CORTH) at Sussex University. She concludes by pointing out,

"Although rights have arrived, justice has not followed!"

"Men as husbands, fathers, policymakers, healthcare providers need to use their privilege to redress gender discrimination for greater social justice."

Pregnancy week 39 wellness guide

Week 39

Your body

changes in the body
What to expect

You feel increased pressure in your lower abdomen and may have severe back pain. On the other hand you could also have bursts of energy. There is likely to be a lot of vaginal discharge. If there is a small blob of mucus, it is likely to be 'show'. It is natural to feel anxious - when am I going to deliver?

Baby size

Honeydew melon - Week 39 size guide
What to expect
Your baby is about the size of a large green watermelon - approximately 48 cm long and weighs 3 kilos.

Your baby

Pregnancy weekly guide - baby size
What to expect
Your baby is full term – Congratulations! Baby has acquired birth weight and length and does not grow anymore. However, the nervous system and brain continues to develop rapidly. Baby even has eyelashes!

Taking care

Mission pageTaking care 2Our services page
Tips
Look out for signs of labour, such as -
  • Breaking of water or rupture of the membranes
  • Diarrhoea or nausea, which many women experience just before the onset of labour
  • Spurts of energy or nesting instinct
  • "Show", that is, the loss of the mucous plug (which seals the opening of the uterus)
  • Bloody show - streaks of blood
At this stage -
  • Keep track of foetal movements.
  • Learn how to differentiate between Braxton Hicks and labour contractions.
  • Keep practising relaxation and breathing techniques.
  • You may be advised (very likely in India) induction of labour by your doctor. In many other countries, doctors advise this procedure after 40 weeks.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions you may have
  1. I feel contractions. Are these labour pains? When do I need to go into hospital?
  2. What are the emergency signs I should look out for?
  3. How painful is labour!? Can I take medication for the pain?
  4. Is it okay to eat or drink during labour?
  5. Do I have to stay in the hospital? How many days will that be? Can somebody from my family be with me in the hospital?
  6. What do I need to bring to the hospital for my baby?

Your to do list

Todoicon
Actions
  1. Keep track of baby's movements
  2. Practice relaxation and breathing techniques
  3. Monitor contractions, foetal movements and level of pain
  4. Keep your hospital bag ready and close to the front door.
  5. Keep emergency and important phone numbers at hand.

Questions you may have

“All new mothers are offered a thorough physical examination for their baby within 72 hours of giving birth. The aim is to spot any problems early so that treatment can be started as soon as possible. Usually, nothing of concern is found. I know that my son’s eyes, heart, hips and testicles were examined.”

“I was frightened of going to the toilet at first because of the burning sensation! I then drank a lot of water and the stinging sensation I was feeling went. I was also constipated for the first few days.

There was some bleeding from my vagina. It was heavy at first and took a few weeks to decrease. The discharge turned brownish before stopping. I also got stomach cramps similar to period pains. I had a normal delivery and did not need stitches because I did not need to have an episiotomy."

Pregnancy week 38 wellness guide

Your body

changes in the body
What to expect
Are you having sleepless nights, a little anxiety and leaking breasts. That is not uncommon. You could also be having diarrhoea.It can be boring and you may be frustrated – you have waited for so long and can’t wait any longer for the big day! Rest assured, your body is preparing for the big day just as your baby is – the cervix (opening of the uterus) is dilating.There’s a chance you might meet your baby this week! Most women go into labour between 38 and 42 weeks.

Baby size

Watermelon
What to expect
Your baby is the size of a small Watermelon (roughly 48 cms and about 2.8 Kilos).

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby is preparing for birth and is ready to cry! His or her vocal chords have developed. Some  small but important changes like fine tuning of the nervous system are taking place.Baby has swallowed some amniotic fluid (the fluid in the sac) and that will be his or her first bowel movement.

Taking care

Mission pageTaking care 2Our services page
Tips
  • Call your doctor or hospital at any time if you have worries about your baby, such as,  your baby’s movements.
  • You need not worry too much about going past the due date. Only about 5% of babies are born on their due date.
  • Your mind must be racing with many thoughts and you may be not be able to sleep. Read a magazine or do something that you find relaxing.
  • Wear loose clothing that keeps you cool and comfortable.
  • Go for a walk – gentle and easy without straining your ankles or knees. A gentle walk can help your baby get into position.
  • Practise meditation and relaxation techniques to help you cope with pain during labour.
  • Staying rested, relaxed and positive will help you.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions
  1. Is it okay that my water hasn't broken as yet?
  2. I have high blood pressure. What are the risks I or my baby can have during or just after delivery?
  3. What happens if I go beyond 40 weeks of pregnancy?
  4. What is a caesarean section?

Your to do list

Todoicon
Actions
  1. Check and count foetal kicks.
  2. Double check hospital bag is ready.
  3. Have folic acid supplement and prenatal vitamins.
  4. Book antenatal appointment with doctor.
  5. List who needs to be contacted to inform that baby has arrived.
  6. Find out the hospital layout -entrance to labour room and which entrance to use after hours.

Questions you may have

“ At this stage, loose bowel movement is nature’s way of making enough room for baby to emerge. After months of feeling constipated it's just the opposite now! Your baby could be born any day! At this point I was asked to drink lots of water and eat lightly.”

“Swollen feet or oedema affects about 75% of pregnant women and usually starts around week 22 to 27 of pregnancy and stays until birth. Mild swelling is harmless and normal. However, if there is excessive and persistent swelling and your blood pressure has gone high contact your doctor immediately.”

Pregnancy week 37 wellness guide

Your body

changes in the body
What to expect
You may notice your breasts leaking some fluid. This is normal. You are also likely to be getting a lot of vaginal discharge. You feel emotional – you have done well and the big moment is to arrive.  Congratulations! Your baby is ready to be born. You may have to wait though as baby may take a few more days or weeks to appear. If this is not your first pregnancy, your baby may not move down until labour. In case you are carrying twins you are likely to give birth this week.

Baby size

Jackfruit
What to expect
Your baby is the size of a Jackfruit (about 47 cms long and 2.8 Kilos in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby is likely to be head down facing your back. 95% of babies are in this position. Baby is also practising facial expressions, such as frowning, smiling  and silent crying. Not to worry, this is not related to sadness or happiness!He or she is now big enough and mature enough to survive the outside world. Baby could come into the world any day!

Taking care

Mission pageTaking care 2Our services page
Tips
  • Know the signs that labour may be starting.
  • Know when to go to the hospital.
  • When you're sitting down, try leaning forwards, with your hips above your knees. It's a technique some say can help a baby get into position.
  • Don’t stop drinking water – 8 glasses a day.
  • There are many daily routine things you might be worrying about. Ask a family member to help keep track with you.
  • Establish a routine if you have been advised bed rest. It makes it easier for you and have magazines, books, your phone and the TV remote at arm’s length!
  • Don’t get annoyed if people keep reminding you that you won’t be sleeping well for a long time! They are just trying to be helpful!! You will be getting a lot of personal advice.
  • Learn more about what happens on labour day – this will help you to deal with terrifying thoughts that you may have.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. What position is my baby in? Is my baby okay?
  2. What are the signs of labour?
  3. I am feeling quite anxious. What do I do?
  4. What are my options for pain relief during birth?
  5. Do I need another scan?

Your to do list

Todoicon
Actions
  1. Make sure of the travel arrangements to get to the hospital.
  2. Have all important telephone numbers in one place and at hand.
  3. Get baby’s items ready – clothing and bedding.
  4. Book appointment with doctor.
  5. Talk about labour and birth with your husband or partner and ask for the kind of support that you would like to get.

Questions you may have

“There are several signs that labour might be starting – contractions, ‘show’ that is when a mucus plug comes away, your waters breaking and a lot of back ache. Most women go into labour within 24 hours of their water breaking.”

“The majority of women don't have an episiotomy. In the early days it was quite common practise believing that it could make delivery easier or to prevent tearing during delivery.

In some cases surgical cuts are necessary, such as, if your baby's heart rate drops and birthing needs to be hurried."

Pregnancy week 36 wellness guide

Your body

changes in the body
What to expect
You are getting aware of the tightening sensations or Braxton Hicks contractions that keep coming. You may not feel like going to your antenatal appointment because it’s such an effort, but make sure you do as it is very important! At your antenatal appointment your doctor will check on your blood pressure, urine, and the size of your bump. You must be wondering or even anxious about what will happen on the day of delivery. Find out from your doctor!Interestingly, you might feel this urgent need to keep everything tidy, organise the house and clean up. Its normal feelings in preparation for baby to arrive. But don’t overdo it!

Baby size

Lettuce leaves
What to expect
Your baby is the length of Lettuce leaves (roughly 46 cms long and nearly 2.5 Kg in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby’s digestive system is fully formed. He or she can suck and digest your breast milk. Baby’s lungs are also fully formed and ready to take the first breath of air. Your baby’s ears are extra sharp and he or she has started recognising your voice and the songs you sing. Overall, your baby’s growth has started slowing down.Baby looks like an infant with puffy ankles and chubby little legs!

Taking care

Mission pageTaking care 2Our services page
Tips
  • Make sure you attend your antenatal appointment with your doctor.
  • Do some pelvic exercises and keep your hips elevated to help with lower back pain. You can also apply warm compress to your lower back.
  • Take frequent rests between doing domestic chores and as many naps as you can in preparation for the big day.
  • Recognise the signs of labour. Contractions becoming longer, stronger and more frequent can be a sign that labour is starting. When contractions are a regular pattern, coming every 5 minutes and lasting at least 60 seconds, it’s time to go to the hospital!

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. What are the signs of early labour?
  2. Is my baby in the right position?
  3. Do I need to have a Vitamin K injection just after giving birth?
  4. I get contractions. Am I going into labour?
  5. What are my options for pain relief during pregnancy?
  6. What can I do in preparation so that I can breast feed?

Your to do list

Todoicon
Actions
  1. Take your iron supplement and prenatal vitamins.
  2. Book an antenatal appointment with your doctor and visit your doctor with a family member for your antenatal appointment.
  3.  Find out about breast feeding from your doctor.
  4. Check if your hospital bag is packed and ready.

Questions you may have

“It’s a myth that nursing comes naturally to mothers at birth! You need to know how to position baby, how to know if baby is getting enough milk and when the next meal is due. There is a bit of trial and error. When you first deliver, you will be producing colostrum, which is a thick, yellowy fluid full of vitamins, proteins and minerals to help your baby ward off harmful bacteria and infections. Doctors will advise that you feed your baby colostrum within the first hour of delivery. Ask your doctor more about
breast feeding. ”

“Antenatal classes help expecting mothers and their husbands with relevant information in relation to keeping healthy during pregnancy, what is best for your baby, how to prepare for birth and to explore any fears that women may have around labour and birth. The information helps you make right choices for you and you also get to meet other expecting mothers and couples.”

Pregnancy week 35 wellness guide

Your body

changes in the body
What to expect
You are nearing your term. However, labour starting before 37 weeks is considered premature and baby will need special care in a hospital. You would have started discharging colostrum (first milk, which is yellowish) in preparation for your baby. Colostrum is important for your baby’s protection against infections.Physically, you could be achy especially with sore ribs and getting severe headaches. Also, wanting to go to the bathroom comes with a feeling of urgency!

Baby size

Melon
What to expect
Your baby is as big as a Watermelon (roughly 45 cms long and 2.2 Kilos in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby’s skinny arms and legs have got plump. She/he has little space but movements still take place, which you may be able to see. Legs are likely to be curled up. Baby is continuing to gain weight and will do so until delivery day. At this stage, baby’s brain is developing rapidly.

Taking care

Mission pageTaking care 2Our services page
Tips
  • You need to slow down now – reduce stress and do not over exert yourself.
  • Lean forwards to completely empty your bladder as much as possible.
  • Practice your pelvic muscle exercises.
  • Step out of the room to get fresh air if it feels stuffy. This can help prevent a throbbing headache.
  • Call your doctor if you notice any significant change in your baby’s movements.
  • Let your doctor know if you are feeling anxious or depressed.
  • Share with your husband or close family members what you would like during birth. Your loved one staying with you and beside you when in labour will be a big support.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. Do I need a whooping cough injection?
  2. When should I have contraception in place?
  3. How can I prepare for delivery?
  4. When should I go to the hospital?
  5. Is my baby’s position okay?

Your to do list

Todoicon
Actions
  1. Monitor facial swelling.
  2. Get weight checked and assessed.
  3. Have folic acid supplement and prenatal vitamins.
  4. Book antenatal appointment with doctor.
  5. Learn what to do first few days of breast feeding.

Questions you may have

“A plan that lists which hospital you want to give birth in, who you want to be with you during the birth, and what facilities you'd like to use. You can also ask your doctor what options you have for pain relief, what positions you could give birth in and then decide. In countries with higher chances of maternal mortality WHO strongly recommends hospital delivery.”

“You are having to make and go through many changes during pregnancy for your little one. Your husband can be supportive by also making adjustments alongside you. For example, to quit smoking and drinking alcohol, be more aware of what happens during pregnancy, go to antenatal classes like the Kushal wellbeing workshops and plan for the day of delivery, such as, arranging transport.”

 

Maternal health in India

Maternal health in India

Maternity is joy. However, pregnancy comes with risks. Physical, mental and emotional issues in addition to weak health systems can take a toll on expectant mothers. The journey of pregnancy until childbirth is beset with barriers that women face. Maternal health in India may have improved in the last two decades, but there is a long way to go. Studies show that 74% of mothers have experienced pregnancy specific anxiety (British Medical Journal) and 25% of pregnant women suffer from prenatal depression, mostly between 18-32 weeks of pregnancy (The Lancet). Women can be unaware of what to expect, and usually are not told about danger signs to look out for or precautions to take.

A woman's health and wellbeing affects her unborn baby too. In fact, most of the issues that newborns are affected by can be prevented by adopting often simple measures during pregnancy. By raising awareness and supporting women to take measures for their health and wellbeing  during pregnancy, neonatal morbidity and mortality can be reduced.

Our pregnancy health and wellbeing guide aims to address and support women on wellbeing issues during pregnancy.

maternal health in India

The COVID-19 pandemic is taking a heavy toll on women's health and wellbeing during pregnancy. Read more here.