Trigger Warning: obstetric violence, communal violence/rhetoric, abuse
The last few decades have seen the Indian government implement numerous strategies and programs to increase institutional births to reduce instances of maternal mortality. But an institutional delivery does not always translate to safe and respectful delivery. Harmful stereotypes about the Muslim community, propelled by State propaganda, have rendered Muslim women vulnerable to dehumanising and neglectful treatment at the hands of medical practitioners in public health facilities.
Shahida with the women of Astitwa NGO (third from the right)
Nausheen*, 35, is a mother of nine from UP’s Chitrakoot district. In 2012, while pregnant, she fell severely ill with a high fever and nausea. With the pain continuing unabated in the following days, Nausheen, a daily wage worker, decided to go to the nearest public hospital on foot for a check-up. A simple trip to the hospital soon turned into a cautionary tale when the doctor forcibly aborted her foetus and sterilised her.
She recounts, “I told the doctor I didn’t want an operation; I needed medicine for my fever, but she didn’t listen. She kept telling me it was for my good.” The doctor had coerced Nausheen and her husband to sign a document, the contents of which they could not read. Within moments of signing the document, three women held Nausheen and took her inside a room while her husband was forced to wait outside. Inside, the staff operated on Nausheen, aborting her foetus and permanently sterilising her.
“I was treated worse than an animal. I was in so much pain, but instead of administering pain relief, they stuffed my mouth with the pallu of my saree to muffle the noise. Eventually, I fainted on the operating table.”
After the operation, Nausheen’s health took a turn for the worse, and her family rushed her to Allahabad for treatment. The treatment costs was borne by her family, who went into debt after the ordeal. Once her health stabilised, Nausheen approached SAHAYOG, a health-based NGO in Lucknow, to seek justice. Representatives from the NGO, along with the media, started building pressure on the hospital to take action against the doctor in-charge of Nausheen’s case, but they soon discovered deeper and much greater malice.
Pravesh, a social worker from SAHAYOG, told the Mojo Story: “The hospital administration expressed no regret over what happened. Instead, they said that they approved of the doctor’s actions. They reasoned that despite being poor, Muslims give birth to many children. It’s because of this reason their children become terrorists.”
Using the communally loaded word “terrorist” instead of “miscreant” or “troublemaker” indicates that more than Nausheen’s class location, her religious identity exposed her to the illegal surgical procedure. It also suggests that a deep distrust of the Muslim community and its loyalty to the Indian nation-state fuels fears regarding its population size.
The collective support from the hospital administration shielded the doctor from facing any consequences for her actions. Despite several months of sustained efforts by SAHAYOG, the doctor was simply transferred to another district, with the freedom to resume practice.
Shahida, 40, is a mother of three from UP’s Muzaffarnagar district. In 2021, after suffering a miscarriage, she visited a private clinic to seek medical help. However, upon learning that the procedure to remove the foetus would cost Rs. 6,000, she returned home with mere painkillers.
Shahida shared, “We are poor people. Spending Rs 6,000 on a procedure that wouldn’t even save our child’s life did not make sense. My husband promised to take me to the Muzaffarnagar District Hospital in the morning, so I took the medicines and somehow made it through the night.”
The next day, around 3:00 pm, Shahida started experiencing severe pain in her lower abdomen. She was rushed to the District Hospital, located an hour and a half-hour away from her home. The staff at the hospital told Shahida not to bring her husband along with her, as only female companions were allowed inside. For approximately two hours, the hospital made a pain-ridden Shahida stand in a queue to receive a blood bag. She also had to go through multiple tests, during which she was treated disrespectfully by the staff based on her attire.
“The staff treated me like I was dirty. One of the nurses refused to touch the container with my urine sample. Instead, she used a long straw-like instrument and took the urine out of the container, and asked me to throw the container in the dustbin. Despite knowing how much pain I was in, she kept screaming at me to stand away from her saying, ‘Door khari reh, meri chhati par mat chari jaa. Apna mask dhang se phen.”’ (“Stand away from me, don’t come close. Properly wear your mask.”)
At around 5:00 pm, Shahida finally entered the waiting area, where she discovered that the nurses were charging each patient an arbitrary sum in exchange for their services. Out of desperation, Shahida paid Rs. 5oo to one of the nurses, hoping this might help quicken the process. Unfortunately, no doctor came to see Shahida until 10:00 pm, and when she protested in helplessness, the nurse screamed at her: “Chup chap padi reh! Chudwa kar aa gyi, ab yahan aake chila rhi hai.” (“Keep quiet and lie down! After enjoying sex, now she is screaming.”)
Shahida recalls, “I broke down at that point. I could not believe the way she was talking to me. The blood bag that I was carrying in my hand all day had also gone bad, but nobody came to see me. At that moment, I knew I had to leave, or I would die.”
With the help of a family member, Shahida managed to escape from the hospital. While on her way out of the hospital, she discovered that the hospital staff had thrown her sandals away. Bare-footed in the middle of the night, Shahida was forced to return to the private clinic near her house, where she finally had her operation.
In retrospect, Shahida believes that the myth of the “dirty”, “disease-carrying”, and “uneducated” Muslim – exacerbated during the Tablighi Jamaat controversy – was partly at the root of her ordeal. She shared, “The practise of chua-chut (untouchability) is rampant in government hospitals. Instead of spending our hard-earned money on our children’s education, we are spending it on treatment in private hospitals.”
In 2017, Naseem*, 28, lost her first child while struggling to receive treatment. One early morning, around the nine-month mark, she started experiencing intense pain in her lower abdomen and was rushed to the nearby government hospital in Purkazi, UP. At the hospital, the nurses treated Naseem with contempt. She recalls, “They said to me, ‘Tum log har roz aa jate ho bacha karwane. Humein subah subah parenshan kardiya; neend kharab kar di humari.’” (“You people [Muslims] come to the hospital every day for delivery. Early in the morning you have come to disturb us; you spoilt our sleep.”)
While screaming at her for increasing the caseload at the hospital, the nurses made Naseem lie down and conducted multiple vaginal examinations on her without her consent. She shared with the Mojo Story, “I was already in so much pain, but instead of helping me, they only made things worse. Whenever I screamed in pain, they grew harsher, inserting their hands inside me with even greater force.”
Seeing Naseem in pain, her family protested; only the staff didn’t care; they asked them to shift her to another hospital if they had a problem. But by the time they transferred her to a private hospital, the child had already died in the womb. The hospital charged Rs 50,000 to conduct Naseem’s operation; the family is yet to pay off the debt.
Shadab, the coordinator of Astitwa Samajik Sanstha (henceforth referred to as Astitwa), a civil rights organisation working with Muslim and Dalit women in UP, shared, “While it is true that government hospitals are frequently understaffed, pushing those working on the front lines to the brink of exhaustion, the treatment meted out to Muslim and Dalit patients is a result of deep-seated prejudice and a gross sense of impunity.”
According to social workers in UP, the crisis of accountability within the health sector has become worse in the last five years. Sunita Singh, Program Officer at SAHAYOG, Lucknow, told the Mojo Story, “Doctors in an UP don’t even pretend to listen to us now when we go to them with our grievances. The situation has become so bad that in the district of Gorakhpur, the number of people visiting Primary Health Centres has dropped significantly because of this.”
It is especially difficult to seek accountability from doctors when the State itself is actively aiding and abetting misinformation, especially against the minorities.
Perpetuating Stereotypes Through Politics
From March 14 to 16, 2020, the members of the Tablighi Jamaat, a transnational religious missionary movement seeking to encourage Muslims to be more religiously observant, met in Delhi for their annual consultations. A day prior, the AAP-led Delhi government, on 13 March, banned “all sports gatherings (including IPL)/conferences/seminars beyond 200 people” to contain the spread of COVID-19. Three days later, the government clarified that the ban would also apply to religious gatherings. By then, the program in Delhi had already ended.
Even though the Home Ministry, as early as March 21, 2020, had written to all states and union territories to screen and test foreign members of the Tablighi Jamaat who had travelled across India, the media started extensively commenting on the matter more than a week later. Until then, all eyes were on the migrant crisis resulting from the all-India lockdown announced by the Prime Minister a few days prior. The news of the highest single-day spike in infection broke on March 30, and almost immediately, members of the BJP linked the surge to the Tablighi Jamaat. The Joint Secretary of the Ministry of Health and Family Welfare, Luv Agarwal, insinuated that the congregation in Delhi caused the spike in COVID-19 cases.
BJP IT cell chief, Amit Malviya, stated that the congregation in Delhi was part of an ongoing “Islamic Insurrection” that started with the anti-CAA protests at Shaheen Bagh, Delhi. The Minority Affairs minister, Mukhtar Abbas Naqvi, called the actions of the Jamaat a “Talibani crime,” adding, “When the entire country is fighting against Corona, such a sin is unpardonable.”
Further, in early April, the BJP-led UP government introduced a column dedicated to the number of positive cases detected among Tablighi Jamaat participants in its daily press statements. At one point, Additional Chief Secretary (Home Department) of UP, Avanish Kumar Awasthi, went so far as to say that 159 out of 305 people who tested positive in UP were participants of the Tablighi Jamaat. It is imperative to bear in mind that claims about Jamaat’s contribution to the overall caseload in UP were made when the testing rate in the state was close to 0.9 samples per 1,000 people (as of May, 2020), one of the lowest in the country.
It is now widely recognised among the scientific community that the large number of positive cases associated with the Tablighi Jamaat incident was misleading as authorities did not trace other events of similar nature as aggressively. Since people belonging to one group were tested widely, even as the overall testing rate in the country remained low, many of the positive cases got attributed to the Jamaat. The State used the sampling bias to propel hate against the Muslim community, blaming them for spreading the virus.
Instead of holding the government accountable for blatant religious profiling, the mainstream media used the occasion to perpetuate harmful stereotypes about the Muslim community. In exchange for heady fanaticism, the government’s failure to test international attendees of the Tablighi Jamaat at the time of entry and the mistake of permitting people to fly in from COVID-19 hotspots like Indonesia and Malaysia were allowed to slide.
The Tablighi Jamaat controversy, manufactured by an incompetent government and its supporters in the media, exacerbated Islamophobia within the healthcare system across the country. At the Civil Hospital in Ahmedabad, Gujarat, COVID-19 patients were segregated based on their religion, with Muslim patients being relegated to a separate ward away from Hindu patients. While the hospital claimed that the decision was based on state government orders, the Health Minister denied the government’s involvement. According to a report, published by Bebaak Collective, a civil rights organisation, pregnant women from Muslim-dominated settlements were denied care in several state-run hospitals in Madhya Pradesh based on the assumption that they were carriers of the virus.
Hasina, the founder of the Bebaak Collective, shared, “The aggravated sense of stigma endured during COVID-19 has greatly undermined the Muslim community’s trust in the healthcare system. It will take an immense effort to restore that trust again.”
However, based on recent political developments across BJP-ruled states, it seems the Tablighi Jamaat controversy was only one among many strategies devised in recent times to deny members of the Muslim community their right to exist with dignity.
The UP Law Commission, under the supervision of Justice Aditya Nath Mittal, submitted the draft bill of the Uttar Pradesh Population (Control, Stabilisation and Welfare) Bill 2021 to the Chief Minister in August last year. The Law, if introduced, will prevent individuals with more than two children from contesting elections at the local level, applying for or getting promoted in government jobs, and accessing government subsidies.
Mittal, who has previously spearheaded the law commission reports on unlawful religious conversions and cow protection in the state, has claimed that the proposed law on population control in UP does not seek to target any particular community. However, given the latest scientific evidence on the matter and the state government’s track record vis a vis the Muslim community, it is not difficult to guess why Mittal’s claims about the innocuous nature of the proposed policy are a hard sell.
According to the fifth National Family and Health Survey (NFHS-5), the Total Fertility Rate (TFR), or the average number of children born to a woman, has declined from 2.2 in 2015-16 to 2.0 in 2019-21 at the all India level. This indicates that for the first time in India’s history, a generation is not producing enough children to replace itself, a factor that will eventually result in an outright reduction in population. More specifically, UP’s TFR has declined from 2.7 in 2015-16 to 2.4 in 2019-21. These figures imply that, even without a population control law, people in the state are using contraception and participating in family planning.
Despite the evidence, members of the BJP and its sister organisations frequently engage in loose talk with the intent to not only evoking the boogey of population explosion but also generating fear about a looming demographic boom among India’s Muslim community. In 2015, the former president of Vishwa Hindu Parishad, an affiliate of the Rashtriya Swamsewak Sangh (RSS), the ideological progenitor of the BJP, claimed that the alleged practise of “love jihad” should be viewed as an act of demographic aggression. More recently, the Chief Minister of Assam, Hemanta Biswa, while announcing the two-child policy in the state, claimed that controlling the growth of the Muslim population is the only way to eradicate illiteracy and poverty among the group.
The Hindu-right’s relentless efforts to spread misinformation and stoke communal tensions took a violent turn during the recent Dharm Sansad in Haridwar, Uttarakhand, where hardline fundamentalists, right-wing activists, and Hindutva organisations came together to give incendiary speeches that, among other things, called for the massacre of Muslims. Yati Narsinghanand Saraswati, a senior member of the Juna Akhara and a former RSS pracharak (preacher), extolled the Hindu community to have more children and take up arms to protect themselves against Muslim aggression. Ashwini Upadhya, a senior member of the BJP, was also present at the event and helped inaugurate ‘Bhagwa Samvidaan’ (Saffron Constitution) with Narsinghanand.
Despite ample evidence, the BJP-led government in Uttarakhand is yet to take action against the key organisers of the Dharm Sansad or those who delivered hate speeches in Haridwar. Upadhya, too, continues to remain a respected member of the BJP.
State-backed Islamophobia, based on phoney scientific assertions, is aggressively infiltrating the health sector, endangering innumerable lives. Shadab of Astitwa told the Mojo Story, “After the police and the media, the medical fraternity has joined the State in actively suppressing and violating the Muslim community.”
The Challenge of Articulating Patients’ Rights
In 2018, the Ministry of Health and Family Welfare released a Charter of Patients’ Rights to prevent and address instances of medical misconduct within hospitals. The Right to Non-discrimination, which addresses discrimination based on illness, religion, ethnicity, caste, gender, sexual orientation, and geographic location, is eighth in the list of seventeen rights in the charter. While the list of patients’ rights is a step in the right direction, civil rights activists are not too hopeful.
Dr Brinelle D’Souza, Co-Convenor of Jan Swasthya Abhiyaan, observed, “Today’s political context does not allow for a genuine non-discriminatory policy. When you have the State, and its various elements, actively engaging in ‘othering’ and perpetuating hate against a special community, it is naive to assume that a list of rights will change anything.”
In the hope of avoiding discriminatory treatment, members of the Muslim community interviewed preferred to visit private hospitals whenever possible. The rationale driving such a choice is the belief that as private hospitals are running a business, they would want to retain customers as much as possible, reducing the chances of discrimination and prejudice. But along with being expensive, private healthcare can also be unsafe. The private healthcare landscape in India is deeply uneven, populated with millions of unregistered and untrained medical practitioners with thriving businesses. Private hospitals also have a financial incentive to carry out medical procedures regardless of whether they are of any benefit to the patient, endangering patients and pushing families into debt.
To break the cycle of disempowerment, Muslim women seek support from rights-based groups. Shahida, who recently became an active member of Astitwa, feels being part of an organisation has helped her gain a sense of strength. She shared, “I used to fear doctors a lot. I would avoid visiting them as much as possible. But ever since I joined Astitwa, I have noticed a difference in myself. I am no longer afraid of raising my voice and people, especially those in power, listen to me when I tell them I am part of Astitwa.”
At this point, it is perhaps necessary to state the obvious: on the pretext of protecting Muslim women, the BJP is using moot points such as criminalistaion of triple talaq, hijab ban, halal ban and, now, the Muslim demographic explosion to perpetuate harmful stereotypes against the community, rendering them vulnerable to acts of violence and political disenfranchisement. It is imperative that members of the larger civil society recognise the pattern, resist political indoctrination and support minority groups in their fight to protect their constitutional rights.
*Some names have been changed