T.N. to take up ‘high-level discussion’ to check on practices of childbirth at home

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Tamil Nadu, a State that has achieved 99.9% institutional deliveries through sustained efforts over the decades, has a new challenge on hand: stray cases of couples “choosing” to have childbirth at home.

Worried that this could undo decades of efforts made to reduce maternal and infant mortality, the Health department is planning to take up a high-level discussion to handle such issues, while public health experts have called for amendments to the Tamil Nadu Public Health Act 1939 and invoking provisions of criminal laws against those involved.

According to the National Family Health Survey – 5 (2020-2021), institutional deliveries accounted for 99.6% in TN [99.8% in urban and 99.4% in rural] as compared to 98.9% in NFHS-4 [2015-2016]. NITI Aayog’s SDG India Index 2023-2024 put TN’s percentage of institutional deliveries at 99.98.

Of recent, there have been stray incidents of couples resorting to births at homes; something that has turned into a cause for concern for public health officials. T. S. Selvavinayagam, Director of Public Health and Preventive Medicine said, such practices were mostly due to misinformation online about births being safer at home without understanding the facts. Around 10 to 20% of the “natural delivery” can turn out to be a complicated one and there is every possibility of losing either the mother or baby or both, he added.

“This will reverse the gains that TN has made in maternal and child health care. This type of informal care practices without scientific basis will increase maternal and infant mortality/morbidity. Any delivery even in a non-high risk mother could turn into an emergency and there is every possibility that they may not get emergency obstetric care in time. The risk for the mother is mainly because of obstructed labour, postpartum haemorrhage and infection and for the baby it is mainly asphyxiation, birth injury and infection,” he explained.

Awareness creation is the solution, he said, adding: “We need to counsel them suitably on the safety and benefits of institutional deliveries for both the mother and baby. Everyone needs to understand that natural delivery is different from home delivery.”

“We are planning to have a high-level discussion to handle such types of issues,” he added. The official noted that there were no specific provisions under the Public Health Act to curb such practices. “However, we can propose action against the untrained person conducting delivery in unsafe conditions, endangering lives using other provisions,” he said.

A health official, who did not want to be named, said that such issues need to be addressed if the State aims at reducing Maternal Mortality Ratio to below 10 per one lakh live births in two years. “Over the years, the percentage of pregnancies requiring interventions is on the rise due to various factors such as metabolic disorders such as diabetes, hypertension, poor physical activity and diet. In such a situation, trying to go back to age-old practices without following science is unsafe,” he said.

K. Kolandaswamy, former director of public health, said the recommended rate for caesarean sections was within 15%. But high rates of caesarean sections have become an advantageous point for such “ill-informed groups” to campaign against institutional deliveries and to promote births at home. “We must take measures to reduce unnecessary caesarean sections,” he said.

While awareness is vital, he called for invoking provisions of Bharatiya Nyaya Sanhita 2023 (formerly Indian Penal Code) without fear as it endangered the lives of a woman and child. “Appropriate amendment to the Tamil Nadu Public Health Act is essential to ensure that maternal and child health are safeguarded,” he said.