It was 11:30 PM when I received a call from Reema’s* mother-in-law. They belong to one of the villages in Panna, Madhya Pradesh where Project Koshika runs a health intervention. Reema complained of severe stomach ache, nausea and fever. I pulled out my notes to see whether her due date was approaching.
She was only in her 7th month of pregnancy so I wasn’t sure if her labour had already been induced. However, I had to keep in my mind that Reema was a 13-year-old girl. She herself was a child giving birth to another child. Not only was she underage but was also going through treatment for low blood levels. While getting Reema’s ante-natal checkup done, the gynaecologist told me that Reema’s uterus was unable to support a 9-month-old baby (a 9 month old, healthy child typically weighs anywhere between 2.5 kg to 3.5 kg) and that the baby would likely be born in the 7th or 8th month. I feared that the baby could need to be delivered soon. Her mother in law and I had a slight communication gap since she was speaking in old style Bundeli. Upon realizing that I am not getting the entire information clearly, I called up our village facilitator asking her to go over to Reema’s place and describe her symptoms back to me. Some probing questions made me realise that she was, in fact, in labour. All of her symptoms checked out:
- Constant urge to urinate
- Pain in lower back and belly that won’t go away
- Feeling of nausea (might or might not be experienced during labour)
- A mucus discharge, usually red in colour (this is the mucus plug from the cervix that comes away when it’s time to deliver)
Premature delivery has its own share of complications, mostly for the child. However, in this case, we had to be extra cautious keeping in mind Reema’s age. The first step in such a case would be to notify the ASHA of that village, who would then make a call for an ambulance to assist the mother to a nearby facility. Unfortunately, in this case, the ASHA stays 8-10 kms away, where there is no network. Given the fact that the ambulance service here is in shambles, we had to look for alternatives. Not only is there a dearth of vehicles, the drivers outrightly avoid going to these interior villages because of the rocky terrain and risky forest routes.
They often ask the families to travel till the main road but in this case, Reema was in no condition to move. The facilitator made an effort to persuade the driver to come all the way to the village. He responded, “Do ghante bhi lag sakte hai aur usse zyada bhi, kuch keh nahi sakta.” (Getting there can take two hours or longer, I can’t say). At this point, we opted against waiting for the ambulance and asked our team member who drives us to our field location, to go get Reema in our own vehicle.
Within ten minutes of him leaving, I got a call from the mother-in-law. She said, “Didi, ladki huyi hai!” (it’s a girl) with so much joy. Even though I was delighted to hear this, I couldn’t help but be concerned about Reema and the baby. I contacted our team member to let him know that she had already given birth, but we decided to get her to Panna district for a postnatal checkup and to also to keep an eye on the baby’s vitals and birth weight.
It was at 4:30 in the morning when we got her admitted and to no surprise, the child was underweight. Merely a 1.6 KG. We quickly got the baby admitted to SNCU (Special Newborn Care Unit). It took her nine days to get off the oxygen and start breastfeeding. Reema seemed to be doing good as well. The doctor discharged both of them with a few cautionary tips to be followed to make sure the child stays healthy and asked them to come back within couple of weeks for a follow up. We chatted with the family in the days when Reema and the child were hospitalised in the District Hospital, and helped them realise the repercussions of her conceiving once more. She needs a gap of at least 5–6 years in order to have a healthy child and avoid taking any unnecessary risks herself. We also talked to the local gynaecologist, who recommended that we give her quarterly injections of contraception as a precaution since it’s possible that he might still get her pregnant even after counselling.
To give you some background, Reema’s elder sibling was initially set to marry Reema’s spouse. Her sister made the decision to leave her house with another man one week before the wedding. Unfortunately, promises hold a lot of significance. There had to be a wedding, however it happened. Now that her sister was missing, Reema’s parents extended an invitation to offer her hand without even a moment of hesitation. She had just turned twelve when she was sent off to live with her in-laws. Reema was pregnant a year after that.
The ASHA of the village faced a lot of backlash from the community. Why hadn’t she heard of this? Why didn’t she advise the family against having children too soon? It’s not uncommon for young people to get married, but it’s not every day that a 13-year-old girl becomes pregnant. The ANM was also in a precarious situation. She would put the ASHA in danger if she reported this. If she didn’t make an ANC (ante-natal checkup) card, or refused to vaccinate Reema for tetanus and diphtheria, and if something were to happen to Reema, she would get into trouble. Eventually, she did her ANC tests, however lied about her age on the record.
The thing that bothered me the most was how everyone’s concern rapidly shifted to being, “Who will be held accountable if something happens to her?” What about her physical, mental, and emotional health? Nobody appeared to care about that. Isn’t it strange that one sister exercised her freedom to choose the life she wanted to live while the other has no autonomy at all?
*Names changed to maintain confidentiality