The international media attention that a booklet for pregnant women has attracted should encourage the Indian government to correct any inaccurate information
Being pregnant can be challenging for a woman. It presents unfamiliar territory for many couples and information on what to expect, how to stay healthy, and how to prepare for a safe delivery and a healthy baby is highly valued. One would expect pregnancy guidance from a national institute of repute to be sound, well considered, unbiased, and evidence-based.
It was surprising therefore to read the recent media reports about an information booklet on “Mother and Child Care” published by the Ministry of AYUSH in India. The booklet advises pregnant women to avoid meat and eggs, and to detach themselves from desire and lust. The ministry oversees traditional systems of medicine, and has since issued a statement saying that the advice is based on concepts promoted in yoga and naturopathy. It has also clarified that the booklet was published in 2013 and has been in circulation ever since. It is unclear why this was not picked up earlier, or why the media have reported on it now. It is possible that growing intolerance towards imposing religious dogma in the public space may have drawn attention to it now. Even so, this calls for urgent action to retract any unsupported, or potentially harmful, guidance that is being propagated through this booklet.
I am not able to comment on the booklet as a whole. Yet, the fact that certain points have been selectively highlighted in the media while ignoring other useful information that the booklet provides, is not justification enough. The concern, as many have shared, is on two levels. Firstly, India has one of the highest rates of maternal deaths globally—a substantial proportion of which is attributed to poor nutrition in pregnant women. Advocating further restrictions in their diet, especially when sources of food and access are known to be limited for the majority, is unjustifiable. Further, India has a diverse community and blanket recommendations that overlook social, ethnic, religious, economic, and cultural facets are unhelpful.
The second concern, and the one that bothers me more, is the continual setting of rules for how women should think, act, and behave in society.
The number of dowry deaths, rapes, and instances of domestic violence, represent just the surface of deep-seated prejudice that many women encounter in their daily lives. Yet they are expected to abide by rules on what they should wear, how they should behave, and where they should or should not go. Having worked and engaged with women in low and middle income groups in rural and urban parts of India, I have often felt saddened by the complete lack of choice or rights that women have over their bodies and lives. Many are pushed into marriage at an early age. They often bear the burden of several pregnancies. Even if a couple decide to choose contraception, the burden is again placed on the woman. Sterilization accounts for 72% of use of modern contraception methods in India, and tubal ligation accounts for nearly 98% of all annual sterilisations according to data from 2013.
The Indian government is pushing for equal social status for women through the “Beti Bachao, Beti Padhao” campaign led by the Ministry of Women and Child Development. This aims to tackle sex selection and foster education and social participation of young girls. Guidance such as this booklet should undergo due process with the participation of the relevant ministries, including the health ministry and civil society, to ensure that the evidence is sound, and that information is relevant and does not perpetrate social prejudice.
The international and local attention that this has attracted should encourage the government to take immediate steps to correct any potentially harmful or prejudiced information in the booklet. Perhaps a section on “how men can help women during a pregnancy” might be appropriate and timely too.
Anita Jain is a clinical editor, The BMJ.