Victims of a culture that puts their needs last, more women die from childbirth in India than anywhere else in the world.
The operating room was chilly on a grey morning in Bihar, Northern India. Tile floors did nothing to insulate from the thick, damp cold seeping through the blankets on rickety hospital beds.
Sugia Devi was spread on the operating table like a martyr, arms wide. But Devi wasn't dead; she was active and flailing in pain. Throughout her caesarean section she responded to each incision, each stitch, jerking her face away and moaning ghoulishly.
India's other sexual violence is the failure to care for pregnant women, medically and socially.
The doctors working on her abdomen, distracted by pulling out the baby and answering a phone call, ignored her cries. But the junior doctor standing next to her face, heard. He held down the thin gauze strip covering her eyes, pressing so strongly he indented the mounds of her cheeks. The cover was ineffective; beneath the thin cloth her eyes were visible, darting in fear.
The doctor pumped Devi full of pain medications during the surgery, and he said that after that she was moaning out of fear. Devi, however, blatantly disagreed: "I remember that I was shouting out of pain."
When she moaned Kumar shook her, then jerked her, and finally hit her, over and over during the surgery. His lip snarled and he looked angry at the disturbance. There was no concept of her cries representing a physical need or something wrong with her pain control. They were only annoying. Devi, abdomen still open, half anesthetized, uterus exposed, had no choice but to weather the health worker's blows.
Devi's physical abuse during her delivery is just one case of the violence many Indian women suffer during their reproductive lives. In the aftermath of the high-profile gang rape of a 23-year-old medical student, discussions have raged in India about the regularity of violence against women. As has been widely noted, the causes of the violence run deep. But they also are broad.
India's other sexual violence is the failure to care for pregnant women, medically and socially. The ingrained iniquities and widespread disregard for women's needs during pregnancy and childbirth contribute to India's shockingly high maternal death rates.
Bihar, where Devi's C-section took place, has among the highest rates of maternal deaths in the country. And India overall is home to the highest number of women dying from childbirth in the world. The majority of Indian women who die in childbirth are poor, uneducated, and young.
Women die around delivery mostly due to excessive bleeding, obstructed labor, infection, and issues around high blood pressure, including eclampsia. But these are the medical causes.
Women die in their homes under the watch of poorly trained midwives and village doctors. Women die in rickshaws when families make last minute runs to the health center. And many of these women die without ever having any say in decisions about their health.
Kumar's abusive behavior in the operating room directly contradicted the World Health Organization guidelines for cesarean section: "The use of local anaesthesia for caesarean section requires that the provider counsel the woman and reassure her throughout the procedure. The provider must keep in mind that the woman is awake and alert, and should use instruments and handle tissue as gently as possible."