On the day the World Health Organization (WHO) launched its “Healthy Starts, Bright Futures” campaign, calling for global efforts to end preventable maternal and newborn deaths, a heartbreaking incident took place in Kerala.
A 35-year-old woman named Asma from Malappuram lost her life due to severe postpartum hemorrhage after giving birth at home. Without access to timely maternity care, her life could not have been saved. A mother of four, Asma’s death serves as a stark reminder of the dangers associated with unassisted home deliveries.
Kerala’s healthcare legacy: A delicate balance
Kerala is often praised for its healthcare model, especially in maternal and child health. With almost 100% institutional deliveries and a maternal mortality ratio (MMR) of just 19 per 100,000 live births, the state’s achievements have long been a model for others.
But a small, yet growing segment of the population is now jeopardizing this progress by choosing to give birth at home, often rejecting medical advice and denying access to health workers.
Preventable death in an era of medical advancement
Health Minister Veena George reacted strongly to Asma’s death, calling it "culpable homicide not amounting to murder” (manslaughter). Despite repeated visits from healthcare workers, the family reportedly refused medical intervention during the pregnancy.
"Earlier, most of our home births were in the tribal belt where people were often late in accessing care. There are also cases of ‘precipitous labour’. But what we are seeing now are home births by choice, about which we are helpless,” a senior official said.
Why are families choosing home births?
Cultural, religious, and misinformed beliefs
Many women still attend prenatal check-ups but strongly reject institutional deliveries.
Families call in untrained midwives or ‘dhais’ to supervise home deliveries.
Some cite religious beliefs, distrust of hospitals, and suspicion of unnecessary C-sections.
A growing trend of alternative practitioners, such as naturopaths and acupuncturists, promotes “painless home births”.
Doctors say it’s worrying that even educated, financially secure families are making this choice, turning away from medically supervised care based on misinformation or false ideas of “natural birth”.
Doctor’s plea for regulation
Dr. K. Prathibha, a medical officer in Malappuram, has taken the matter to the Kerala High Court, urging the state to formulate clear guidelines for home births.
In 2022, when I had taken charge as the medical officer at Tanalur PHC in Malappuram, there were 16 home births in the region. I went to the court seeking guidelines for home births because for every birth that ends up as a home delivery — with possible complications or maternal/neonatal deaths — it is the medical officers who are answerable. Also, it is a question of child rights because every newborn baby deserves the best of care, including the newborn screening for congenital anomalies, mandatory vaccinations, etc.
Dr. K. Prathibha, Medical Officer, Malappuram, Kerala, India
Malappuram: A hotspot for home deliveries
While the overall number of home births in Kerala is just over 500 annually, Malappuram alone accounts for about 300 of them.
What recently raised eyebrows was an event in the district that celebrated over 1,200 families who opted for home births, a practice that public health experts have found deeply concerning.
When things go wrong: The hidden dangers of home birth
Even in a “normal” pregnancy, unexpected complications can arise:
Postpartum hemorrhage
Cardiac arrest
Retained placenta
Fetal distress causes brain damage in newborns.
Infections due to a lack of sterile conditions
While some women survive with severe long-term illnesses, others – like Asma – are not so lucky.
What’s next? Strengthening awareness and policy
The Kerala Health Department has announced plans for more aggressive awareness campaigns and community interventions to ensure that no mother or child is left behind due to misinformation or lack of access.
(Input from various sources)
(Rehash/Muhammad Faisal Arshad/MSM)
