Janhavi Nilekani PhD 2018 wanted the childbirth of her dreams. That meant returning in 2016 to her home country of India where the then-fifth-year PhD student in public policy could be closer to family, ensure her forthcoming baby’s citizenship, and get away from the cold New England winter. It also meant finding a health care provider committed to evidence-based medicine—and to treating expectant mothers with respect. Nilekani particularly wanted to avoid delivery by cesarean section, which is performed in India much more frequently than in high-income countries. She was frustrated in her search until she connected with a U.S.-trained midwife and a local Indian obstetrician dedicated to giving her the birthing experience she was determined to have. To get it, however, Nilekani says she needed to leverage all the research and analytical skills she acquired as a PhD student.
“My work at Harvard gave me the training I needed to study childbirth in an evidence-based way,” she says. “It gave me the ability to do a cost-benefit analysis and make decisions. And, maybe above all, the concept of smart policy design and implementation that I learned while a student at Harvard taught me that if I wanted a respectful, evidence-based childbirth, the incentives of all the actors had to be aligned.”
Today, as the founder and chairperson of the Bangalore-based Aastrika Foundation, Nilekani leverages her graduate education and personal experience to advance an audacious vision: “a future in which every woman is treated with respect and dignity during childbirth, and the right treatment is provided at the right time.” If she’s successful, Indian mothers won’t need a Harvard PhD to receive the same high-quality maternal care that she did.
“…the concept of smart policy design and implementation that I learned while a student at Harvard taught me that if I wanted a respectful, evidence-based childbirth, the incentives of all the actors had to be aligned.”
By the time Nilekani graduated in 2018, she knew her path would lead her not to academia but back to India, where she could have a direct impact on her home community. “Aastar is the Sanskrit word for expansion,” she says. “Urmika means wave. So, the contraction Aastrika represents the foundation’s mission to create a sea change in maternal care that will ripple out and transform the birthing experience for mothers across India.”
Challenges in maternal care in India include physical and verbal abuse of birthing mothers, a lack of accessible health care, as well as over-intervention—particularly excessive surgery. At the center of the Aastrika Foundation’s efforts to address these issues is midwifery, an affordable way to improve rates of infant and maternal mortality. The foundation’s two-pronged strategy aims to dramatically upskill 200,000 health professionals and to train 1,000 new midwives to meet the need for those providers across the country, as well as to create demand for high-quality care among expectant mothers.
“We want our programs to touch thousands of existing professionals to make them better at their work,” Nilekani says. “We also want our efforts to lead to scores of new midwives in India, either by training them directly or by training faculty who teach others.”
Aastrika is well positioned to realize its goals, says Dr. Evita Fernandez, chairperson of the Fernandez Foundation, an NGO that works to “humanize childbirth” in India. Calling the foundation’s approach “long term and sustainable,” Fernandez says that Aastrika’s work makes it possible to envision a more humane world—for mothers, their children, and nearly 1.4 billion of the world’s people.
“Imagine a world where no woman is disrespected during birth or is plied with unnecessary medical interventions,” she says. “What Aastrika is doing will change the face of maternity care in India. Isn’t that going to improve everybody’s lives?”
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Editor’s note: A , by Paul Massari, originally appeared in Harvard’s Kenneth C. Griffin Graduate School of Arts and Sciences’ Colloquy magazine.
Photography provided by Aastrika Midwifery Centre.