Antenatal care: What Maneka Gandhi and her ministry can learn from ancient Hindu texts

Last week I visited the women and child welfare ministry website and found it rather underwhelming. I asked on Twitter if anyone knew what the ministry "does" and someone replied, "They maintain their website".

One might suppose that the good work they do has been drowned out by other, much more important headlines. We hear about education, railways; we even hear about textiles. But information about the achievements of the "WCD" ministry? Slim pickings.

Is it that we don’t demand that this area be prioritised? Of particular concern is antenatal care. I wondered if there was something to learn from ancient times, and as always, I was not disappointed.

The focus on antenatal and postnatal care is impressive across the board – not just medical texts, but even grihya and dharma sutras. A look at verses from some key texts gives us a sense. These are from another era but barring a few, they are extremely logical and relevant even today.

Take the sixth-century medical text Ashtanga-hridayam, which says with regard to the health of the foetus: "If a girl who has completed 16 unites with a man who has completed 20 [they] deliver a healthy child, (other physiological features like the womb, the birth canal, semen and menstrual discharge being pure/healthy). If it is even a year less, the foetus may be ill, short lived and not prosperous." (Garbhavakranti vs 8-9)

This medical recognition that a girl’s body is not ready for child birth just because she has attained puberty is significant.

The physical and mental well-being of the expectant mother was of great concern to our "smriti-kaaras". She was not just to be taken care of, but indulged. We have all heard of "atithi-devo bhava", but perhaps we don’t know that pregnant women are to be fed even before the guest (Manu 3.114, northern manuscripts). Charaka Samhita (sharirasthanam 4.17) says "whatever she wishes must be given to her, other than that which may be harmful to the foetus..."

The 18th century Dharmasindhu also concurs.

Ashtanga-hridayam mirrors advice given in the iconic Charaka Samhita. Pregnant women are to be attended to with affection and care by the husband and attendants. (अष्टाङ्गहृदयंगर्भावक्रान्तिः-१ vs.43). They must avoid excessive exercise, stress, weight, heavy (cumbersome?) upper garments, untimely waking and sleeping, difficult seated position(s), sadness, anger, fear, agitation or excitement.

They must control the vegas, avoid fasting, hot spicy [or] heavy meals that might impede (the digestive tract). Things which might be unpleasant such as – blood, nudity, looking at a cavern, a hole or a well, alcohol, meat and lying on the back must be avoided. Hemorrhage and cleansing [activities] such as vomiting and purging must be avoided. From the eighth month onwards, enemas (basti) must not be given. If these are done the embryo could be miscarried, may "dry up" or die in the womb. (vs 44-47)

The 18th century धर्मसिन्धू of Kashinath Upadhyaya gives advice of a more practical nature. Pregnant women should avoid climbing elephants, horses, hills, buildings and so on. They should avoid riding on a cart, moving too rapidly and exercising.They must not sit on ash, at a pestle and mortar… must avoid immersion in water, an empty habitation and the base of a tree.

Avoid strife, breaks in the body (joints?), consuming hot and spicy food, very cold, sour [and] heavy food in evening… being upset and sitting in a position like cock (squatting).

They must always take care of womb by excreting daily, by writing auspicious mantras, [being well groomed] adorned with ornaments the application of sandal powder etc…dwell in a clean house…apply auspicious kumkum, turmeric, saffron, kajal etc…groom the hair, consume tambula and wear auspicious ornaments. From the sixth or eighth month (depending on health), they should avoid travel, especially from the sixth month on.

The need for a balanced diet is also stressed. Perhaps to ensure compliance, the perils of an unbalanced diet were held up as a potential threat. Much like women these days are urged not to smoke, drink or abuse substances while pregnant, lest the foetus be deformed.

Ashtanga-hridyayam (vs 48) says if the diet has an excess of vaata, the child will have a hump back, be lazy or a dwarf. If there is too much pitta, the child will be born with a reddish, brownish or tawny skin colour; while too much kapha would lead to a very pale complexion.

Clearly the health and well-being of the mother was linked in the mind of smriti-kaaras, with that of the child. A healthy, happy mother meant a healthy, happy child.

Manu (9.9) says the kind of child born depends on how the mother behaves during her pregnancy. So for a healthy child of good character, women should be taken care of (protected?) with [great] effort.

Charaka Samhita recommends abstinence from meat, alcohol and wearing red clothes. (sharirasthaanam 4.18) Mahabharata (2.22.8) even tells of a tumultuous sound so frightful that women miscarried their foetuses.

Perhaps from a modern perspective this might seem a bit extreme, but avoiding anything horrific and stressful still makes sense. Given the effort ancient writers devoted to the care of mother and child, there is wisdom to be gained.

Coming back to the profile of the women and child welfare development ministry. If they are doing good work, can we hear more about it please? Our textile minister has nearly five million followers on Twitter, while the external affairs minister has over six million. The women and child welfare minister fares poorly by comparison with a mere 78, 200 followers. 

There is world outside Twitter for sure, but even in other media, the initiatives of the ministry don’t exactly stand out. For instance, did you know they had a Daughter’s Day in August this year?

At the risk of sounding naïve, if we put the spotlight on its putative role, perhaps we may be pleasantly surprised by its achievements? After all, the priorities of any administration are said to depend on what is important to its electorate. We would like to know more about current efforts and improvements in antenatal care.

The original Sanskrit verses quoted in this article can be seen here.

Care pregnant woman must take:

Verses from

अष्टाङ्गहृदयं गर्भावक्रान्तिः-१

पूर्णषोडशवर्षा स्त्री पूर्णविंशेन सङ्गता ।

शुद्धे गर्भाशये मार्गे रक्ते शुक्लेऽनिले हृदि ॥८॥

वीर्यवन्तं सुतं सूते ततो न्यूनाब्दयोः पुनः ।

रोग्यल्पायुरधन्यो वा गर्भो भवति नैव वा ॥९॥

उपचारः प्रियहितैर्भर्त्रा भृत्यैश्च गर्भधृक् ।

नवनीतघृतक्षीरैः सदा चैनमुपाचरेत् ॥४३॥

अतिव्यायामायासं भारं प्रावरणं गुरु ।

अकालजागरस्वप्नं कठिनोत्कटासनम् ॥४४॥

शोकक्रोधभयोद्वेगवेगश्रद्धाविधारणम् ।

उपवासाध्वतीक्ष्णोष्णगुरुविष्टम्भिभोजनम् ॥४५॥

रक्तं निवसनं श्वभ्रकूपेक्षां मद्यमामिषम् ।

उत्तानशयनं यच्च स्त्रियो नेच्छन्ति तत्त्यजेत् ॥४६॥

तथा रक्तस्रुतिं शुद्धिं बस्तिमामासतोऽष्टमासात् ।

एभिर्गर्भः स्रवेदामः कुक्षौ शुष्येन्म्रियेत वा ॥४७॥

वातालैश्च भवेद्गर्भः कुब्जान्धजडवामनः ।

पित्तलैः खलति पिङ्गः श्वित्री पाडुः कफात्मभिः ॥४८॥

व्याधींश्चास्या मृदुसुखैरतीक्ष्णैरौषधैर्जयेत् ।

अष्टाङ्गहृदयम् was composed by Sri Vagbhata. It is believed that he was in 6th century AD. So his composition must be in 6th century. अष्टाङ्गहृदयम् – Rashtriya Sanskrit Sansthan, New delhi, 2012

चरकसंहिता, शरीरस्थानम् – ४

सा यद्यदिच्छेत्तत्तदस्यै दद्यादन्यत्र गर्भोपघातकरेभ्यो भावेभ्यः ॥१७॥

गर्भोपघातकरास्त्विमे भावा भवन्ति, तद्यथा – सर्वमतिगुरूष्णतीक्ष्णं दारुणश्च चेष्टाः, इमांश्चान्यानुपदिशन्ति वृद्धाः – देवतारक्षोऽनुचरपरिरक्षणार्थं न रक्तानि वासांसि बिभृयान्, न मदकराणि मद्यान्यभ्यवहरेत्, न यानमधिरोहेत्, न मांसमश्नीयात्, सर्वेन्द्रियप्रतिकूलांश्च भावान् दूरतः परिवर्जयेत्, यच्चान्यदपि किञ्चित् स्त्रियो विद्युः ॥१८॥

Charaka saṃhitā is pre 2nd century text was preached by Seer Punarvasu and composed by Agnivesha and reedited by Charaka and Drudhabala.

चरकसंहिता – Rashtriya Sanskrit Sansthan, New Delhi, 2011.

धर्मसिन्धू by Kashinath Upadhyaya

गर्भिणीधर्माः

गर्भिणी कुञ्जरश्वादिशैलहर्म्यादिरोहणम् ।

व्यायामं शीघ्रगमनं शकटारोहणं त्यजेत् ॥१॥

न भस्मादावुपविशेन्मुसलोलूखलादिषु ।

त्यजेज्जलावगाहं च शून्यं सद्म तरोस्तलम् ॥२॥

कलहं गात्रभङ्गञ्च तीक्ष्णात्युष्णादिभक्षणम् ।

सन्ध्यायामतिशीताम्लं गुर्वाहारं परित्यजेत् ॥३॥

व्यवायशोकासृङ्मोक्षं दिवास्वापं निशि स्थितम् ।

भस्माङ्गारनखैर्भूमिलेखनं शयनं सदा ॥४॥

त्यजेदमङ्गलं वाक्यं न च हास्याधिका भवेत् ।

न मुक्तकेशा नोद्विग्ना कुक्कुटासना न च ॥५॥

गर्भरक्षा सदा कार्या नित्यं शौचनिषेवणात् ।

प्रशस्तमन्त्रलेखनाच्छस्तमाल्यानुलेपनात् ॥६॥

विशुद्धगेहवसनाद्दानैः श्वश्र्वादिपूजनैः ।

हरिद्राकुङ्कुमं चैव सिन्दूरं कज्जलं तथा ॥७॥

केशसंस्कारताम्बूलं माङ्गल्याभरणं शुभम् ।

चतुर्थे मासि षष्ठे वाप्यष्टमे गर्भिणीवधूः ॥८॥

यात्रां विवर्जयेन्नित्यमाषष्ठात्तु विशेषतः ॥

गर्भिणीपतिधर्माः

गर्भिणीवाञ्छितं द्रव्यं तस्यै दद्याद्यथोचितम् ।

सूते चिरायुषं पुत्रमन्यथा दोषमर्हति ॥

सिन्धुस्नानं द्रुमच्छेदं वपनं प्रेतवाहनम् ।

विदेशगमनं चैव न कुर्याद्गर्भिणीपतिः ॥

वपनं मैथुनं तीर्थं श्राधभोजनमेव च ।

वर्जयेत् सप्तमान्मासान् नावारोहणं तथा ॥

धर्मसिन्धु was composed by Kashinath Upadhyaya in Śaka 1712 or 1790-91 A.D.

मनुस्मृतिः

स्वां प्रसूतिं चरित्रं च कुलमात्मानमेव च ।

स्वं च धर्मं प्रयत्नेन जायां रक्षन्हि रक्षति ॥९/७

पतिर्भार्यां सम्प्रविश्य गर्भो भूत्वेह जायते ।

जायायास्तद्धि जायात्वं यदस्यां जायते पुनः ॥ ९/८

यादृशं भजते हि स्त्री सुतं सूते तथाविधम् ।

तस्मात्प्रजाविशुद्ध्यर्थं स्त्रियं रक्षेत् प्रयत्नतः ॥ ९/९

सुवासिनीः कुमारीश्च रोगिणो गर्भिणीः स्त्रियः ।

अतिथिभ्योऽग्र एवैतान्भोजयेदविचारयन् ॥ ३/११४

सकृत्संस्कृतसंस्काराः सीमन्तेन द्विजस्त्रियः ।

यं यं गर्भं प्रसूयन्ते स सर्वः संस्कृतो भवेत् ॥

(लौगाक्षिगृह्यसूत्रम्) अभवत्तुमुलो नादः सर्वप्राणिभयङ्करः ।

वित्रेसुर्मागधाः सर्वे स्त्रीणां गर्भाश्च सुस्रुवुः ॥ महाभारतम् २-२२-८

_________________________________________________

Bibliography

अष्टाङ्गहृदयम् – Vagabhatta, published by Rashtriya Sanskrit Sansthan, New Delhi, 2012

चरकसंहिता – Rashtriya Sanskrit Sansthan, New Delhi, 2011.

धर्मसिन्धुKashinathUpadhyaya in Śaka 1712 (1790-91 CE)

Manu’s Code of Law, critical edition & translation by Patrick Olivelle, OUP, 2005.

(With inputs from Rohini Bakshi.)

Also read: Why India needs a fertile debate on Surrogacy Bill