The Taj Mahal: Symbol of Maternal Death?

Taj Mahal, Painting
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Mumtaz Mahal, the lady in whose honour the Taj Mahal was built, died of preventable, maternity-related ailments.

The Taj Mahal is a symbol of love, but really, it should be a reminder of maternal health. Mumtaz Mahal was the most precious of Shah Jahan’s wives. In practice, this meant that she yielded him fourteen pregnancies, against one each for his other wives. Of this fourteen, only seven survived – with the birth of the fourteenth killing her.

Mumtaz had been pregnant almost every year of her marriage to Shah Jahan. Though India’s most iconic monument was built as a testimony to his love, a greater legacy would have been one of promoting maternal care. Mumtaz died from preventable ailments – a post-partum haemorrhage that could have been contained with a blood transfusion. It’s no leap of faith to say she suffered from her many pregnancies –  and suffered as a result of her frequent pregnancies.

Was the Taj Mahal built out of guilt, as some are suggesting?

Big Picture

167 women die per 100,000 births in India – one of the highest ratios in South Asia. The number has gone down significantly over the years (in 1990, it was 560), especially in more developed states. But in some parts, like Assam, it’s over 300 a year.

Seeking medical care is the only way to ensure a safe pregnancy. Yet, up to half of all women in Uttar Pradesh did not avail such facilities (in 2001). And half of all households today incur what is called Catastrophic Medical Expenses when they face pregnancies.

Schemes like the Janani Suraksha Yojana have the potential to help households finance their pregnancies – but the payoff is just Rs. 500 per birth (a 2016 study estimated the average cost of a pregnancy to be $258 or over Rs. 16,000 at current exchange rates).

It stands to reason that there isn’t enough money for pregnancies. India’s healthcare spending trails those of many developing countries, at just over one percent of GDP in 2016). When you factor in state-level spending, the situation is markedly different.

What could Shah Jahan have done to save Mumtaz?

When she died, she had been accompanying Shah Jahan across the country. It was at the battlefield that she went into labour, tended to by many attendants and midwives. In a case report published by Elsevier, Anant Kumar speculates a variety of physiological factors for her death – from the trauma of being surrounded by war to delays in receiving treatment, and a lack of transportation.

But birth-spacing by Shahjahan could have been a preventive measure – she had 14 pregnancies in 19 years, something that would be stressful even with modern medical care. Anant adds that while medical care in India was advanced, the quality of maternity care has changed little in rural areas.

Mumtaz’s example is often compared to that of Queen Ulrika Eleonora of Sweden– who ruled in the same period and also lost children at birth. But Ulrika acted after observing the quality of maternal care, and set up the first dedicated midwife school in Sweden. Every town had to send two women to train there. The result is evident today after years of social progress – Sweden’s Maternity Mortality Rate (MMR) in 2015 was four.

The importance of public healthcare

Public healthcare is key to ensuring expectant mothers get treatment when they need it and wherever they are – even in the midst of a battlefield. Kerala leads in this aspect, with the lowest MMR in India at 61 at last measure. It and Maharashtra are the only states on track to meet the Sustainable Development Goal of keeping MMRs to less than 70. Clearly, GDP growth alone does not account for social development – which is where Gujarat comes in. Despite being a highly-industrialized and fast-growing state, Gujarat’s MMR has been rising – accompanied by a drop in spending on social welfare.

The Taj Mahal costs about 16 crore rupees to maintain every year. Shah Jahan built it at a cost of 33 crore rupees at the time (equitable to under a billion dollars today). Though we throng to the flawless monument as witnesses to his grieving love, it should also remind us that better maternity care has long been wanting in India.

Mumtaz did not have to die for the Taj Mahal to have been built. A better record of maternity care needs to be the legacy we leave for future generations.

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