 It's now my pleasure to introduce Kaveri Myra, who's a qualified in nursing, midwifery and public health. She's a doctoral candidate at the University of Southampton in England. She has passionately worked on nursing and midwifery workforce development and governance, health systems research, quality and respectfulness in maternal health care, gender and women's empowerment. Kaveri started her career with an NGO called Academy for Nursing Studies and Women's Empowerment Research Studies, or ANSERS, and she currently serves as a member on its governing board. She's consulted with a variety of leading development organizations, including World Health Organization, JAPIGO, and the Public Health Foundation of India. Kaveri has worked in almost all of the states in India and includes countries such as Bangladesh and Thailand. We welcome Kaveri as our final keynote speaker in the 2021 VIDM. Kaveri, you have control of the slides. Thank you so much. I'm just trying to see, okay, now I see the control of slides. Thank you so much. I want to ask a question before I get started, and I also would like to give a disclaimer that at parts, the content of this presentation is going to be a little sensitive. It might remind you of past trauma you might have experienced, so at any stage if you feel that then given this is the only room in the conference right now where an event is happening, I think you'll have to step aside and prioritize your mental health if you feel the content is getting emotionally very heavy. Over the course of this presentation, I think you will mainly understand my obsession about asking people their birthing experiences, and it is something that has happened over the course of last 15 years and how that has kind of happened, and I have taken it forward is what I'm going to mainly talk about, which is why it's called the pursuit of honoring women's childbirth narratives through visual arts-based research. Most of my work is from India, but I have asked this question to people around the world now, but most of it is not included in this presentation. So before I go to the next slide, I have a question and I know you have already answered where you are coming from, but I just want to know wherever you are at have you heard of obstetric violence? Do you think it's a problem in your country? So you just have to in the chat box put the name of the country and say yes, if you think it is a problem in your country and no if it is not, and I'm going to give like 30 seconds to that. The question is whether obstetric violence is an issue in your country. I also see the participation has increased a little. India, absolutely. I can vouch for that. So I see most people have said yes. I am not seeing any nose here. All right. So I think the answer to this question already is there where obstetric violence exists. And what you're seeing in this map depends only on the countries I have read literature form and given the PhD on obstetric violence, I get to read a lot and write a lot. And this map in no way suggests that these are the only countries where obstetric violence is a problem. In fact, there's a high chance some of you may feel you may see your country there in gray and might tell me that I need to color it red. But the point is that it is quite a global phenomenon now. It feels diverse. There are parallels. And it's an issue that needs to be tackled urgently. And this is not just coming from researchers and midwives like me, but in the What Women Want campaign, which went to 114 countries and it reached out to 1.2 million girls and women asking them just one question of what their key demand is for quality, reproductive and maternal health care. The top demand was for respectful and dignified care, which clearly suggests that there is obstetric violence that these women have either heard of or experienced or are wary that they do not want to experience something like that when they give birth. Not just that, when you look at the other demands like water, sanitation and hygiene also shows disrespect and abuse. Number 14, ethical, lawful, non-abusive and secure care. Women asking for that. There are indications of obstetric violence there as well. But this issue is very sensitive. And there is a denial that you will hear in newspaper articles, in journals recently in South Africa, Violence Against Women Journal published a few commentaries and a paper that talks about how gentle should violence be for it to not be called obstetric violence. There is one discourse in Italy about a paper that reported women reporting obstetric violence in a community health survey. And then there were four associations, including that of doctors and midwives, resisting to it with a very strong language. So this denial is something that has also become a part of the narrative. And that is just one side of the issue. The other side is to understand this problem, because it's sensitive. And I will tell you why. But it's important to know a little bit about my story and why I do what I do before I tell you about that. Well, this hazy picture shows me as a student here. And this is 2000, I think, five or six, I would have been 18 or 19. And that is when Midwifery kind of showed up in my nursing degree. Midwifery was embedded in it. And we were all unmarried girls doing a degree course and quite unprepared, not in terms of theory, but in terms of more emotionally prepared to know what we are going to experience and see. And disrespect and abuse, all kinds of obstetric violence was kind of very normalized in this situation. And we used to observe it like every single day, sometimes not registered and some extreme forms we used to register as well. But some of these incidents used to stay. And one of those kind of changed how I observed birth from then onwards. I'm sorry if many of you have already heard this story, but for those who have not, there was this woman whose name I don't remember, but she was under my care as a student midwife and the head of the department, the obstetrician, he comes and he wishes to do a vaginal examination on her. And I was with her, I had taken her to a covered area, even though there were a couple of people who had come in as well. Right before he would go to do a vaginal examination, he just roughly lifts her sari with his elbow and looks at her genitals and said, how does your husband want to do anything with you with the jungle you have grown there? And that even though wasn't probably the most extreme form of, you know, obstetric violence that I had observed, but it just kind of stayed with me. And I had tried to resist that I had tried to file a complaint, but not much happened. And there were challenges and I was supposed to face repercussions if I took it forward. So this is around that time when I had kind of out of frustration thought that nothing is going to happen as a student midwife. I am far at the bottom of, you know, the power based hierarchy, the medical hierarchy, it's all very patriarchal. But I also realized that the nursing superintendent or the midwifery professors, people who I had approached, even they were not that far up on the hierarchy to solve something like that. So no matter how far up you were going on a midwifery or nursing powder, your voice still didn't matter. It didn't count. So my brilliant idea that evening, sitting at the library was like, I was in tears talking to my best friend saying, I have to do a PhD on this. Otherwise, nobody will listen to me. And 15 years down the line or so, that is exactly what I'm doing. I'm finishing so that people listen to me. And I understand that this whole presentation is now becoming about listening. But more about my experiences as a student and India is not the only country where student midwives face this kind of sexism. And I have written at length about my experience in this particular article that came out in June on the Practicing Midwife Journal, if you wanted to have a read later. But the problem didn't end there. I had observed the issue. But when I moved forward in my career, I kept doing research, but funding in obstetric violence is less. It's not that as a new researcher, you can just jump into research for that and find the money to do it. But I did get an opportunity when I was doing my masters in public health. And this was the thing that had been bothering me. So I thought that's the most obvious thing I would like to study. And although I was not really looking for an answer to disrespect interviews, I just wanted to find a way which makes childbirth a little more bearable. And I used to see all these, you know, pictures and even in movies where I only used to see like, you know, white couples. And I would see that the man is actually holding the woman's hand when she is in labor. And like they are in these large tubs of water. It's like, what is happening here? That was such cultural shock for me. But then thinking about it, it's also like, that would probably help me as well if I wanted to give birth. Because this is also around the time when our student advice, we were observing this and were like, we are never going through something like that. We would rather go for an elective cesarean or never give birth to a point I now understand. And I have known for a while that I suffer from something called secondary tocopophobia. I have never given birth and I do not plan to and no matter how many different reasons I find about environment and this and that, but I know deep down watching as much obstetric violence has had a very deep impact on me as a person and on my choices of whether I would like to give birth or not. But women, I interviewed at that time, this is in 2012, they reported that actually, you know, they want their husband to be there as a protector so that nobody disrespects and abuse them. So that was quite shocking. And that also made some kind of grassroot, you know, understanding for me to understand what am I going to do in my PhD. So I'm going to take a leap forward by like seven, eight years. And this is, this is the picture that I thought I wanted to talk about positionality. And I was like a picture that represents my current status, the best is what I thought this is. I feel I'm kind of juggling life on my stomach, balancing multiple things. But jokes about I am 34 year old woman. I am divorced. I, like I said, have never given birth and I never plan to. And the kind of birthing stories I have heard from around the world has had a lot of impact on me on how I experience childbirth and the stories as well. And there has been a change in scenario all my life I had been in India. And I am in the UK right now, just to do my PhD. So this is my first proper international migration experience, I guess. And in the PhD, I wanted to study all that you are seeing on the screen, because I wanted to understand not just the woman's perspective, the midwife's perspective as well, because those were the two main voices I felt were lacking in the research we were doing in India, in terms of leadership, in terms of being a stakeholder, everything. And my supervisors, then Zoe Matthews and Sabu Padmadas and later Jane Sandler at King's College London as well. They felt I was trying to do around six PhDs together. And they were quite brave to accept me as a student. So in the first bit of the PhD, I went to three different countries. And India, at the state level, at national level, I was in the United Kingdom already. So I spoke with international experts, midwifery leaders here. And also in Switzerland, because all the main health policy making UN bodies and their headquarters are mainly in Switzerland, Geneva. And I went and asked all these senior midwifery leaders at three different contexts, what do you think will change care for women? And I wanted to understand what drives obstetric violence and what drives respectful care. But this, like I have been saying again and again, is not an issue that you can quickly start talking about. You cannot specially care providers, you cannot just some suddenly ask, you know, about obstetric violence, are you seeing it in your workplace? Do you think you have engaged in it? Do you see your colleagues engaging in it? So visual methods then come in handy. This particular painting by Shomi, it was something me and her we observed in a labor room in India. And she, a midwife herself, she painted it. And I used it as a visual method as a, you know, a flyer to show it to these nursing and midwifery leaders to ask their opinion on what is happening? How do you perceive her experiences? And although most of them kind of felt it is, you know, showing extreme forms of disrespect and abuse, but many found parts of respectful care in that as well. And they felt these are all the situations, all the things with the woman, with the nurse midwife in their immediate environment and at the policy environment that needs to change if care has to improve for these women. But most importantly, they thought that listening to women's experiences and expectations is key for a midwifery model for women-centered care. So that's what I did next. I went to talk to women in a state called Bihar in India. It has a population of 104 million people. And it's important to understand a context of violence in general, because in some parts of the country, as it is in the world, intimate partner violence is more. Some people have been sexually harassed. Like here you are seeing 40% of the women have experienced spousal violence. And this is a statewide survey. 3% have experienced violence during pregnancy. And just below that, 8% of the girls who were interviewed between 18 to 29 years of age had already experienced sexual violence by the age of 18. So when you talk to women with history of violence and without asking them, it's always, there is a need to ask them in a way that does not further traumatize them, that helps them open up in a way where they are taking the lead to tell you as much as they want to tell you. And you are not asking them sensitive question directly, which might further traumatize them. And that is something I have been trying to do for all these years in India, in different parts of India. And sometimes I come across these experiences where this is a guy who is also called a traditional midwife in India. And she is showing me how she gave birth. And she was saying, I was just sweeping the floor on my knees. And then suddenly I felt the baby is coming out. And this woman came from the neighborhood and she is holding me the way she was held. And I have no idea what to say about this position or how to write it down. So that is the limitation of written language when you do not have these ideas and you go somewhere with that lack of language. We often say it's a limitation of language of the participant, but it's actually more of the researcher or the person who's interviewing who does not have the language to explain this. So then began the evolution of birth mapping. What I could not record on my body then went on to be looking like a gingerbread on my notepad because certain parts of the body, it's difficult to engage with women to talk about. So you show it on your notepad, okay, what was happening where? And then I came across something called body mapping, which I tried before doing my main data collection in the third picture you're seeing. And finally, the final picture you're seeing is something called birth mapping that I will be telling you more about. But this is the main process how it happens. It begins on a plain sheet of paper and you carry as much art-based material as you feel the need for. There are some rules that you need to follow like I go with the question on how did you give birth? Like being in a position in which you give birth. And that is the only point where the participant is a little passive, where the facilitator kind of draws an outline around her body. And after that, it's a completely participatory method. Even many of these women had never held a pen before. Some of them were completely illiterate, but still slowly that confidence came in when you meet them again and again. And this is quite a lengthy process. I met them several times over a week and the trust developed, the stories got more detailed and this was done with four women in a rural village, rural villages in Bihar and four women in urban slums. Even though they are all in the same state, there is still quite a bit of diversity that you will see. And although I will not get into the analysis details, but I just want to tell you how beautiful the feminist relational discourse analysis is and how completely complex it is. But as you analyze it, it just opens up the data and makes you absorb and see and listen and feel it like I have never analyzed data before. It also helps you use these arts-based methods in a very, very good way. And some of the products of analysis I will show you in a bit. But yes, the process is quite challenging because these are low income settings. Space is an issue. So it's a life-size sheet, right? So like seven feet long. So it was quite difficult to find space and to also get women's time for like two to three hours every time we went there. But they always found time and we always tried to work around their schedules, that kind of work. These are the eight women. And even though it's eight, but actually it's very diverse and each person's story is what really matters in terms of age, education, occupation, birth setting, they're all very different. And it shows in how they experience their birth, the aspects that they feel in their childbirth were good, were bad, something they expect. And that is what we need to focus on is the point of this research that every individual's experience matters. Here are a few of the body maps, but I will quickly go to three. And this one is a very proper thematic analysis, a traditional way of understanding. And you will notice I have not started my presentation. I did not introduce any definition or typology or terminology, anything from literature, because I wanted to only focus on these women's stories and what respectful care is for them. So this one, for example, is a definition that Amrita, who you see in the birth map, besides the definition says. So for her, she says, care should be like, when I told them what problem I have, they should come and check me completely and tell me about my condition, that in how much time I will deliver. I will feel respectful when they will do my delivery on time without delay, when they will speak with me politely with a smile, when they will take care of me nicely, if they gave me a bed. They should treat us like family members, no matter whether I am giving birth to a boy or a girl, I should be treated well. They should talk to me nicely, no matter whether it is a nurse, doctor or guy. They should give immunization, injection, medicines and other supplies from hospital. Then only we will share our good experience with other women in the neighborhood, that we are not disrespected there and people are not greedy. What is the point of going there otherwise? There are two other firms that come out of this analysis that I am particularly keen to talk about, something called an I-Poem, which you create by filtering out sentences that the participant begins with an I. And this is a particular section and even the title has been taken from Urmila's narrative. So here Urmila is describing about her episiotomy experience. The poem is called The Lady Doctor was really nice. I told her not to do it, but she forced her hand in me. I told her don't put your hand in me because it was hurting, but they continued to do so, didn't listen to me. I was so angry with the doctor because she called me so many times for vaginal checkups. Every time she told me the passage did not open. I didn't like it. I was shouting and crying due to pain, but still doctor kept on suturing. I asked them for Bihoshi Ki Dawa Anastasia, but they were not listening to me and kept doing it. I thought my problems are over after giving birth, but the real challenge was post birth. I was screaming. The doctor and sisters were holding me down from all sides and kept stitching me. I felt all of it. I kept screaming and asking for Anastasia. I felt all of it. I didn't have such pain in my first delivery while stitching. I like the behavior of my doctor and one of the nurses. I didn't like those two frowning sisters who shouted at me. The way women share their stories, it's not always one kind of voice and that is what came out in this very detailed and complex analysis. Something we call contrapuntal voices and this framework, it's coming out in the publication soon, uses the language of music where you see it's not always a voice of sorrow or pain or silence. There is the voice of anger, desirability, resistance, triumph, happiness, all of it and that you understand when you listen and re-listen the audio recordings and you read again and again the transcript that you have. Something that you will get a little idea of when I read Perot's birthing story. It's going to take me around five minutes but I request that you look at Perot's birthing map on the side when you listen to me read her story. My heart was beating out of my chest because I knew what was going to happen next. He held my hand tightly, a stranger but it felt good. As if someone my own is keeping me calm. Scared, I asked him to press his hand on my chest on my heart. I'm 29 years old, government school teacher and this was my second childbirth a year ago. Memories of my first birth have traumatized me. Everything is still fresh in my mind. Even now when I think about it, I just know never again. I wasn't in pain but I was leaking some fluid so everyone took me to the government hospital that morning. There were many women all waiting for their turn but then I saw that doctor wearing a plastic glove checking everyone in that dirty environment. I ran from there. I was taken to a private hospital next. The lady doctor just made the nurse lift my petticoat and nighty up and force her hand inside me without any explanation. I started screaming and crying out of pain. You can never have a normal birth if you cannot bear this pain. The next three days I was in observation when I was given 19 bottles of fluids, many injections to increase the labor pain and numerous vaginal examinations. The nurses would just come and insert their hand, not even minding the crowd and how many people are around me. I was frustrated and complained to the doctor. Why does everyone has to first insert a hand in me without even talking to me? Is there no other way to check? She said nothing. My mother says women have to endure that to have a child. Even now sometimes I tell mummy that wasn't right. I was in the cafeteria with my family when the nurse came and just dragged me by my hand to the operation theatre. No explanation given. My family stayed outside the OT. There were eight men in the room all in regular clothes like they're on a picnic. One of them said get up gave me an injection on my back and made me lie down. No explanation given again. That's when I realized I'm going to get operated. No one told me. My only solace was that there won't be any labor pain. Another man blindfolded me because the less I see the less uncomfortable I will be. I felt someone was taking my petticoat off and lifting my knighty to my chest. They were treating me like a doll or like an animal doing whatever they want not caring about me at all like I did not exist. I was filthy and my hair tangled without a shower in four days my clothes getting drenched in my fluid and drying on me. I did not know anyone in that room. I asked about my lady doctor to this other guy who was apparently her son. She arrived later. They played music in the OT. It was calming. There were other sounds too of instruments and scissors cutting through me like they are cutting a jewel crab. Everyone was talking amongst themselves while they took the girl out of my body. It's a girl they discussed and I thought I will tie her hair in two pony tails and take her to school with me. I stayed in the hospital for 10 days after that because I had fever and chills and was recovering from surgery. Meanwhile the baby's doctor did not tie my baby's cot properly which kept bleeding. She got infection the same night and my husband had to take her to another hospital three kilometers away every day for injections. I struggled to breastfeed her and even hold her properly. I cried when I couldn't have a normal birth the second time with my son two years later. The doctor pressed on the incision and it hurt. It can get torn and you might get a cut down there anyways you need a big operation she said. The normal birth's pain lasts four days but the misery of cesarean section lasts for years and breaks your body. In the beginning sometimes the incision used to hurt like someone dropped chili powder on it. For the medicine I was prescribed to apply on it to get rid of the pain and redness in the first place. This was a quack in our village who considers himself our area's doctor. My husband asks why did you not get sterilized if you don't want another child? You get sterilized I tell him. He makes excuses that he'll get weak so we both don't get it done but I do tease him saying my life is in your hands when we get intimate. I feel I needed to share these with someone. It all needed to come out as I could not talk about it with anyone. That day somehow got over but those haunting memories have stayed with me and I hope you could hear some of these contrapuntal voices that I have been talking about. So in conclusion I think about all these narratives that you're hearing. The point is about listening and learning. As you will see many people are saying the same thing and to do that we also need to go through a process of unlearning. So while I'm listening and learning I'm also kind of taking it forward and passing it on by writing about it, publishing about it, presenting in conferences, getting platforms like this to share women's stories. I am also writing furiously about the sexism, the patriarchy, the political nature of this problem that exists. I take up activism every chance I get and this is a picture from the what women want campaign. I had led that in the United Kingdom which is one of those 114 countries and to create more awareness and to make people more comfortable and more aware about obstetric violence as a problem and so they acknowledge and talk about it to address it. I started the obstetric violence journal club which is on Twitter and I would love for you to join it. The link is right there. And lastly there is something called a birth and body book club that I also run where I talk about literature from around the world on birth and body because during my PhD I had felt there is kind of an inequality or an equity and the global birth literature was kind of dominant from global north and there was not much narrative from the global south that was coming in. So I'm trying to bring a balance on that. The book club exists on Twitter and Facebook and I have realized that I mostly talk about obstetric violence even now in the book club given my PhD but that will change soon. So with that thank you very much. My Twitter ID is there. If you are taking selfies I hope you still have the energy to do that. Please do tag me on that and I hope you break all the Twitter selfie records of the idea going forward. Thank you so much for giving me the opportunity. Thank you. Kaveri that almost leaves me speechless. Now is time for yeah look at the comments. Wow how inspiring. This your work is an emotionally heavy and emotionally burdening type of work and I'm so grateful that you have the strength to do it and to talk with us today about it. We can take questions from the participants. You can write them in the chat box if you'd like to ask a question. You can unmute your microphone. I see Jane and Karleen are typing. Yeah Jane says you are so brave and so she's so grateful you have the strength for this. Thank you. Those are beautiful words. I'm going to copy this chat and keep it wherever I feel down. Yeah actually we will have a copy Kaveri and we'll send it to you. Thank you. Does anybody have a question for Kaveri? This works. I'm trying to think in I guess. Yeah it takes time to feel that and then gather yourself so that you can ask a question. I saw Jane wanted to ask a question. I know you talked about the global south but the global north is also suffering. Obstetrical violence both in personal observations and professional observations specifically in my family and also with women of color that I've cared for in the United States of America and I would just really like to ask how do we start when I've tried to address this with the powers that be the obstetricians, the midwives. I'm referred to that this is normal education for obstetricians that they need to do an unnecessary forceps. They need to have a vacuum that's not required because this is required as part of some kind of training and I was just wondering how do we start addressing this need both within our families personally and within professional settings and thank you so much for beginning this conversation. Thank you so much for that question. We have to first understand that this is a complex problem and there is no easy solution and I think the beginning would be to acknowledge that it exists and there is quite a bit of denial amongst the healthcare workers community right now as well and amongst people who are suffering through this as well they sometimes don't want to you know talk about it because you're talking about your healthcare provider in some cases they are the only healthcare providers available in the whole community who will take care of your children who will take care of your the elderly in your family so you do not want to be the reason for that healthcare worker who has probably agreed to be in the remote area to be taken away. I showed a slide which had which had like this framework it talks about the drivers and it talks about all the things related to the nurse midwife and the women I mentioned about these two people because they are the key stakeholders in birth and you look at their personal attributes you look at their immediate environment related attributes and you look at the context the larger context so when you look at that that only gives you a few bullets but it's like a comprehensive list you can think of the context of the area you work in or the country you are a part of there is no one solution which can be replicated immediately in another country even in India it's so diverse I think we'll struggle to you know we have to find a solution in every area every community we go to but it kind of helps you to plan and what are the levels where changes have to be made who are the stakeholders you need to engage with and listening to women in the process again and again to understand that change is the most important and one traditional way of training that has even in India and most lower income countries we see that whatever problem we see we start training midwives we start training nurses we add more to the curriculum I don't think that's a solution if the point is about sexism if the point is about patriarchy if it is the context that needs to be addressed you need to enable the environment and make it possible for them to flourish and sometimes for that you have to target people who are on top of the power ladder first you have to target the doctors you have to target policymakers politicians people who hold that power to make space for them to move out only then will people we are you know wanting to listen to will come out I'm sorry that was a very long answer looking somebody was asking there are so many comments somebody was asking about the links to the journal the links to the digital journal links to the digital journal digital journal I'm sorry I'm going back and maybe that was it Kavari maybe the journal club yeah okay okay so this is the this is the book club link and this is the journal club on twitter if you find me on twitter then everything is there on my bio there all the links so that is an easy one any any more questions Karleen was somebody speaking no I was okay Karleen asked can you consider how to create partnerships with physician champions absolutely I feel we have this example of Vita Fernandez in India who is just so genuinely honest about you know her kind of training as an obstetrician in India and her practice and then the process of understanding the harm there is in that and I'm not just saying about medical education but but those aspects of you know patriarchy and colonialism use you see that in the nursing and midwifery curriculum as well and you know she she talks about unlearning and then learning this whole process of how to collaborate how it can be a teamwork and that collaboration is also something where interventions should be targeted because when you target interventions just at midwives somewhere it also makes it look like we are the part of the problem like I'm the only abuser in this facility that you see a problem and you're only targeting the nurses the team approach will include everyone who is going to be a part of care provision so that they can all ensure that care is respectful in whatever role they are playing in the care provision for that person but I think honest communication respectfulness within team members is the first thing that needs to be you know looked into if you do not have respectful communication and a respectful relationship within your team it's kind of like a domino effect you you abuse the one who's next in the hierarchy so even way before that we you need to address the birthing environment and the relationships there before we even talk about approaching them thank you kivari there's also a question about your i poems are they reproduced anywhere um well uh well they are under review right now they are accepted in a journal and that framework about the contrapuntal voices and with i poems it's all coming in one publication uh but but it's it's under review right now but it is coming out and i will shout out on all my social media platforms when it does carleen i know you were trying to speak were all the questions you wanted answered addressed carleen's microphone is on but we're not getting any sound i see a different question from katie uh okay should i should i take yeah yeah please kivari um it says i think katie saying when respect is so important why are we still using the word delivered thanks for pointing that out that is something that i kind of say in all my meetings in all the reports in you know the professional work that i do um and i kind of now take a strict approach that you know i personally don't use the word delivered unless the participant has used it then i insert it even in the translation like in the indian context we say the word delivery very easily even people who do not speak english at all some of these words are there in our vocabulary delivery is that word and i think it obviously seeped in from you know the care providers the doctors the nurses the midwives us using the word delivery so often that has gone into their vocabulary but even when i review papers and i always encourage people that we we cannot say that we have to say birth and not just that i will mention this particular commentary in lancet that came out very recently i think a couple of months back it it says something the title is something about mind your language and it's not an exhaustive list but it kind of gives a table and shows that some of these languages that are being used in in the birthing settings and an alternate better example that can be used and but again when it comes to language this change is based on context so in your own language you will find there are some of these words and terminologies or ways of approaching people that are you know quite bad and you need to find alternative in your own language and more respectful ways of communicating absolutely but thanks for bringing that out