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This content was originally published here.
lux cozi nigeria tv commercial 2013 (www.sureshselvarajan.com)
This content was originally published here.
Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing labor for going past your due date.
Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.
Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing versus waiting for labor when you’re going past your due date. I’m going to be joined by Anna Bertone, MPH, our Research Editor at Evidence Based Birth to talk about this topic.
Before we get started, I have a quick announcement, and that is next week we are hosting free webinars for the public all about the Evidence Based Birth Childbirth Class. On Monday, March 2, we’ll host a special webinar just for parents. We’ll give you a peek behind the scenes at what it’s like to take our Evidence Based Birth Childbirth Class. Then on Tuesday, March 3, we’ll have a special webinar just for birth professionals to give you a tour of the Evidence Based Birth Childbirth Class so that you can decide if it’s something you’d like to recommend to your clients or not. You can register for these free webinars at evidencebasedbirth.com/childbirthclasswebinar. That’s all one word /childbirthclasswebinar.
All right, now back to the topic at hand, inducing labor for going past your due dates. Now before we begin, I do want to give a brief trigger warning. In our discussion about the research evidence on this topic, we will be talking about stillbirth and newborn death. So there has been a ton of new research on the evidence on induction versus waiting for labor when you go past your due date. So much research, in fact, that we have decided to separate our Signature Article on due dates into two separate articles.
So we still have the original article, The Evidence on Due Dates, which you can find at ebbirth.com/duedates. And although we updated that article a little bit, it’s remained very similar to previous additions. It talks about the length of a normal pregnancy, factors that can make you more or less likely to have a long pregnancy, et cetera. But then we separated out the research on induction into a new article that you can find at ebbirth.com/inducingduedates. This is a peer-reviewed article that covers all of the research on induction versus something called “expectant management” for going past your due date. And in today’s podcast, we’re going to update you on the latest info that we found for that article.
Just a heads up, we will not be covering the research evidence on inducing at 39 weeks. We already covered the ARRIVE study, a randomized trial that looked at induction versus expectant management for 39 weeks of pregnancy in episode 10 of the Evidence Based Birth podcasts. And just a tip, if you’re having trouble finding any of our earlier episodes of this podcast, iTunes has stopped showing the earliest podcasts, but they’re still out there and you can find them on Spotify and any other podcasting app. You can also find info about the ARRIVE study at ebbirth.com/arrive.
So we’re not going to talk about induction at 39 weeks. Instead, we’re going to be focusing on the evidence on induction versus waiting for labor once you reach 41 weeks. And to do so, we’re going to talk with our Research Editor, Anna. So welcome, Anna, to the Evidence Based Birth podcasts.
Anna Bertone: Thank you! I’m glad to be on the podcast again.
So I want to start by explaining to our audience a little bit kind of about the background of why this topic is important. Inductions for non-medical reasons have been on the rise in the United States and all around the world for the past 30 years. And increasingly, more people who are pregnant are being induced for reaching their estimated due date. So we really want to cover the benefits and risks of elective induction for going past your estimated due date. And we’ll also talk about whether or not your goals and preferences for your birth matter, which of course they do, but that kind of plays a role as well.
So how often are people induced for going past their due date? Well, we don’t know for sure because this hasn’t been measured recently. But according to the 2013 Listening to Mothers III survey, which was now published about seven years ago, more than 4 out of 10 mothers in the U.S. said that their care provider tried to induce labor. Inducing labor for going past your due date was one of the most common reasons for an induction. Out of everyone who had an induction in this study, 44% said they were induced because their baby was full term and it was close to the due date. Another 18% said that they were induced because the healthcare provider was concerned that the mother was overdue.
The Centers for Disease Control in the U.S. also reported in 2018 that about 27% of people had their labor induced, but we think that number is probably low and that the percentage of people who have labor induced is under-reported in the Vital Statistics Program in the United States. So Anna, can you talk a little bit about why there’s so much controversy over this concept of electively inducing labor once you go past your due date?
Anna Bertone: So why is there so much controversy about elective induction? Elective inductions by definition are labor inductions that do not have a clear medical reason for taking place. They occur for social reasons, like the provider wanting the mother to give birth before the provider goes out of town or for other non-medical reasons like the pregnancy getting uncomfortable and for the mother’s convenience. But there’s also a gray zone about what constitutes an elective induction. Many providers only consider an induction to be “elective” when the mother is healthy, pregnant with a single baby, and less than 41 weeks pregnant. The gray zone is that sometimes when the pregnancy goes past 41 weeks, some providers consider that to be a medically indicated induction rather than an elective induction. But in general, inductions are considered medically indicated when there are accepted medical problems or complications with the pregnancy that make it less safe to continue the pregnancy.
For many years, and I remember when I first entered the birth world in 2012, a lot of people talked about the fact that if you have an induction it doubles your chance of cesarean. And then all of a sudden there were people saying that wasn’t true. So can you talk a little bit about that controversy?
Anna Bertone: So for many years, the common belief was that elective induction doubles the cesarean rate, especially in first-time mothers. But researchers nowadays consider those earlier studies to be flawed. In the earlier studies, what they would do is they would compare people assigned to elective induction to people who went into spontaneous labor. Nowadays, they don’t compare those two groups anymore. They compare people assigned to elective induction to the people assigned to what’s called expectant management, or in other words waiting for labor. And in that group, the person could either go into spontaneous labor or they could require an induction for medical reasons (so that would be a medically indicated induction), or they could choose elective induction further along in the pregnancy.
So that’s a subtle difference but an important one because in the earlier studies they compared elective induction to spontaneous labor. But you don’t have the choice to go into spontaneous labor today. Your choice is to be induced today or to wait for labor to start. And sometimes during that waiting period you might develop complications that require an induction, or you might change your mind and decide to have an elective induction, or you might go into spontaneous labor.
Anna Bertone: Right. So nowadays, we compare a group assigned to elective induction to a group assigned to expectant management. One example of this was the ARRIVE trial.
The ARRIVE trial was a study comparing elective induction at 39 weeks versus expectant management. We’re not going to go into that trial in detail because we already covered it in detail in episode 10 of the Evidence Based Birth podcasts. But they actually found a lower risk of cesarean in the elective induction group. Researchers think that had to do with the fact that of the people in the expectant management group, more of them developed problems with blood pressure that required medical inductions and increased risk for complications. So again, that just kind of goes to show you that it does make a difference when you compare elective induction to expectant management.
Although, one thing you have to keep in mind with the ARRIVE study is that they had a very low cesarean rate in both groups compared to some settings. The cesarean rate was 19% in the elective induction group versus 22% in the expectant management group. So those research results cannot probably be generalized to settings with extremely high cesarean rates or high cesarean rates with inductions. We have some, for example, some professional members at Evidence Based Birth who talked to us about where they’re practicing and how high the cesarean rates are with the elective inductions there. So I think you have to be careful how you generalize or apply that data from the ARRIVE study, and we talk more about that in episode 10 of the podcast.
Which leads me to another point, and that is some cautions about the evidence. When I say generalize, that means taking research from a research study, and seeing if you can apply that to where people are giving birth in your community. So it’s important to understand that there are some major drawbacks to some of the research that we’re going to be talking about. Many of the studies are carried out in countries or time periods where there are low cesarean rates. So when that happens, when a study is carried out in a setting where culturally there’s low C-section rates, that might not apply to a hospital with high cesarean rates. If your hospital has high rates of “failed inductions” and strict time limits on the length of labor, then the evidence in these studies may not apply to you because induction might be more risky in your community hospital.
Also, another disclaimer about the evidence, in these trials, people are randomly assigned to induction or expectant management. And it’s important to remember that the people assigned to expectant management do not always go into labor spontaneously. There’s a mix of people in that group. Some of them do have a spontaneous labor. Others have an elective induction later on, and others have a medical induction for complications.
Also, you have to look at what they’re doing for fetal testing in the studies. In some studies there’s lots of fetal testing going on in the expectant management group. However, we’re going to talk about one of the studies where they were not doing any standard fetal monitoring during expected management. So those results might not apply to your community if your community does the fetal monitoring, and the study did not have fetal monitoring.
Finally, another disclaimer about the research evidence is that the induction protocols vary from study to study, and even within studies themselves. So knowing what the protocol was for induction in that study can be very helpful to decide if this is going to apply to your unique situation in your local community or not.
So with all of those disclaimers being said, there’s been quite a lot of new research in the past year about induction at 41 weeks. So Anna, can you talk about one of the most recent studies? Let’s talk about the INDEX trial from the Netherlands. There were two trials that came out in 2019, two large randomized control trials. Let’s talk about the INDEX one first.
Anna Bertone: Sure. So the INDEX trial was from the Netherlands. INDEX stands for induction at 41 weeks, expectant management until 42 weeks. This was a large multicenter trial. It was conducted at 123 midwifery practices and 45 hospitals. Most of these pregnancies were managed by midwives.
…So this was the midwifery-led model of care-
Anna Bertone: Exactly.
… which is very different than in the United States which is typically an obstetrician-led care model.
Anna Bertone: The researchers randomly assigned a total of 1,801 pregnant people to either induction at 41 weeks and zero to one days or to wait for labor until 42 weeks and zero days, which is called expectant management. The reason they were able to conduct this study in the Netherlands and got ethical approval for it is because it was standard practice for them to not induce labor before 42 weeks with an uncomplicated pregnancy.
…Whereas in the U.S. it’s rare to see someone go to 42 weeks, in the Netherlands, they typically won’t induce you unless there’s medical reasons until you get to 42 weeks –
Anna Bertone: Exactly. So the mothers were enrolled in the study between 2012 and 2016. Everyone had to be healthy, and pregnant with single, head-down babies. The gestational ages were estimated with ultrasound before 16 weeks of pregnancy. They excluded people with a prior cesarean, with high blood pressure disorders, with expected problems with the baby’s growth, abnormal fetal heart rate, or known fetal malformations (congenital anomalies). In both groups, cervical ripening and induction methods depended on local protocol. It’s like what Rebecca was talking about earlier. There wasn’t a standard protocol to apply to both groups in this study when it came to cervical ripening and induction. It was based on local protocol. And this is an important weakness of the study because the providers might’ve managed labor inductions differently based on whether someone was being electively induced or was assigned to the expectant management group. It also limits the study’s generalizability, which means our ability to apply the results of this study to the population at large because providers don’t have an induction protocol that they can replicate.
…So we can learn from what happened in this study, but it’s difficult for us to apply it to across the board because there’s no specific induction protocol that could be followed –
Anna Bertone: Yeah. What happened was in the elective induction group, 29% of the participants went into labor before their induction and 71% were induced. Then in the expectant management group, 74% of the participants went into labor spontaneously before their planned induction and 26% were induced.
…And before we talk about how long the pregnancies were, I think it’s important for people to understand that when you have a randomized controlled trial like this the researchers do something called intent to treat analysis. So it doesn’t matter what type of birth they had, whether it was a spontaneous labor or a medical induction, the data were analyzed depending on which group you were originally assigned to. So if you were assigned to an elective induction but you happen to just quick go into labor on your own before the induction, you were still grouped with everyone in the elective induction group and vice versa. So that’s just an important distinction for people to understand. –
Anna Bertone: Yes. What happened with these results is that the median pregnancy was only two days shorter in the elective induction group compared to the expectant management group. This is interesting because they still found a difference between these two groups, but-
…And this is important because a lot of people ask us like, “Well, I only want to wait one more day, or two more days, or three or four more days,” but they’re saying by decreasing the length of the pregnancy by two days they found significant results. So what did they find in the INDEX trial? –
Anna Bertone: So for mothers, they found that there was no difference in the cesarean rates. This was taking place in a country with low cesarean rates. It was a midwifery model of care and the rates were very low in both groups (11%).
They only had an 11% cesarean rate then?
Anna Bertone: Yeah. They also had an outcome called a composite outcome, which is a combined outcome for mothers, and there was no difference in that measure either. They were looking for things like excessive bleeding after birth, manual removal of the placenta, severe tears, intensive care admission, and maternal death, and they didn’t find a difference in those things. There were no maternal deaths in either group. So as far as the bad outcomes for the mothers, there were about 11% to 14% in both groups, but not different.
…And what about for the babies then? –
Anna Bertone: And then for the babies, the babies in the elective induction group had a lower composite outcome rate. And in this composite outcome, what they were looking at was perinatal death, Apgar score less than seven at five minutes, low pH, meconium aspiration syndrome, nerve injury, brain bleeds, or admission to a NICU. And here they found a lower composite adverse outcome rate with the babies in the elective induction group (1.7% versus 3.1%).
And why do they think that outcome was better with the elective induction group?
Anna Bertone: They think that it was mostly due to the lower rate of Apgar scores less than seven at five minutes, and that probably contributed the most to having a lower adverse outcome rate with the babies in the elective induction group. The author’s note that there was no difference in rates of Apgar score less than four at five minutes, but they found that the combined outcome was still lower in the elective induction group if they used an Apgar score of less than four at five minutes and excluded fetal malformations. So basically, the babies in the elective induction group had better Apgar scores overall.
…And what about stillbirths? Because that’s like the main reason they’re doing these kinds of elective inductions, is to lower the risk of stillbirth. –
Anna Bertone: Yep. And they did not find a difference in stillbirth in this study. There was one stillbirth that occurred in the elective induction group. It was at 40 weeks and six days, before the mother was induced. Then, there were two stillbirths that occurred in the expectant management group while the mothers were waiting for labor.
Anna Bertone: I looked for a few more details about those stillbirths because I was interested in that. Of the two stillbirths that occurred in the expectant management group, one was a small for gestational age baby at 41 weeks and three days to a first-time mother. The other one was to a mother with a prior birth, and that was at 41 weeks and four days. The mother’s placenta showed signs of infection (infection of the membranes). Then, the one stillbirth that occurred at in the elective induction group at 41 weeks was to an experienced mother (someone who had already had given birth before), and that was at 40 weeks and six days, and there was no explanation for that one. But with two versus one, they didn’t find a significant differences in stillbirths between those groups.
And what was the protocol for fetal monitoring in that study?
Anna Bertone: There was no protocol for fetal monitoring. It depended on local guidelines, just like the induction and cervical ripening protocol. But the study authors say that fetal monitoring and assessment of amniotic fluid levels was typically done between 41 and 42 weeks.
So how would you sum up the results of this INDEX study then?
Anna Bertone: They found that elective induction at 41 weeks resulted in similar cesarean rates and less overall bad outcomes for babies compared to waiting for labor until 42 weeks. However, they say that the absolute risk of a bad outcome happening was low in both groups. It was 1.7% in the elective induction group versus 3.1% in the expectant management group (the group that waited until 42 weeks).
All right. Well, the next study we wanted to talk about was the SWEPIS trial from Sweden, also published in 2019, also coming out of Europe. It’s S-W-E-P-I-S, and it stands for the Swedish post-term induction study, or SWEPIS. It got a lot of media attention with headlines like … There was one that said, “Post-term pregnancy research canceled after six babies died.” And it is true that this study was ended early after deaths in the study. The researchers intended to enroll 10,000 mothers from multiple centers across Sweden, but they ended up stopping the study with about 1,380 people in each group after their data safety and monitoring board found a significant difference in perinatal death between the groups.
Data safety and monitoring boards are basically a board that keeps track of what’s going on in the study. They get interim reports. And if they see any concerning safety issues, they have the power to stop the studies. That’s a standard part of a lot of randomized controlled trials is to have one of these safety boards.
Similar to the INDEX trial in the Netherlands, in Sweden, labor is typically not induced before 42 weeks if you have an uncomplicated pregnancy. Also similar to the Netherlands, in Sweden, midwives manage most of the pregnancies and births. It’s a midwifery-led model of care.
The purpose of the SWEPIS study was to compare elective induction at 41 weeks and zero to two days versus expectant management and induction at 42 weeks and zero to one day if the mother hadn’t gone into labor by that point. The study was carried out in the years 2015 to 2018. The researchers enrolled healthy mothers with single babies in head-first position. They had accurate gestational ages. They excluded people with a prior cesarean, diabetes, and other complications such as high blood pressure, small for gestational age, or known fetal malformations.
There is a pretty low stillbirth rate in Sweden, so they thought they would need about 10,000 people to see a difference between groups, but they ended up not needing nearly that many people to find a difference in stillbirth rates. One of the big strengths of the SWEPIS trial is that in contrast to the INDEX trial, in the SWEPIS trial they defined an induction protocol and they used that same protocol with everyone in the elective induction group and everyone in the expected management group who had an induction. The protocol was basically if the mother’s cervix was already ripe, they simply broke her water and gave her oxytocin as needed by IV. If the mother’s cervix was not ripe or the baby’s head was not engaged, they used mechanical methods or Misoprostol, or prostaglandins, or oxytocin, but they did cervical ripening first.
In the elective induction group, most of the people were induced. 86% had their labor induced. 14% went into labor spontaneously before the induction. In the expectant management group, 67% of them went into labor spontaneously and 33% ended up with an induction. Similar to the INDEX trial, there was a really tiny difference in the length of pregnancy between groups. Pregnancy in the elective induction group was in general only three days shorter than pregnancy in the expectant management group, but yet they did go on to find significant differences.
So what the SWEPIS trial found was that for babies – this is why this study was stopped early – there were five stillbirths and one early newborn deaths in the expectant management group out of 1,379 participants for a death rate of 4.4 deaths per 1,000 women. There were zero deaths in the elective induction group out of 1,381 participants. All five stillbirths in the expectant management group happened between 41 weeks, two days and 41 weeks, six days. Three of the stillbirths had no known explanation. One was for a baby that was small for gestational age. The other was with a baby who had a heart defect. There was one newborn death that occurred four days after birth due to multiple organ failure in a baby that was large for gestational age.
The authors mentioned that when complications are present at the end of pregnancy, such as problems of the placenta, or the umbilical cord, or fetal growth, these problems may become increasingly important as each day of pregnancy progresses, which they believe is why they found a higher death rate with expectant management past 41 weeks.
Another key finding of the study was that all of these deaths occurred to first-time mothers, which suggests that 41-week induction may be especially beneficial for babies of first-time mothers. They found that it only took 230 inductions at 41 weeks to prevent one death for a baby, and this was a much lower number than previously thought. If you remember, though, as Anna was saying, the INDEX trial did not find a significant difference in death between the induction group and the expectant management group. We think the reason the SWEPIS study found a difference was because it was a larger study, it was better able to detect differences in rare outcomes like death. Also, with the SWEPIS study, there might not have been as good fetal monitoring. So it’s possible that the better fetal monitoring of participants between 41 weeks and 42 weeks in the INDEX trial might’ve been protective, leading to fewer perinatal deaths. We can’t be certain though because there were no fetal monitoring protocols in either trial.
Another thing to note is that participants in the SWEPIS expectant management group tended to give a birth a little later than the participants in the INDEX expectant management group. That might help explain the higher perinatal death rate in the expectant management group in SWEPIS. They did not find a difference in what they call the composite adverse perinatal outcome, which included death, low Apgar scores, low pH, brain bleeds, brain injury, seizures, and several other major complications, but there was that significant difference in perinatal death (either having a stillbirth or newborn death).
Also, the elective induction babies were less likely to have an admission to intensive care, 4% versus 5.9%. They had fewer cases of jaundice, 1.2% versus 2.3%, and fewer of them were big babies, 4.9% versus 8.3%.
For mothers, the outcomes were overall pretty good. There were no differences in cesarean rates similar to the other trial. The cesarean rate in this study in both groups was about 10% to 11%. More mothers in the elective induction group had an inflammation of the inner lining of the uterus called endometritis, 1.3% versus 0.4%. And on the other hand, more mothers in the expected management group developed high blood pressure, 3% versus 1.4%. They also interviewed the women in both groups and they found that the mothers in the expectant management group really struggled with negative thoughts. They described feeling in limbo while they waited to go into labor. So Anna, can you talk a little bit about the fetal monitoring in this study and how it may have differed from the other study?
Anna Bertone: Sure. Fetal monitoring in this study was done per local guidelines. So there was no study protocol for fetal monitoring during the 41st week of pregnancy. However, the mothers recruited from one region of Sweden, called the Stockholm region, which made up about half the people in the study, had ultrasound measurements of their amniotic fluid volume and abdominal diameter at 41 weeks, whereas the people that came from the other areas of Sweden in the study did not receive these assessments regularly. None of the six deaths that occurred in this study occurred in the Stockholm region of Sweden where they received this type of fetal monitoring, which leaves us with the question of how important was this fetal monitoring. Could it have made the difference between the Stockholm region participants not experiencing fetal deaths whereas participants from other regions did?
Anna Bertone: So that’s just an important thing to keep in mind with this study is that the fetal monitoring may have made a difference as far as the perinatal outcomes. It also means that the results of the SWEPIS study might not apply equally to mothers who receive fetal monitoring at the end of pregnancy, specifically during that 41st week of pregnancy which seems to be the really critical time period. Another thing, all of the perinatal deaths in this study occurred to first-time mothers, which tells us that the results might not apply equally to mothers who have already given birth before.
…So in the SWEPIS study, out of the mothers in the study who had already given birth before and were having a subsequent baby, none of them experienced this stillbirth or newborn death, correct?
Anna Bertone: Correct. Yes.
Okay. So all of the perinatal deaths occurred to first-time mothers.
Anna Bertone: And the first-time mothers, by the way, they only made up about half of the participants in the sample, so it was about a 50/50 split.
So all of the fetal and newborn deaths from this study came from first-time mothers who lived in the areas of Sweden that did not do any prescribed fetal monitoring during that 41st week of pregnancy.
Anna Bertone: That’s my understanding. Correct.
Okay. So those are the two big randomized trials that came out in 2019. Before they were published, there was a 2018 Cochrane meta-analysis. Anna, I was wondering if you could talk a little bit about that. This study did not include the SWEPIS and the INDEX trials, but we still wanted to talk about it in our article. So can you explain to our listeners a little bit about this Cochrane review?
Anna Bertone: Sure. There was a 2018 Cochrane review and meta-analysis by Middleton. Unlike these randomized control trials that we were just talking about, they didn’t focus specifically on the 41st week of pregnancy versus the 42nd week of pregnancy. It was much more broad than that. What they did was they looked at people who were electively induced at some point, and compared them to people who waited for labor to start on its own until some point. So there was a much more broad range of gestational ages there. But they included 30 randomized control trials with over 12,000 mothers, and they compared a policy of induction at or beyond term versus expectant management. All of the trials took place in Norway, China, Thailand, the U.S., Austria, Turkey, Canada, the UK, India, Tunisia, Finland, Spain, Sweden, and the Netherlands.
So it’s quite a global sample.
Anna Bertone: Yes. But one study in this meta-analysis really dominated and accounted for about 75% of the data, and that was the Hannah post-term trial that I think Rebecca is going to be talking about soon. Because that one trial dominated this meta-analysis so much, most of the data was on giving birth at 41 weeks or later.
And they did not include the ARRIVE trial in this meta-analysis.
Anna Bertone: Right. They didn’t include the ARRIVE, INDEX, or SWEPIS trials. So in its next update, it’s going to be updated with those three randomized control trials. But they did include 30 other randomized control trials. What they found was that a policy of induction at term or beyond term was linked to 67% fewer perinatal deaths compared to expectant management. So that was two deaths with induction at or beyond term versus 16 deaths in the people assigned to expected management.
Anna Bertone: The Hannah post-term trial excluded deaths due to fetal malformations, but some of the smaller trials that were included in the Cochrane meta-analysis did not. So if we exclude the three deaths from severe fetal malformations, then the final count is one death in the induction group and 14 in the expectant management group. So it doesn’t change the results too much overall to exclude fetal malformations. Overall, they found that the number needed to treat was 426 people with induction at or beyond term to prevent one perinatal death. Specifically, there were fewer stillbirths with a policy of induction at or beyond term.
Which was a different number needed to treat than the SWEPIS trial, which found only took 230 inductions at 41 weeks to prevent one perinatal death.
Anna Bertone: Yeah. I think part of the reason the SWEPIS trial was so groundbreaking and got so much media attention is because it did find a lower number needed to treat than had been found previously. So the absolute risk of perinatal death was 3.2 per 1,000 births with the policy of expected management versus 0.4 deaths per 1,000 births with the policy of induction at or beyond term. They found that a policy of induction was linked to slightly fewer cesareans compared to expectant management, 16.3% versus 18.4%.
Anna Bertone: Fewer babies assigned to induction had Apgar scores less than seven at five minutes compared to those assigned to expectant management. They didn’t find any differences between the groups with the rate of forceps or vacuum assistance at birth, perinatal trauma, excessive bleeding after birth, total length of hospital stay for the mother, newborn intensive care admissions, or newborn trauma. The authors concluded that individualized counseling might help pregnant people choose between elective induction at or beyond term or continuing to wait for labor. They stress that providers should honor the values and preferences of the mothers.
We need more research to know who would or would not benefit from elective induction. And the optimal time for induction is still not clear from the research, which is what they said in 2018. I think Rebecca’s going to talk about the famous Hannah post-term study that accounted for 75% of the data in that meta-analysis.
Yeah, so we’re kind of working backwards through time. We started with the 2019 randomized trials, then the 2018 meta-analysis where they said the optimal time for induction is not clear, but they stated that before the two new randomized trials came out. Then even before then going back in time is the 1992 Hannah post-term study, which is one of the most important studies on inducing for going past your due date and it was the largest randomized trial ever done on this topic, larger even than INDEX or SWEPIS. And it controls most of the findings in that Cochrane meta-analysis that Anna just described.
So let’s look at what happened in this study because it plays so much of a role in the meta-analysis. It was carried out between the years 1985 and 1990 when a group of researchers enrolled 3,407 low-risk pregnant people from six different hospitals in Canada into the study. Women could be included if they were pregnant with a live single fetus, and they were excluded if they were already dilating, if they had a prior cesarean, pre-labor rupture membranes, or a medical reason for induction.
This study had a much different expectant management protocol than INDEX or SWEPIS because unlike those studies where the longest you would go was 42 weeks and zero to one or two days, in the Hannah post-term study, the people assigned expectant management were monitored for as long as 44 weeks pregnancy before they were induced, so up to a month past your due date, which is almost unheard of today. At around 41 weeks, people who agreed to be in the study were either randomly assigned to have an induction of labor or fetal monitoring with expectant management.
In the induction group, labor was induced within four days of entering the study, usually about 41 weeks and four days. If the cervix was not ripe and if the fetal heart rate was normal, they were given a prostaglandin E2 gel to ripen the cervix. They used a maximum of three doses of gel every six hours. If this did not induce labor or if they did not need the gel, people were given IV oxytocin, had their waters broken, or both. And they could not receive oxytocin until at least 12 hours after the last prostaglandin dose.
So one strength of this study is that it had a defined induction protocol that providers could replicate. But the big weakness of this study is that the expectant management group did not have that same induction protocol. In the monitored or expected management group, people were taught how to do kick counts every day and they had a non-stress tests three times per week. They also had their amniotic fluid levels checked by ultrasound two to three times per week. And labor was induced if there were concerning results in the non-stress test, or if there was low amniotic fluid, or if the mother developed complications, or if the person did not go into labor on their own by 44 weeks. And if doctors decided the baby needed to be born, mothers in expectant management group did not receive any cervical ripening. Instead, they either had their water broken and/or IV oxytocin, or they just went straight to a cesarean without labor. So Anna, do you want to talk a little bit about what the researchers found in the study?
Anna Bertone: What the researchers found in the Hannah post-term study is that in the induction group, 66% of the people were induced and 34% went into labor on their own before induction. And in the expectant management group, 33% were induced and 67% went into labor on their own. There were two stillbirths in the group assigned to wait for labor and zero in the group assigned to induction. This difference was not considered to be statistically significant, which means we don’t know if it happened by chance or if it was a true difference between the groups. The more interesting outcome to look at with the Hannah post-term trial are the findings on cesarean rates because they differ depending on what numbers you look at. You can either look at the outcomes for the two original groups, which were the people randomly assigned to induction and then those assigned to expectant management, or you can look at the breakdown of what actually happened to the people in the two groups, in other words what happened to the people who were actually induced or who actually went into spontaneous labor.
Anna Bertone: So what happened in the original randomly assigned groups? If you look at the two original groups, the overall cesarean rate was lower in the induction group. It was 21.2% versus 24.5%. That was even after taking into account factors like the mother’s age, whether or not it was her first baby, and cervical dilation at the time of study entry. Or you could look at what happened with the people who were actually induced or who actually went into labor on their own. And if you look at that, you see two very interesting things. You see that people who went into spontaneous labor, regardless of which group they were assigned to, they had a cesarean rate of only 25.7%. But if people in the monitoring group had an induction, their cesarean rate was much higher than all the other groups. It was 42%. The same was true for both first-time mothers and for mothers who had given birth before.
Anna Bertone: So what does this mean? It means that only the people who were expectantly managed but then had an induction had a really high cesarean rate. The people who were expectantly managed and then went into labor spontaneously did not have a higher cesarean rate. One possible reason for this, for the highest cesarean rate seen in the people who were assigned to expectant management but then ended up getting an induction, is that the people in this group might’ve been higher risk to begin with since a medical complication could have led to their induction. The people that were assigned to expectant management and never developed a complication requiring an induction, those were the lower risk people, which means they were the ones less likely to end up giving birth by cesarean.
Anna Bertone: Then, another important factor that I know Rebecca has discussed previously is that doctors might’ve been quicker to call for a cesarean when assisting the labors of people with medical inductions if their pregnancies were beyond 42 weeks. They may have been less patient waiting for labor.
…Or more easily worried about the course of the labor, big baby, etc. –
Anna Bertone: Yes. More worried.
So basically, it seems like from the Hannah post-term trial, one of the benefits of considering expectant management is that if you do have spontaneous labor, your chance of cesarean is pretty low. But the risk is that you’ll develop medical complications and need an induction, in which case an induction at 42 weeks is going to be riskier than an induction at 41 weeks. So what do you think? We have all this research from all over the world, from the Hannah post-term trial, to the 2018 meta-analysis, to two trials out in 2019. Do you still feel like routine induction at 41 weeks is still going to be controversial or not?
Anna Bertone: I think it’s definitely still controversial, and I think everybody’s still processing the results from the INDEX trial and the SWEPIS trial. Rebecca and I reached out to Dr. Wennerholm who conducted the SWEPIS trial in Sweden, and she said she’s currently working on secondary analysis of the data. They’re talking about the economic implications of the findings in Sweden and what it means for Swedish national policy. So I think it’s still controversial. People are still talking about what to make of these findings.
Anna Bertone: There was another systematic review from 2019 by Riedel. This one came out too early to include the SWEPIS and the INDEX trials, but it’s still interesting to look at. Because unlike the Middleton Cochrane review, these authors were specifically interested in induction during the 41st week of pregnancy versus during the 42nd week of pregnancy. So in their analysis, they restricted the studies only to people having a routine induction at 41 weeks and zero to six days versus routine induction at 42 weeks and zero to six days. If you remember, the Cochrane review was much broader than that. They also only looked at studies published within the last 20 years. They only looked at studies with low-risk participants, and they ended up with three observational studies, two randomized controlled trials, and two studies that they called “quasi experimental studies”, which they grouped with the randomized controlled trials even though these studies weren’t truly randomized.
Anna Bertone: What they found was one perinatal death in the 41 week induction group and six deaths in the 42 week induction group. That was a rate of 0.4 versus 2.4 per 1,000. This finding was not statistically significant. In other words, we don’t have strong enough evidence that this couldn’t have happened by chance. These same studies, those two randomized controlled trials and the two quasi experimental studies, they showed no difference in cesarean rates between groups also. But the authors did report that one observational study found an increase in the cesarean rate with the 41 week induction group. So basically, they’re saying if you look much more narrowly at the evidence of induction during the 41st week versus the 42nd week, then there might not be a significant difference in the death rate.
But that Riedel study from 2019 is already outdated because that was before the two big randomized trials came out.
Anna Bertone: Yes. We need to see a systematic review and meta-analysis that includes those two randomized controlled trials and see if that changes. These authors also expressed concerns about the cesarean rate possibly rising with 41-week induction because both the SWEPIS trial and the INDEX trial took place in countries with very low cesarean rates. So we just don’t really know at this point whether there would be a difference in cesarean rates if they took place in countries with higher rates of cesarean, such as the U.S.
Anna Bertone: So I think it is still controversial. There’s also countries that are changing their policies about induction and going back and looking at whether that policy change led to any difference in outcomes. One such country is Denmark. They just published a study where they compared birth outcomes from 2000 to 2010 versus 2012 to 2016. And in that time period there was a change in policy from recommending induction at 42 weeks and zero days to 41 weeks and three to five days. They included over 150,000 births in the dataset. And when they looked back, they didn’t see any difference in stillbirths, or perinatal deaths, or low Apgar scores when they compared the period before versus after the policy change. The perinatal death rate was already declining before the policy change in 2011, and it just continued going down without any additional impact from the 2011 policy change. There was also no impact on the rate of Cesareans with the policy to switch from 42 weeks to 41 weeks.
Anna Bertone: That’s just an example of how this is still controversial. Countries are implementing new policies, and Sweden and the Netherlands may implement new policies based on the INDEX and the SWEPIS studies. Then they’ll probably conduct a study the same way that Denmark did to see if that policy change had any real impact on the population.
I think it’s important to mention, though, that with the Denmark national policy, they switched from 42 weeks and zero days to 41 weeks and three to five days, and that might not have been early enough to make an impact on the stillbirth rate because the studies that we were looking at from 2019, SWEPIS and INDEX, were looking at inductions happening at 41 weeks and zero to one or two days and it was that couple of days difference that made the difference between low stillbirth rate and a higher stillbirth rate.
Anna Bertone: Right. Exactly. I think that future researchers shouldn’t group 41 weeks and zero to six days together in one grouping because there seems to be differences between the earlier part of the 41st week and the later part of the 41st week because, like you said, SWEPIS and INDEX found that waiting even just two or three days make a difference in outcomes during that week.
So let’s just sum up the pros and cons of induction at 41 weeks versus continuing to wait for labor since that’s what we have the bulk of the evidence on now. I would say that the research shows that the pros of inducing labor at 41 weeks include a lower risk of stillbirth, especially among those with risk factors for stillbirths such as being pregnant with your first baby. In our article, we have a table of the pros and cons. The absolute risk of stillbirth is 4 out of 10,000 pregnancies at 39 weeks, 7 out of 10,000 pregnancies at 40 weeks, 17 out of 10,000 pregnancies at 41 weeks, and 32 stillbirths out of 10,000 pregnancies at 42 weeks. Research also shows a lower risk of the baby receiving intensive care with an elective induction at 41 weeks, lower risk of the baby having jaundice, lower risk of the baby being large for gestational age, and lower risk of needing a cesarean, although that finding may depend on your practice setting. There is a lower risk of mother developing a high blood pressure disorder. at the end of pregnancy. And for some people, they may find an elective induction at 41 weeks convenient and it could help them end an uncomfortable pregnancy.
Also, in our article, we reference one study that found some cognitive benefits for babies. It suggests that the cognitive benefits for the baby from the mom remaining pregnant appear to increase until about 40 to 41 weeks after which there’s no cognitive benefits to the baby’s brain development for continuing to remain pregnant. So Anna, can you share the cons of elective induction at 41 weeks?
Anna Bertone: Yeah. One of the cons of being induced at 41 weeks instead of continuing to wait and see if you go into labor is the potential for medicalization of birth. One example of this is continuous fetal monitoring may occur if you have the induction, whereas you might not get continuous fetal monitoring if you go into labor on your own spontaneously during that 41st week.
Anna Bertone: Another con would be a potential for failed induction leading to a cesarean. That also depends a lot on your practice setting. Another con is the potential for uterine tachysystole, which is defined as more than five contractions in 10 minutes averaged over 30-minute window. There’s a potential increase in the risk of uterine rupture with medical induction. That is especially important among people with a previous cesarean having a VBAC.
Anna Bertone: Another con is missing the hormonal benefits of spontaneous labor. Another con is increased risk of mother getting inflammation of the inner lining of the uterus, endometritis. One study found that as a possible risk of induction 41 weeks. Then, lastly, medically-induced contractions might increase pain and make epidural use more likely.
We also have a section in the article where we talk about whether there are any benefits to going past your due date. That table we just took you through was comparing the benefits and risks of elective induction. In terms of benefits of going past your due date, one of the major benefits of awaiting for spontaneous labor are the hormonal benefits, which Anna briefly mentioned. In our article, we link to the book Hormonal Physiology of Childbearing by Dr. Sarah Buckley, which talks about the physiologic understandings and the physiology of spontaneous labor. So that is something to keep in mind, and that’s one reason why some people prefer to wait for spontaneous labor. So Anna, if someone wants to wait for labor to begin on its own and they’re talking with their care provider about expectant management, what’s kind of the bottom line about that?
Anna Bertone: I think the bottom line about that is it all needs to be very individualized. When someone goes past their estimated due date, they could talk to their care provider about the benefits and the risks of elective induction versus continuing to wait for labor and how those benefits and risks apply to them personally. Most research articles and guidelines say that because there are benefits and risks to both options, the pregnant person’s values, goals, and preferences should play a part in the decision-making process.
Anna Bertone: It’s important for expectant families to be aware of the growing research evidence showing that there could be worse health outcomes for those who wait for labor after 41 weeks of pregnancy instead of being induced at 41 weeks, especially among first-time mothers and those with additional risk factors for stillbirth. But ultimately, after receiving accurate evidence-based information and having conversations with their care providers, pregnant people have the right to decide whether they prefer to induce labor or wait for spontaneous labor with appropriate fetal monitoring.
I want to also let people know about a couple more resources that are in this article at evidencebasedbirth.com/inducingduedates. We have a section all about how people and their care providers can talk about the risk of stillbirth with some sample scripts that healthcare providers can use when they’re talking about risks of stillbirth. We also have links to different guidelines from different organizations about induction at 41 weeks. Then we also have our section called The Bottom Line. So what would you say are some of the bottom lines, Anna, about elective induction at 41 weeks and zero to two days?
Anna Bertone: I think the bottom line is that elective induction at 41 weeks and zero to two days could help to reduce stillbirths and poor health outcomes for babies without increasing harm, like the risk of Cesarean for mothers. We’re getting that from those two large randomized controlled trials published in 2019 that both found benefits to elective induction at 41 weeks instead of continuing to wait for labor until 42 weeks. One of those studies, as we mentioned, found less perinatal death with 41 week induction and the other found fewer poor health outcomes for babies like intensive care unit admission and low Apgar scores with 41 week induction. Neither of those trials found an increase in the risk of Cesarean during birth with 41 induction compared to continuing to wait for labor until 42 weeks. However, both of those trials took place in countries that follow the midwifery model of care and the overall Cesarean rates were very low. So I think it remains to be seen how that will translate into countries like the U.S. that have higher Cesarean rates.
So I hope you all found this podcast helpful in looking at the recent research on induction at 41 weeks versus expectant management. Make sure you check out the blog article that goes along with this podcast episode for all of the resources, links, research references. We also have a free one-page handout you can download that summarizes the results of this research. Just go to evidencebasedbirth.com/inducingduedates to download that new article. Thank you so much, Anna, for joining us to help our listeners understand the evidence.
Anna Bertone: Happy to do it, Rebecca. Thank you.
Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth Professional Membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast as well as other resources are supported by our Professional Membership program. Everyone who joins our professional membership gets access to a library with all our printer-friendly PDFs. Each signature article that we publish online has been turned into a professionally-designed, easy-to-print PDF so that our members can print and share evidence-based info with their clients, other parents, or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.
The death toll during the four-day communal violence in the Indian capital city rose to 46 on Sunday, officials said.
“Today three more bodies were recovered from the violence-hit northeast part of the city,” a police official said. “One of the bodies was found in a canal in Gokalpuri and two were recovered from the Bhagirathi Vihar canal.”
According to the officials, the death toll by now stands at 46. Over 350 people were also injured in the violence that ravaged the city.
Police officials on Sunday said the situation was under control. However, the huge deployment of police and paramilitary remains in the affected parts.
The violence left a trail of damage in the northeastern parts of the city as rioters torched vehicles, vandalised shops and burnt buildings including schools.
Many people, especially Muslims, have left their homes in the affected areas and took refuge in the shelters set up by the government.
Delhi Police has come under fierce criticism for its apparent inaction. Locals alleged their calls to police for help proved futile.
The police have set up two Special Investigative Teams (SITs) to probe the violence. According to officials, hundreds of people have been detained in connection with the violence.
The clashes broke out between pro- and anti-Citizenship Amendment Act (CAA) groups in the northeastern part of the city last Sunday and took an ugly turn on Monday and Tuesday.
Protests against the controversial new citizenship law were triggered on Dec. 11 last year, the day India’s upper house of parliament passed the law. Since then there has been no let-up in the protests.
The law aims at granting citizenship to illegal immigrants belonging to six religions – Hinduism, Sikhism, Buddhism, Jainism, Parsi and Christianity – from Bangladesh, Afghanistan and Pakistan. However, it has kept out Muslim immigrants from applying for citizenship.
So far, the violence against the law has killed over 70 people across India.
BEIJING, February 17. /TASS/. The number of people who died from the novel coronavirus in China has reached 1,770, more than 70,500 cases of the disease have been confirmed, while more than 10,800 people are said to have recovered from it, China’s health committee reported Monday.
On Sunday, the committee informed about more than 68,500 cases, 1,665 deaths and 9,419 recovered. According to the data update, the official coronavirus death rate is now standing at 2.5% compared to Sunday’s 2.43%
Among China’s regions, the Hubei Province has the most cases with 58,100 people identified to have contracted coronavirus, 1,696 of them dead and 6,639 recoveries. Hubei is followed by the Guangdong Province (south China) with 1,300 infections, the Henan Province (central China) and the Zhejiang Province (east China) which report 1,200 and 1,100 cases respectively.
According to data available on Sunday, there are 381 coronavirus cases in Beijing, 144 of them were discharged from hospitals, while four people died.
According to the latest official reports, more than 150,500 Chinese citizens are monitored in the country because they had close contacts with those who are known to have contracted the disease. China also says there are about 7,200 people placed in quarantine because of coronavirus fears. According to doctors, more than 10,600 people are in critical condition.
A pneumonia outbreak caused by the COVID-19 virus (previously called 2019-nCoV) was reported in China’s city of Wuhan – a large trade and industrial center in central China populated by 11 million people – in late December. The WHO declared it a global emergency, describing the outbreak as an epidemic with multiple foci.
The virus spread to 25 more countries, apart from China: Australia, Belgium, Cambodia, Canada, Egypt, Finland, France, Germany, Japan, India, Italy, Malaysia, Nepal, the Philippines, Russia, Singapore, South Korea, Spain, Sri Lanka, Sweden, Thailand, the United Arab Emirates, the United Kingdom, the United States and Vietnam. The WHO declared the coronavirus outbreak in China a global health emergency. Chinese authorities have confirmed more than 68,500 cases of the disease, over 1,665 people died, while more than 9,400 people are reported to have recovered.
Stand-up comedian Kunal Kamra, who was banned from flying with IndiGo airlines for six months amid recent controversies, has now sent a legal notice to the airlines demanding a public apology and an amount of Rs 25 lakh for “causing mental pain and agony”, as well as the revocation of the ban.
On Tuesday, IndiGo airlines had suspended the comedian from flying with the airlines for six months following his ‘unacceptable behaviour’ onboard the flight. This came after Kamra had posted a video on social media on Tuesday, which shortly went viral. In the video, it could be heard that the comedian was throwing a series of questions at an anchor of a popular broadcast news media network, Arnab Goswami, inside an IndiGo airlines flight. The comedian was also heard making several comments regarding the anchor’s journalistic ethics.
IndiGo airlines had also tagged the Ministry of Civil Aviation and Union Minister of Civil Aviation Hardeep Singh Puri in the Twitter post where it informed of the ban.
@MoCA_GoI @HardeepSPuri In light of the recent incident on board 6E 5317 from Mumbai to Lucknow, we wish to inform that we are suspending Mr. Kunal Kamra from flying with IndiGo for a period of six months, as his conduct onboard was unacceptable behaviour. 1/2
— IndiGo (@IndiGo6E)
Union Minister Hardeep Puri also called Kunal Kamra’s behaviour “offensive” and “designed to provoke and create disturbance inside an aircraft”. It is “unacceptable and endangers the safety of air travellers,” he said. Following the precedent set by Indigo; Air India, SpiceJet, and GoAir airlines, too, had on Wednesday suspended stand-up comedian Kunal Kamra from flying with the airlines until further notice.
However, several critics later pointed out the reported inconsistency in the airline’s actions. It has been highlighted that, according to the Director General of Civil Aviation (DGCA) guidelines, the normal procedure regarding any complaint dictates that an internal committee be formed by the airlines within 30 days to probe the complaint. Moreover, the committee’s decision can later be challenged in an appellate body of the Ministry of Civil Aviation and a court. Without following any of these procedures, a direct ban of six months seems somewhat arbitrary, critics have pointed out.
Moreover, DGCA guidelines list three categories of passengers who are prevented from flying. The category which matches Kamra’s alleged actions – “disruptive behaviour” – only carries a three-month ban. The other two which are unlikely to match the comedian’s actions – “physically abusive behaviour” and “endangering aircraft and passengers” – carry six-months and two-years bans respectively.
Moreover, the pilot who was operating the flight has now pitched in his opinions on the matter. The pilot has penned a letter to the airlines expressing his concerns over the airlines taking action ‘without consulting the Pilot-in-Command’.
In the letter that the pilot of the aircraft has now penned to the airlines, he stated that he did not observe any physical contact between the two individuals involved in the controversy. Moreover, he said that he had noticed Kamra was gesticulating to Goswami, who was unresponsive.
“I did not observe any physical contact between the two gentlemen at any point. I made a Passenger Address to the cabin asking the gentleman standing in the passenger aisle near Row 1 to return to his seat,” the pilot expressed in his letter.
The pilot further penned that even though Kamra’s behaviour was unacceptable and verbally abusive, he had complied with the instructions of the flight crew.
Today was an important day of the year as the Union Budget 2020 was presented by the Finance Minister of India, Nirmala Sitharaman. The major highlight of the budget is the new income tax slabs but the government has given an option to the citizens, they can either choose to continue with the old tax rates with exemption or can opt for the new tax rates in which the exemptions are not provided.
As per the Finance Minister, Union Budget 2020 is focused on three points – improving the standards of living, economic development for each section and a caring society. The Finance Minister has also called the Goods and Service Tax (GST) as a historic reform in the Indian tax regime. Nirmala Sitharaman emphasized on the need of making compliances easy to fulfill for the startups too.
Every person tries to find out what this budget has for him and after the 2.5 hours long speech of the Finance Minister, the micro-blogging site Twitter is flooded with reactions. While some expressed their happiness or annoyance, there were some who felt that the speech was unnecessarily long and compared it with Sajid Khan’s movie. Here are some of the selected reactions:
Middle class people trying to understand #Budget2020 . pic.twitter.com/LVp4vOrfVf
— Hunटरर (@nickhunterr) February 1, 2020
Nirmala Sitharaman talking about government’s achievements #BudgetSession2020 pic.twitter.com/wOsKn4GPR6
— Sir Yuzvendra (parody) (@SirYuzvendra) February 1, 2020
*Rahul Gandhi trying to understand the Budget* pic.twitter.com/uIrkC4294Z
— Ashutosh Singh (@ashusarcastic) February 1, 2020
1. Indians before budget speech.
2. Indians after budget speech.#Budget2020 pic.twitter.com/4G9WD2BIaQ
— Nirmala Tai Halwe wali (@Vishj05) February 1, 2020
Income Tax slabs over the years#Budget2020 #BudgetSession2020 #NirmalaSitaraman pic.twitter.com/RIDt3ykkVQ
— Siddharth Patni (@aageSeLeftLelo) February 1, 2020
Salaried taxpayers waiting for tax cuts be like:#BUDGET2020 pic.twitter.com/0vbG4XGMuC
— VJ (@CA_Hemwani) February 1, 2020
A friend just said “budget chaahe jaisa marzi aa jaye, hum month end tak gareeb ho hi jaayenge”, and it hit me hard. #BudgetSession2020
— Pakchikpak Raja Babu (@HaramiParindey) February 1, 2020
People : Is bar ka #Budget2020 Middle class wala hoga !!
Nirmala : pic.twitter.com/IUiK97hcTg
— Sourabh (@SourabhJainIET) February 1, 2020
The #Budget2020 was a Sajid Khan movie #BudgetSession2020
— HOLLA! (@AshokaHolla) February 1, 2020
#BudgetOnZee #Budget2020 #BudgetSession2020
When tax Rates and you realise
Gets Reduced no deduction will
Be allowed as well pic.twitter.com/4XjvY05Au6
— CUagain (@RECinaction) February 1, 2020
Everybody right now. #Budget2020 pic.twitter.com/U0GVYbe24Z
— अंकित जैन (@indiantweeter) February 1, 2020
Common Man trying to understand #Budget2020 listening to #NirmalaSitharaman’s speech. pic.twitter.com/oXLCjKHp1c
— Godman Chikna (@Madan_Chikna) February 1, 2020
Middle class people checking the budget benefits #Budget2020 pic.twitter.com/oJVhN90lIF
— Aishthetic ?? (@Badassgirlll) February 1, 2020
New income tax regime #Budget2020 pic.twitter.com/l2QmPyfjWH
— Megha Mandavia (@MeghaMandaviaET) February 1, 2020
New Tax slab … #Budget2020 https://t.co/CGwLmE0coJ pic.twitter.com/uUJE77gbeS
— Mr. Dua (@koolmunddaa) February 1, 2020
The share market doesn’t seem to be happy with the budget as it closed almost 900 points down today. The experts feel that the government has not talked clearly on the matter of dealing with economic slowdown.
What is your opinion on the Union Budget 2020? Let us know your views.
The post Twitter Flooded With Hilarious Memes After Nirmala Sitharaman Presented Union Budget 2020 appeared first on RVCJ Media.
India, China and Myanmar are three Asian countries currently engrossed in carrying out physical and cultural genocides on their Muslim populations. While the plight of Rohingya Muslims and Uighur Muslims is well known, the recent introduction of a new law expressly aimed at dispossessing Muslims of Indian citizenship has alerted many to the reality that India’s ruling BJP government sees itself as Hindu first and foremost.
Questions such as “Why aren’t the rich Arab countries saying anything?” have come up, with the implicit inference that Muslim-dominated countries are supposed to stick up for Muslims everywhere in the world. Others have pointed out that despite suffering oppression in some parts of the world, Muslims are also responsible for brutal acts of oppression against other minority groups elsewhere, which allegedly negates the sufferings of the prior group.
In this article, I will pick through these questions and viewpoints with a goal of isolating some useful truths about how religion, geopolitics and human nature constantly interplay and produce much of the world around us.
Which religion is the most oppressed? I like to troll my Christian friends with the image below whenever the topic comes up about some religion or the other allegedly imposing its will at their expense.
The truth is however, that this image could apply to just about every religion on earth. As a general rule of thumb, the only limiting factor on whether or not a religion functions as an oppressive tyranny in a particular jurisdiction is the proportion of the population that practises it there. Similarly, the only thing stopping any religion from being an oppressed and downtrodden identity is whether it is a small enough minority for that to be possible.
While Muslims in India, Myanmar and China are going through untold degrees of horror because of their religious identities, Muslims in places like Bangladesh, Indonesia, Afghanistan, Malaysia and Northern Nigeria are simultaneously visiting very similar horrors on Bah’ai, Shia Muslims, Christians, Budhists and other minorities in those areas. It turns out that the mere fact of belonging to a religious identity does not in fact, confer unrestricted global victimhood.
This point is important because it disproves the notion held by every major religion that its adherents follow a single set of standards and do things in the manner of a global “brotherhood.” In reality, Islam according to a Rohingya Muslim hiding from the Burmese military, and the same religion according to an itinerant herder in Kogi State bear almost no similarity to each other save for the most basic tenets. Environmental factors in fact have a bigger influence on how religions are practised than their own holy books.
The current antics of India’s ruling BJP and its Hindu fundamentalist support base provide an important case in point as to how this works. Looking at the evolution of Hinduism from a passive philosophy into an openly militant ideology gives an important insight into how religion is in fact, a thoroughly contrived and amorphous set of ideas that can be changed, adjusted, aligned and revised at a moment’s notice in justification of anything at all.
Hinduism traditionally sees itself as a religion of thoughtful, considered spirituality as against the angry dogmas of its Abrahamic neighbours, but something interesting is happening. Some argue that it started in the days of Gandhi, and some ascribe it to current Prime Minister Nanendra Modi, but whoever started it is a side note. The key point to note is that based on political factors, i.e anticolonial senitment against the British and anti-Muslim sentiment fueled by India’s national rivalry with Pakistan, Hinduism has somehow been coopted into the narrative of a jingoistic, monotheistic, mono-ethnic state which is historical nonsense.
India has always been a pointedly pluralistic society, and in fact the geographical area now known as “India” does not even cover the geographical area of the India of antiquity. That India was a place of Hindus, Budhists, Muslims, Zoroastrians and everything in between. Hinduism never saw a problem with pluralism because Hinduism itself is a very plural religion – it has at least 13 major deities. The conversion of the Hindu identity into a political identity movement is a recent and contrived phenomenon first exploited by Gandhi as a means of opposing British colonialism, and now by Modi to oppose the Pakistanis/Muslims – it is a historical falsity.
The creation of Hindu fundamentalist movements like the RSS (which PM Modi belongs to) is something done in response to environmental factors. Spectacles like the RSS march below are evidence of yet another religion undergoing constant and ongoing evolution into whatever suits its purposes.
Something similar happened when medieval Europe turned into colonial Europe and European Christianity transitioned into a peaceful and pacifist ideology after centuries of being a bloodthirsty doctrine. The environmental factors that created the Crusades, the Spanish Inquisition, book burnings and witch hunts went away with the introduction of an industrial society, and thus the religion too transitioned.
In plain English, what all this means is that nobody actually practises a religion in the pure sense they imagine they do. Everyone who subscribes to a religion merely practises a version of it that is subject to the culture and circumstances of their environment and era. This is directly connected to the next major insight raised by these events.
While anti-Muslim violence has continued apace for years in China, Mynammar and India, the question has often been asked: “Why are the wealthy Arab nations not saying anything?” There is a perception that since the Arabian peninsula is the birthplace of Islam and Arabs – particularly Saudis – are viewed as the global gatekeepers of the faith, they must be at the forefront of promoting the interests of Muslims worldwide.
To many, the fabulous wealth and international influence that Saudi Arabia, Kuwait, Qatar and the UAE enjoy, in addition to the presence of two of Islam’s holiest cities – Mecca and Meddinah – in Saudi Arabia, means that they have a responsibility to speak for the global Muslim Ummah and stand up for them when they are unfairly targeted and mistreated. Unfortunately for such people, the wealthy nations of the Arab Gulf region tend to respond to such questions with little more than an irritated silence – and with good reason.
To begin with, these countries are not democracies led by the wishes of their almost uniformly Muslim populations. They are autocracies led by royal families who came to power in the colonially-influenced 20th century scramble for power and influence. Saudi Arabia, which houses Islam’s holiest sites, is named after the House of Saud, its royal family which came into power in its current form at the turn of the 19th century. The priority of the regimes in these countries first and foremost is self-preservation.
Self-preservation means that before throwing their significant diplomatic and economic weight behind any attempt to help out fellow Muslims, the first consideration is how doing so will benefit them. India for example, is a country that has close diplomatic ties with the UAE, and supplies most of their cheap labour for construction and low-skilled functions. India has even coordinated with UAE special forces to repatriate the dissident Princess Latika when she made an audacious escape attempt in 2018.
What does the UAE stand to gain if it napalms its diplomatic relationship with India by criticising Modi’s blatantly anti-Muslim policy direction? It might win a few brownie points with Islamic hardliners and possibly buy some goodwill among poor Muslims in South Asia, but how much is that worth? The regime and nation’s self-interest is best served by looking the other way, so that is exactly what they will do.
The Saudis make a similar calculation. At a time when they are investing heavily in military hardware to keep up with their eternal rivals Turkey and Iran, and simultaneously preparing for the end of oil by liberalising their society and economy, does it pay them to jump into an issue in India that does not particularly affect them? As the status of their diplomatic relationship with the U.S. remains unclear following the Jamal Khasshoggi incident, are they going to risk pissing off the Chinese because of Uighur Muslims?
In fact self-interest like that mentioned here is the basis of the considerations that underpin all international relations. Well I say “all,” but what I really meant to say was “all except African countries.” It is only African countries that take diplomatic decisions based on little more than flimsy emotions and feelings of religious affinity. Gambia for example, has dragged Myanmar before the UN and filed a genocide case against it on behalf of the Rohingya Muslims.
This would be commendable and great were it not that Gambia itself is hardly a human rights luminary, and generally has little business fighting an Asian battle when its own worse African battles lie unfought. The only thing Gambia stands to gain from fighting a diplomatic war that the rest of the world seems unwilling to touch is the temporary goodwill of a few Muslims in Asia and around the world – goodwill that cannot translate into something tangible for it.
To coin an aphorism from social media lingo, you could call it ”diplomatic clout chasing.’
Last November, thousands of Lagosians including hundreds of UBA Bank employees attended what was billed as the ‘party of the year’ at the Lekki Special Events Centre on Admiralty Way.
The UBA RedTV Rave had everyone from Wizkid to Olamide to Jidenna to Burna Boy thrilling the festive crowd as UBA chairman Tony Elumelu and CEO Kennedy Uzoka mingled with the artists and guests.
On the surface, this was the best of times, as a bank that was clearly in rude health celebrated a successful year with thousands of employees, friends and family. The bank had also recently concluded a recruitment exercise that would add nearly 4,000 new employees to its staff strength, so the year ahead looked to be a promising one for most employees present.
Unknown to them, while senior executives danced with Wizkid in the VIP area, one of the most brutal staff layoffs in Nigerian banking history was just around the corner. They partied well into the night and then showed up for work the following week as usual. A week went by. Two weeks. Four weeks. Then right at the start of the new year – a shocker.
Ifunanya (name has been changed) was asked to wait behind at work on Friday January 3. As a 12-year UBA veteran including a long stint in her role as a Branch Operations Manager at a branch in Ojodu, Lagos, this was not an unusual request to receive. She was even used to working weekends so that the ATMs could remain functional and she could troubleshoot other onsite customer-facing issues. This time however, was different.
Along with other staff members at the branch, she was asked to wait for a board meeting. By 10.30PM, the assembled staff were informed that their services were no longer required. They were then told verbally to write out their resignation letters on the spot and leave voluntarily or be forced out. At this point, her security pass was taken, and along with the other affected staff, her profile was unceremoniously deactivated from the bank’s internal system. She was reminded to drop her work ID on the way out, and thus ended a 12-year association with the bank.
When a relative of hers reached out to tell the story, he was keen to make the point that she was not an agency employee, but a full UBA employee on a monthly salary of N153,000. He could not understand why the bank would treat her that way. I heard similar stories from two other sources who insisted that they were coerced into resigning after being told that their services were no longer required right at the start of the new year.
Shocking and callous as these stories may have sounded, one of the first things you are taught in any professional journalism program is to always balance the story. So I sought an alternate account of what transpired, with the goal of putting the picture together to tell a complete story. There were conflicting accounts of the events of January 3 flying around, with some accounts describing a recruitment and promotion exercise without mentioning any firings, while others reported a purported “restructuring” at UBA, which is a well-known euphemism for “mass sack.”
I managed to establish contact with a current senior employee at UBA who asked to remain anonymous because he is not authorised to speak about such matters. This was his account of what happened at UBA bank at the start of this year:
“Usually when anyone joins UBA with a Bachelor’s degree, they are put on a GT1 level (N80,000). After one year, they are promoted to GT2 (N100,000), then after another year ET1 (N140,000) which is where a lot of people get stuck on. If you are lucky, you get to ET2 (N165,000). So what UBA did was to meld those 4 levels into one (ET) so any one who was on GT1 and GT2 gets automatically promoted to ET2. Those that were on ET1 and ET2 got promoted to SET (Senior Executive Trainee).
So it was a promotion of sorts, but honestly it was long overdue because compared to other banks, N80,000 for entry level staff is quite low. About the layoffs: I only know 4 people personally who got affected. The people affected were on manager grades and worked at the head office, they all reportedly got 6 months arrears.”
According to this source, he was not personally aware of the fate of any branch staff or what he termed ‘OND staff.’ He did however say that in his opinion, the bank handled the situation poorly and that Nigeria does need stronger labour laws to protect young graduates fresh out of school from exploitation for cheap labor at the hands of corporates like UBA. He also mentioned that he knows current UBA staff have not had a salary increase in ten years – a remarkable situation for workers in a country whose currency has declined 195 percent over the same period.
As it later emerged, more than 2,000 staff were affected by the shocking late-night cull at UBA. It also became increasingly clear that the firings had nothing to do with a harsh operating environment or decreased profitability. The bank which had brought together Nigeria’s most expensive music stars to perform at its end of year shindig was anything but struggling – it actually hired more people than if fired. What the sackings did though, was clear out a number of people in roles that the bank considered obsolete, particularly within branch operations.
It can definitely be argued that such restructuring is inevitable in the face of rapidly changing technology, which is hardly a terrible thing. What is also true however, is that the bank that paid huge sums of money to bring Burna Boy and Jidenna to an annual vanity event that adds nothing to its bottom line could also afford to retrain its redundant staff to fit into new roles – instead of just sacking them and instantly bringing in thousands of readymade replacements.
Yet again, the actions of a Nigerian corporate made the point that Nigerian labour law, in addition to be being poorly enforced is also woefully inadequate and unfit for purpose. If after 12 years of useful service to a bank, Ifunanya could be dumped out onto the street without even a few hours of notice – and no regulatory action was forthcoming – then clearly, Nigerian employees working for Nigerian companies have a problem on their hands.
As much as the UBA situation made that point, nothing could have prepared me for what I was about to unearth about another Nigerian corporate behemoth.
While senior executives at UBA House were going over the finer points of their plan to log 2,000 employees out of their work systems and force them to resign on the spot, a different level of labour exploitation was entering its fourth year about 73KM east of the Marina. There, at the site of the Dangote Refinery at the Free Trade Zone in Ibeju-Lekki, Lagos, the refinery was taking delivery of the world’s largest crude oil refining tower.
While this was predictably being celebrated across local and foreign media as the start of a glorious new chapter in Nigeria’s industrial history, I was speaking to a whistleblower with close and detailed knowledge of the project. What he had to say about the refinery project, the Indian project managers, the company’s internal culture and its much-publicised trainee program left me absolutely floored. Naturally I reached out to Dangote Group for a comment, but at press time I have received no response or acknowledgment.
My source, whom I shall call “Mukhtar” worked in and around the refinery project between 2016 and 2018, and what I found most distressing amidst everything he said was the revelation that deaths due to onsite accidents are not just known to happen at the refinery site, but are effectively covered up by Dangote. This he said, is because the people who die are mostly site labourers who are hired through staffing agencies instead of directly. When they die, it becomes the staffing company’s problem and the Dangote brand distances itself from it – even though the site owner is legally responsible for all safety-related incidents onsite.
Something else that struck me was that he implied that – contrary to all its public posturing – the company actually has no intention of using Nigerian engineers to run the refinery anytime soon. The trainee program that sent dozens of Engineering graduates for a one-year training program in India? “Strictly PR,” he said.
For full effect, I have decided to reproduce the full and unredacted transcript of our conversation instead of using quotes and reported speech. Here is the conversation below:
ME: When we started this conversation, you mentioned that Dangote Refinery is exempt from Nigerian labour laws. What were you referencing?
Mukhtar: Because the refinery is in the FTZ, it is not subject to certain laws like local content laws. As such, even mundane jobs are given to non-Nigerian companies. Even the refinery’s fence wall was handled by a Chinese company. This didn’t stop long stretches of the fence from collapsing sometime in 2017. The FTZ affects Labour laws too. The company is not really under any obligation to employ Nigerians. They do so mostly for PR. All key decision makers are Indians (say 98%).
ME: There have been several horror stories about Indian-run businesses in Nigeria. Was this one of them?
Mukhtar: Yes, the Indians are quite racist. Some even demand to be referred to as “master”. To be fair, when this is reported, the HR unit makes a show of cautioning them. But I dont think anyone has ever been dismissed for it or seriously punished. Most of workers who meet their death on site are labourers. So their names might be known to many staff. I’ll see what I can get. It happens. It’s kept under wraps but it happens.
ME: Now you mentioned onsite deaths earlier. I want to know all about this. Why haven’t we heard anything about this?
Mukhtar: The refinery site is not really the best place to work. Mortality rate on site is quite high. People falling from heights or getting crushed by heavy vehicles/machines is quite common. These numbers are not reported because most staff are contract staff (or outsourced) so the company gets to wash its hands off such cases. But safety on site is the ultimate responsibility of the owner of the project. The construction site has a board that is supposed to display the safety statistics but it is never displays the truth. According to that board, there has never been a fatality on site. But in reality, I think 2018 had about 5 fatalities between January and March. If I were to guess, I’d say there have been over 25 fatalities since construction started in 2016/17.
ME: Now you said earlier that the trainee program was a washout and a disappointment. Fill me in on that.
Mukhtar: I was one of the first batch of engineers sent to India for training in 2016. In my opinion, the whole scheme was either poorly thought out or the company was somehow compelled to do it, and did so for PR. Our salaries were being paid into our accounts in Nigeria, so we were using our debit cards to access our Nigerian accounts for expenses over there) Around July 2016 when the naira went from around 160 per dollar to nearly double that number, our spending power was effectively halved.
ME: I also remember that there was a forex shortage crisis in 2016 and Nigerian bank cards stopped working outside the country.
Mukhtar: So when the banks eventually stopped all cards from functioning abroad, we were stranded. The company resorted to selling us dollars or rupees at the black market rate.They deducted the money from our salaries. We had accommodation (two adults per room) and feeding (Indian food which many of us did not like). Some of had to buy intercontinental dishes regularly, because Indian food is really not nice if you’re not into many smelly spices. It was crazy. Meanwhile we were told categorically that we would have Nigerian food and Nigerian cooks. It was a blatant lie by the Indian HR director.
Also, no arrangement was made for our medical care. Those who fell ill had to treat themselves from their pockets. During the currency crisis, those who fell ill had to rely on the rest of us to put together our spare change to pay for their treatment. The company promised to refund medical expenses, but this shouldn’t have been the situation in the first place.
ME: Tell me about the training program. What was the course content and the experience like? Was it what you were expecting?
Mukhtar: The training itself was a mess too. We were supposed to be trained to operate the refinery (at the time, it was said that it will be completed by mid 2017), but we were sent to a design company. These (designing a refinery and operating it) are two very, very different things. The trainers did not want us there in the first place. It was not a part of their initial contract with Dangote. Plus, they didn’t know what to teach us because designers are not operators. They were confused, several times, they asked us what we wanted to learn. But we could not know what we wanted to learn cos we knew nothing about the entire business. In the end, they reluctantly settled for teaching us design (skills we were/are unlikely to use cos the refinery was already 90% designed).
ME: If you say that the refinery was “already 90% designed,” and you were learning design in India, that sounds like your presence was superfluous. Was the company really serious about sending you to learn skills to run a refinery?
Mukhtar: Indians will run the refinery. It will take many many many years before that refinery will be populated by just Nigerians. It was strictly PR. Anyways, the training with that design company was suddenly terminated on December 31st. Apparently, Dangote had not paid them a dime for all the months were were being taught design. They didn’t want to send us back to Nigeria so they moved us to the Dangote office in India. The office housed the Indian engineers (around 150 – 200 in number) who were supervising the design work being done by the design company. Now, it is interesting that these guys were working and earning as expatriates within their own country.
But realising that the “training” was a blunder, the company sent back some engineers to train in an actual refinery. So what was supposed to be a 1 year training became 2 years.
ME: Since returning to Nigeria, is there anything else you have noticed about the project that worries or disturbs you?
Mukhtar: Yes. So we have only the refinery at the FTZ, but the company gets to import things meant for other branches of the company duty-free. As a matter of fact, with the Dangote jetty in place and a customs office right there, the company no longer needs to clear stuff at Apapa. Dangote empire effectively has its own customs and port, because we cannot assume that the custom officers stationed at Dangote’s jetty/FTZ are extremely meticulous in checking what comes in and goes out. Personally, I find this disturbing. No non-military entity should be able to import stuff that easily into any country. This is bigger than just skipping custom duty payment.
Between bank staff being fired at 10.30PM and refinery site labourers being killed by workplace accidents without accountability, the sheer grimness of the picture facing Nigerian workers comes into stark relief. It is afterall, an employer’s market, with several thousand qualified people jostling for every job opening, which creates the possibility and incentive to treat staff like battery animals.
Whether the Labour Ministry is willing or able to do anything about such blatant labour exploitation is anybody’s guess. Nigeria’s government is increasingly weak and unable to impose its will on the country even territorially. In the event that the government did take interest, there is a valid fear that it would go to the other extreme and adopt a lazy anti-business Hugo Chavez approach, as it so often does. The real solution if there is to be one, must come from Nigerian labour having a stronger bargaining position through an improved economy. Anything else as it stands, is little more than a sticking plaster.
As Mukhtar mentioned, even inside the ridiculous situation of being financially stranded in a foreign country at the behest of an irresponsible and insincere Nigerian corporate, the vast majority of the group chose to suffer in silence. They did so because spending a year abroad learning useless information, suffering deprivation and experiencing diarrhea after being forced to eat unfamiliar food was still preferable to whatever alternative was at home.
Ultimately, that is the biggest problem facing Nigerian labour.
The 2019 Venice Biennale feels like the end of everything: the end of art tourism, the end of vacations, the end of the beach and the climate of pleasure. With bad news about the climate crisis worsening every day, the nationalistic turn of governments from the U.S. to Britain to Italy to India and Brazil, it’s unclear whether the liberal ideology that produces world-scale cultural events like the Biennale can hold much longer, or whether the economic or ecological structures of global tourism can continue to support it. The liberal democratic order of free markets and free will is undermined around the globe by violent nationalism and economic protectionism. The Biennale exhibition, May You Live in Interesting Times, offers little but a hollow scream in opposition. The whole thing feels a bit like buyer’s remorse, a magnum opus from a lapsed believer in Francis Fukuyama’s promise that we’d reached the End of History.1
Joint Italy-EU military vessel with helicopter, Piraeus Port, Greece, August 2019. Photo: Anuradha Vikram
Both the main exhibitions and the various national pavilions feature more women and artists of color this year than any previous. Diversity is manifest with respect to types of work, interests, materials, biographies, and ages of the artists on view. Curator Ralph Rugoff states that “[the artists’] work grows out of a practice of entertaining multiple perspectives: of holding in mind seemingly contradictory notions, and juggling diverse ways of making sense of the world.”2 Diversity and multiplicity appear here to be set up as counternarratives to universalism, the ideology that has historically governed the international contemporary art discourse. But is this in fact the case? Fukuyama says, “The spectacular abundance of advanced liberal economies and the infinitely diverse consumer culture made possible by them seem to both foster and preserve liberalism in the political sphere.” If, as Fukuyama suggests, there are “fundamental ‘contradictions’ of human life that cannot be resolved in the context of modern liberalism, that would be resolvable by an alternative political-economic structure,”3 diversity is not one of those contradictions. Rather, pluralism reinforces the “common ideological heritage of mankind,”4 while fascism’s resurgence around the globe and the popular embrace of nationalist identity are more of a contradiction in light of the realities of international markets. This is the turn of events that market utopians like Fukuyama failed to anticipate.
Rugoff never comes off as a utopian, given his pervasive air of weary detachment. Rather, the exhibition transmits how it feels to watch the ascent of Donald Trump and the unfolding catastrophe of Brexit from the “all-knowing,” cool remove of the contemporary art insider—omniscient, yet impotent, and unable to divest from toxic habits. George Condo, Sun Yuan and Peng Yu, Christian Marclay, and Arthur Jafa channel an anxiety bordering on panic. Construction, shipping, air travel, commerce, monuments, the body, gender—all once fixed as concepts in the Western imagination, with clearly associated positive values, are now invoked by artists such as Yin Xiuzhen, Nicole Eisenman, Slavs and Tatars, and Martine Gutierrez as hazardous, unstable, and volatile. Nowhere is this instability more evident than in the work of Mari Katayama, a Japanese artist whose self-portraiture tableaus tease the boundary between agency and objectification. These artists, more than the comparably straightforward representation advanced by artists like Zanele Muholi, Njideka Akunyili Crosby, or Gauri Gill, capture the zeitgeist of not just the show but the present time. Our historical moment is monumentally catastrophic, and the usual serious response to extremism doesn’t seem to be working. Instead, the images range from abject to absurd.
Indios antropófagos: A Butterfly Garden in the (Urban) Jungle. Peru Pavilion, Venice Biennale 2019. Photo: Anuradha Vikram
Especially relevant are the artists who toy with the fetishization of Indigenous bodies and cultures for Western consumption. Within the main exhibition curated by Rugoff, Gutierrez situates her U.S.-born Latinx, trans body within a series of photographic landscapes, Body in Thrall, that challenge touristic notions of indigeneity, cultural authenticity, and romanticized poverty around non-white people. She occupies diverse personas, from a film noir femme fatale to the terrifying Aztec deity Tlazolteotl, “Eater of Filth,” always negotiating the high fashion aesthetics of desire with a subversive decolonial aggression. Similar themes and tactics appear in Indios antropófagos in the Peruvian Pavilion, curated by Gustavo Buntinx, in which historical artifacts from the Spanish colonial era and large mosaic tile works by Christian Bendayán depicting frolicking Indigenous youth come together in a scathing critique of cultural tourism. In the French Pavilion, curated by Martha Kirszenbaum, artist Laure Prouvost references the oceans and the sea life projected to die out by 2048, only 29 years into the future, with a number of glass animals seemingly cast into the sea floor, strewn across a landscape of refuse and discarded technologies.
Back in the real world, there’s no way to excise or sequester the beautiful parts into a future that can outlast the very real catastrophes happening now. The overwhelmingly urgent need for a complete lifestyle change played in my head over the week following my visit to the Biennale, as I recuperated from a difficult personal and professional year on a seven-day Greek Islands cruise with my young children, partner, and parents. Looking over the waters where thousands of migrants have drowned, from the top deck of a massive, yet outdated, luxury vessel, I considered how the looming climate crisis creates a condition of simultaneous enjoyment of the modern world that is all around us, and a mourning for its obvious and inevitable loss. Is this the end of curating? The traditional role of the curator as guardian of the world’s collected treasures seems as irrelevant as the contemporary job of mounting resource-heavy exhibitions for an international crowd of jet-setters. Conceptualism has begun to rot from the head, as when Rugoff controversially chose to include Christoph Büchel’s installation of a salvaged boat that, in 2015, sank in the Mediterranean with more than 800 people aboard. I reflected on this watery tomb, recommissioned as a tourist attraction, while looking out across Piraeus port. In the distance, a military troop (jointly operated by Italy and the European Union) performed exercises atop a warship in a city where anti-immigrant attacks are on the rise. In the seventeenth century, the Venetians gained and lost control of Athens in a rivalry with the Ottomans. Today, it seems the EU’s primary objective in the Mediterranean is to sever thousands of years of interconnection between these three regions. Two years ago, the regenerative promise of art as a universal cultural good was undermined when documenta 14 recreated the financial dynamics of German austerity policies in Athens, Greece afresh. Debts went unpaid, workers uncompensated, all in the name of “fiscal responsibility” that nearly shuttered the sixty-year-old event for good. What better outcome ought we to expect this year from an art event born out of universal nationalism?
Halil Altindere, Space Refugee, 2016. May You Live in Interesting Times, Venice Biennale 2019. Photo: Anuradha Vikram
An explicitly utopian impulse is fugitive in May You Live in Interesting Times, but it manifests in the intersection of art, science, and technology. Margaret and Christine Wertheim’s Crochet Coral Reef raises awareness about preservation of the oceans through a crowdsourcing practice that combines mathematical learning with environmentalism and craft. Tavares Strachan’s meditation on African American astronaut Robert Henry Lawrence, Jr., locates metaphysical discourse about the afterlife within a scientific conversation about space travel—where elsewhere Halil Altindere complicates this view with the tale of Syrian cosmonaut Muhammed Ahmed Faris and his persecution by the state. Ryoji Ikeda bathes us in cleansing white light and describes a massive, thunderous universe of data that takes breathtaking shape before our eyes. Hito Steyerl’s This is the Future is a post-internet pastorale in which computer vision is applied to the Venetian landscape to depict a state of perpetual, dreamlike futurity in which the present persistently refuses to resolve into view. The protagonist of Steyerl’s installation seeks out a garden that she had previously hidden in the future in order to protect it from the ravages of the present.
The song of the Lithuanian Pavilion Sun & Sea (Marina) still rings in my ears:
“When my body dies, I will remain,
In an empty planet without birds, animals and corals.
Yet with the press of a single button,
I will remake this world again”
The finale of Sun & Sea (Marina) details the 3D printing of facsimiles of species in widespread collapse, taking comfort in their simulated resurrection as one would in the cold rays of a dying sun.
Sun & Sea (Marina), Lithuanian Pavilion, Venice Biennale 2019. Photo: Anuradha Vikram
The gentle tenor of the apocalyptic visions in Sun & Sea (Marina) perfectly encapsulates the feeling of living at the outside edge of the story of the human species on planet Earth, with the knowledge that history as we know it may well be about to end because our species is one of millions undergoing collapse. The emptiness of our endeavors is invoked by Shilpa Gupta, whose wildly swinging metal gate hammers an effigy of national borders into a gallery wall. Otobong Nkanga’s drawings in acrylic on crayon reference the mechanical, industrialized nature of exploitation in the 21st century. Unlike the bees, whose society is organized around abundance, we humans have engineered systems to maximize our suffering. If humankind can truly lay claim to a common ideological heritage, as Fukuyama once argued, we have only ourselves to blame for our impending end.
By Funmilola Olukomaiya
The Nigerian movie industry has evolved, but this didn’t come cheap as it was achieved through a lot of hard work, dedication and persistence through the efforts of the pioneers of the industry.
Most millennials know little or nothing about how Nollywood came to be and the truth is, they really careless.
Below are 12 of Nigeria’s movie industry (both English and Yoruba) celebrities and pioneers from the decades you must know.
1.) Hubert Ogunde
Hubert Ogunde was a Nigerian playwright, actor, theatre manager, and musician. He was a pioneer in the field of Nigerian folk opera (a type of drama in which music and dancing played a significant role). He was the founder of the Ogunde Concert Party (1945), the first professional theatrical company in Nigeria. Ogunde who was often regarded as the father of Nigerian theatre sought to reawaken interest in his country’s indigenous culture. He died on April 4, 1990, in London, England.
2.) Duro Ladipo
Duro Ladipọ was one of the best known and critically acclaimed Yoruba dramatists who emerged from post-colonial Africa. Writing solely in the Yoruba language, he captivated the symbolic spirit of Yoruba mythologies in his plays, which were later adapted to other media such as photography, television and cinema. As a teacher in a church school at Oshogbo in 1960, Ladipo scandalized church members by including bata drums in the Easter cantata that he had composed for the church and was thereafter obliged to seek a secular outlet for his musical interests. In 1962 he founded the Mbari Mbayo Club, and for its inauguration, his new theatre company performed his first opera, Oba Moro (“Ghost-Catcher King”). He premiered Oba Koso (“The King Did Not Hang”) at the club’s first anniversary in 1963 and a year later introduced Oba Waja (“The King is Dead”). All three operas are based on the history of the Oyo kingdom and are available in English in Three Yoruba Plays (1964). He died Mar. 11, 1978, in Oshogbo.
3.) Ola Balogun
Born 1st of August 1945, Ola Balogun is a unique figure in Nigerian cinema. In the 1970s and 1980s, he influenced the film industry in Nigeria like no other person and paved the way for the Nollywood boom that began in the early 1990s. The fact that he is virtually forgotten outside of Nigeria nowadays is also a function of the fact that many copies of his films have disappeared. He also ventured into the Nigerian music industry in 2001. Balogun studied cinematography at Institut des hautes études cinématographiques.
4.) Adeyemi Afolayan (Ade Love)
Adeyemi Afolayan also known as Ade Love was a Nigerian film actor, director and producer. He brother to actress Toyin Afolayan and father to film actors, Kunle Afolayan, Gabriel Afolayan, Moji Afolayan and Aremu Afolayan. In 1966, Afolayan joined Moses Olaiya’s drama troupe, and in 1971, he left to establish his own drama group which went on to stage comedic plays. He appeared in Ola Balogun’s Ajani Ogun in 1976, and later produced and starred Ija Ominira, also directed by Balogun. Kadara, ‘Destiny’ in English was the first movie he wrote, produced and also starred as the leading actor. The movie was shown at the ninth Tashkent film festival for African and Asian cinema. Afolayan went on to produce and star in other productions such as Ija Orogun, Taxi Driver and Iya ni Wura. He died in 1996.
5.) Sam Loco Efe
Sam Loco Efe was a popular comic actor who was born in Enugu. His first experience with acting was at his school when a theatre group came to stage a play called ‘The Doctor In Spite of Himself’, afterwards, he discussed with members of the group about the theatre and performance arts. In elementary school, he was a member various groups including a drama society that performed a rendition of Shakespeare’s ‘Julius Caesar’ at an Eastern regional arts festival in Abakaliki, the play came last in the drama competition but Efe was noted as the best actor which earned him a scholarship to complete elementary school. After finishing elementary school, he attended various secondary schools and was active in the drama society, organizing a performance of ‘The Doctor in Spite of Himself’ and a play called ‘Vendetta’. After secondary school, he was a member of a travelling theatre group and played soccer earning the moniker locomotive later shortened as loco. He died 7th August 2011.
6.) Oyin Adejobi
Chief Oyin Adejobi was a very popular dramatist and seasoned actor in South-Western Nigeria. He wrote and performed in a variety of Yoruba productions on the stage, television and movies. He was especially well known for his autobiographical movie ‘Orogun Adedigba’. He also had a weekly television show, ‘Kootu Asipa’ meaning “Ashipa’s Court” on Nigerian Television Authority, Ibadan. The Oyin Adejobi Popular Theatre Company is named for him. He died in the year 2000.
7.) Professor Peller
Professor Moshood Abiola Peller was a Nigerian magician and one of Africa’s most renowned magicians. He was born in 1941 at Iseyin, Oyo State and he was named Moshood Folorunsho Abiola. He later picked the stage name of ‘Professor Peller’, an appellation that has stuck to him like a second skin. He started performing illusion tricks in 1954 travelling to Ibadan, Lagos and Oyo for performances. In 1959, he changed occupation and began work as a representative of G.B.O. and later moved into trading. His interest in illusion continued and in 1964, he attended a school of magical arts in India, he spent 18 months at the school and after completion, settled in Liberia. In 1966, he had his first post-training show at the Federal Palace Hotel, Lagos. He was later assassinated in 1997.
8.) Alade Aromire
Muyideen Alade Aromire was a popular actor and producer who was also the owner and creator of Yotomi Television, a cross-cultural broadcasting station with bias for Yoruba-based programmes. Alade was believed to have produced the first home video in Nigeria as he was the pioneer of Yoruba home video industry. He died 4 July, 2008 in an auto crash along the Lagos/Ibadan expressway.
9.) Moses Olaiya
Moses Olaiya, better known by his stage name “Baba Sala”, was a Nigerian comedian, dramatist and actor. Baba Sala, regarded as the father of modern Nigerian comedy, alongside other dramatists like Hubert Ogunde, Kola Ogunmola, Oyin Adejobi and Duro Ladipo popularized theatre and television acting in Nigeria. He was a prolific filmmaker. He started his career in show business as a Highlife musician, fronting in 1964 a group known as the Federal Rhythm Dandies where he tutored and guided the jùjú music maestro King Sunny Adé who was his lead guitar player. As a young boy, Olaiya played the class clown and sometimes dressed outlandishly to please people. While he chose to develop a career in entertainment his parents wanted a path that will lead to a professional career such as medicine or law. Baba Sala died in October 2018.
10.) Lere Paimo
Born November 1939, Pa Lere Paimo, OFR is an ace Nigerian film actor, film-maker, producer and director. He began his acting career in 1960 after he joined the Oyin Adejobi theatre group, founded by Pa Oyinade Adejobi before he later joined Duro Ladipo’s Theatre Group where he featured in a stage play titled ‘Obamoro’ with the role of “Chief Basa”. He became popular following a lead role as Soun Ogunola played in an epic Yoruba film titled ‘Ogbori Elemosho’ which brought him into the limelight. He has featured, produced and directed several Nigerian films since he began acting in 1963. In 2005, in recognition of his immense contributions to the Nigerian film industry, he was bestowed with a National award of Member of the Federal Republic alongside Zeb Ejiro by former president Olusegun Obasanjo. On May 2013, it was reported that he had a partial stroke, an attack he survived.
11.) Funmi Martins
The legendary Funmi Martins was a shining star of the Yoruba movie industry in the ’90s. She was shot into limelight in 1993 when she starred in her first movie called ‘Nemesis’ directed by Fidelis Duker. Funmi Martins before her death starred in dozens of movies. Some of her most notable works include Eto Mi, Pelumi, Ija Omode, Eru Eleru. She died on May 6, 2002.
12.) Bukky Ajayi
Zainab Bukky Ajayi was a Nigerian actress who was born and bred in Nigeria but completed her higher education in England, United Kingdom courtesy of a federal government scholarship. In 1965, she left England for Nigeria where her career began as a presenter and newscaster for Nigerian Television Authority in 1966. Bukky made her film debut in the television series ‘Village Headmaster’ during the ’70s before she went on to feature in ‘Checkmate’, a Nigeria television series that aired during the late 1980s to the early 1990s. During her acting career, she featured in several films and soaps including ‘Critical Assignment’, ‘Diamond Ring’, ‘Witches’ among others. In 2016, her contributions to the Nigerian film industry was recognized after she and Sadiq Daba were awarded the Industry Merit Award at the 2016 Africa Magic Viewers Choice Awards. Bukky Ajayi died at her residence in Lagos State on 6 July 2016 at the age of 82.
NOTE: This list is not exhaustive, do share the names of others who didn’t make our list in the comment session.