What to expect from our cities when you’re expecting

Pregnancy is not just a personal journey. It is a way of reading the city differently

As soon as I found out I was pregnant, my first instinct was to redesign my life. Should we move to a house with a bigger balcony? Rearrange furniture to make space for a crib? Install anti-slip mats in the bathroom?

As a faculty member in a design school, I am now trained to notice how design shapes behaviour. Pregnancy sharpened that instinct. Every corner of my home suddenly felt like a decision — about safety, comfort, care. But as I adjusted my interiors, a more unsettling question emerged: What about the city outside? Was it designed to accommodate pregnancy, or early childcare? Both experience and evidence suggested the answer is no.

The challenges begin each morning with my commute. Despite owning a car, I spend nearly 90 minutes navigating potholes, uneven roads, unplanned speed breakers, and frequent waterlogging. Potholes, we are often told, are an inconvenience. But they are also deadly. Government data show that 9,438 lives were lost in pothole-related accidents between 2020 and 2024. Not just pregnant women, the national capital’s roads are unsafe for all vulnerable bodies, including children, the elderly, the unwell.

And then comes the second challenge: On my route, there is not a single reliable, safe, and clean public toilet. The only options are at petrol pumps, often locked, poorly lit, or lacking water. As pregnancy progresses, so does the need for frequent urination — and with it, the risk of urinary tract infections. Even as the city ranks high on municipal cleanliness, data from Praja Foundation (2024) reveal the scale of the problem: One toilet seat for nearly 10,000 people in Indian cities. It is telling that the most practical solution suggested to me recently was a personal workaround — wearing adult diapers. This is how urban India manages — by pushing individuals to privately solve what are public failures.

If weekdays are consumed by navigating the city, weekends are spent planning the birth. I was delivered at home by a dai, whose skilled hands brought most of the children in our neighbourhood into the world. Midwifery, once a trained and respected practice, has been steadily absorbed into institutional healthcare since the 1970s. Auxiliary nurse midwives have been redirected toward immunisation and family planning. India has made remarkable progress in maternal health. Over three decades, maternal deaths have declined by 86 per cent. These achievements conceal a complex shift: Childbirth has become increasingly medicalised. In 2008-09, caesarean births accounted for just 6.4 per cent of institutional births in India. By 2024-25, that number had crossed 27 per cent. The World Health Organisation recommends an optimal rate of 10-15 per cent. In private hospitals, the average now stands at 47.4 per cent.

Pregnancy, I am beginning to realise, is not just a personal journey. It is a way of reading the city differently — through vulnerability, dependence, and care. It makes visible what cities are designed to ignore. That care is treated as private, that vulnerability is seen as an inconvenience, and that survival often depends on personal jugaad rather than public systems.

The writer is assistant professor, Jindal School of Design and Architecture, OP Jindal Global University