The name Anaarkali in the present context has many meanings - Anaar symbolises the anarchism of the Bhils and kali which means flower bud in Hindi stands for their traditional environmentalism. Anaar in Hindi can also mean the fruit pomegranate which is said to be a panacea for many ills as in the Hindi idiom - "Ek anar sou bimar - One pomegranate for a hundred ill people"! - which describes a situation in which there is only one remedy available for giving to a hundred ill people and so the problem is who to give it to. Thus this name indicates that anarcho-environmentalism is the only cure for the many diseases of modern development! Similarly kali can also imply a budding anarcho-environmentalist movement. Finally according to a legend that is considered to be apocryphal by historians Anarkali was the lover of Prince Salim who was later to become the Mughal emperor Jehangir. Emperor Akbar did not approve of this romance of his son and ordered Anarkali to be bricked in alive into a wall in Lahore in Pakistan but she escaped. Allegorically this means that anarcho-environmentalists can succeed in bringing about the escape of humankind from the self-destructive love of modern development that it is enamoured of at the moment and they will do this by simultaneously supporting women's struggles for their rights.
Tuesday, October 7, 2008
Women and Poverty
Women's health is a much more complex issue than just the provision of adequate healthcare services. It has come to be recognised that women's health, safe motherhood, population control, and poverty alleviation are all dependent on women having reproductive health rights apart from economic and political rights at par with men in a society that is egalitarian in all respects. Thus the basic requirements for improving the health status of women are a direct multi-pronged attack on poverty through the creation of labour intensive work opportunities, removal of social inequalities of all kinds, a campaign against traditional and modern myths and a comprehensive community health care system with primary and referral services. So any programme aimed at improving the health status of poor adivasi women has to necessarily incorporate both the service delivery and the mass organisational approaches to community work if it has to be successful.
The adivasi women's organisation Kansari Nu Vadavnu has done some work in this sphere. It has organised women to fight for their rights and also arranged for special reproductive health camps to be held. A reproductive health survey was conducted by the organisation in Barwah Tehsil of Khargone district. The results presented a shocking picture of the reproductive health status of the women of the area. As many as 84.7% of the women suffered from some reproductive health problem or other. 49.1% suffered from vaginal discharges and 45.4% from dizziness arising possibly out of high blood pressure. 65% of the women complained of waist pains. Another disturbing statistic was that 6.8% of the women suffered from STDs, which was quite high for such a remote rural area where there was no prostitution. On an average the number of diseases being suffered simultaneously by a respondent, the morbidity index, was as high as 3.1. This morbidity index for adivasi women was highest at 3.5 while that of the dalit women stood at 2.6 and that of other caste women at 2.1. Thus even though the other caste women who are economically well off are not as badly off as the adivasis and the dalits nevertheless the level of morbidity among them too is very high. Statistical testing showed that the null hypothesis that the means of the samples of the different caste groups were from the same population could be accepted at a 5% level of significance. Thus it can be surmised that some other factor in addition to poverty was responsible for the poor reproductive health of the women. Significantly none of the 28 unmarried girls surveyed reported as suffering from any problems. The detailed observations of the day to day life of the married women in the area confirmed that the pernicious effects of patriarchy were mainly to blame for their sorry reproductive health status irrespective of their economic condition.
The survey revealed that the average haemoglobin level of the women was only 7.36 grams per decilitre of blood, which was about 46% of the desired value. Thus our hypothesis that there was a close relationship between the anaemic condition of the women and their poor reproductive health status too was amply borne out. Significantly unmarried girls showed an average of 11.1 grams per decilitre, which was relatively all right further confirming that it was married women who were more subject to the pressures of patriarchy. Furthermore 73.6% of the women had been married before completing 18 years of age, 41.7% had lost at least one child, 17.3% of women had more than 5 children and only 10.4% of the women had been sterilised. These discouraging statistics also pointed toward the pervasiveness of patriarchal values. The survey also revealed that there was no statistically significant difference in the literacy levels of boy and girls and the nutritional levels of girls was slightly better than that of the boys even though the difference was statistically insignificant. These levels, however, were far below that of the upper socio-economic strata in urban areas as was only to be expected. Thus these data too confirmed that the effects of patriarchy begin to make themselves felt on women only after marriage. The picture below shows a teenage adivasi woman who is eight months pregnant and yet is bringing drinking water on her head from a distance of one kilometer with a smile!
This obviously puts women under severe stress during pregnancy when they have to deal with the added burden of the foetus inside the womb. Under the circumstances the single most important health service for ensuring safe motherhood for poor women whether in the rural or urban setting is that they should get at least three ante natal checkups by qualified gynaecologists backed up by proper laboratory facilities. Since the women do not have the wherewithal to obtain such facilities it should be the responsibility of the public health system. Now this is where the government health system in Madhya Pradesh invariably slips up. Most primary health centres do not have gynaecologists and neither do they have proper laboratory facilities. Over and above this the PHCs serve a much larger population than is the norm because the government does not have the funds to set up and run PHCs as per the norm. Consequently most pregnant women in both urban and rural areas do not get the necessary specialised ante natal checkups. Thus even though the National Family Health Survey III data show that 40.2% of the respondents in Madhya Pradesh had three ANC visits this means in most cases visits by the Auxiliary Nurse Medics and not qualified gynaecologists. Pregnancy for poor women is a very difficult time because they are in most cases severely anaemic (due to factors that arise from the prevalence of deep rooted patriarchy). Thus in such cases only qualified gynaecologists can provide proper help.
The partial solution to this problem in Madhya Pradesh has been to hold special monthly camps in selected areas where the health department tries to provide these services in collaboration with NGOs. one such attempt has been in operation in the slums of the city of Indore with funding from USAID for some five years now. But even this focused attempt has been lacking in impact because of the neglect of the following gender sensitive aspects -
1. The camps are held in the community centres of the slums and tent house material is used to create partitions where women are to be checked up. This immediately creates the problem of lack of privacy because there is not enough seclusion of the table on which the women are to be checked up.
2. Proper instruments and rubber gloves and sanitisation facilities are not provided to the doctor and so she cannot do the checkups properly.
3. The doctors keep on changing and so the patients find it difficult to relate to them enough to be able to freely discuss their problems.
4. No laboratory facilities are available.
5. Proper medicines are also not available.
6. There is no attempt to involve the men in the whole process and sensitise them to the special needs of their wives during pregnancy.
Consequently even though all the pregnant women in the slums in which these camps are held are ostensibly covered by the programme in reality they do not get the quality of service that they are entitled to. This sorry state of affairs exists because of the lack of gender sensitivity on this critical issue. Thus the focus for ensuring the reproductive health of women should be on providing proper checkups by qualified gynaecologists on a regular basis to all poor women in this country. This is their right as citizens of this country. It is solely because of deep set patriarchy and widespread poverty that women are still being deprived of this right within their family and by the government. The picture below shows women flocking to a mobile clinic for medication and testing in one of the reproductive health camps organised by Kansari Nu Vadavno.