Medha Pande
Nainital, India
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| Photo by Pradeep Pande |
For the wedding of a second cousin, I visited my ancestral village for the first time at the age of twenty-five. The tiny hamlet is in a quaint, expansive valley in the middle Himalayas of Uttarakhand, India. The once prosperous region is struggling under the pressure of out-migration to the plain areas.1 Since those who have even minimal resources have either migrated or are on the verge of it, most of the residents left behind are destitute, especially dalits.2 Most of them live in abject poverty as daily wage laborers in the unorganized sector or agriculturists under distress.3,4 Because of their economic, social, and legal standing, they have very little if any power in elections and therefore suffer from acute government apathy.
Interacting with the people there, one cannot help but be dumbstruck by the lack of health services and in particular maternity facilities.5 Hospitals are few and lack even basic services. There is a dearth of skilled health care providers; sometimes there are no doctors at all. Critical equipment and instruments are either missing or inoperable. Because of this, along with a lack of accountability, a simple surgery like a C-section cannot be performed, and referrals—even for common ailments—is the norm. To make matters worse, the staff are rude to poor patients. These facts translate on the ground in the following manner: a single checkup may take all day because of a lack of doctors and hence is avoided. Women hesitate to reveal themselves to male doctors and so remain undiagnosed if female doctors are unavailable. For routine ultrasounds, a trip to adjoining cities with poor connectivity has to be made and the money involved, though small, is substantial for them. They fear “irrational” referrals to cities for deliveries—the trust in doctors and medicine is lost. The outcome is that the pregnant women are often just under the unskilled supervision of the female elders of the household. They do not consult doctors at all and are taken to hospitals only in emergencies, when things may already be out of control.
One woman, pregnant for the second time, told about the dramatic birth of her daughter fourteen months earlier. Her daily wager husband had insisted on a hospital delivery, much to the chagrin of the family. She went into labor at night, and to reach the hospital had clung to her husband’s arm for half a kilometer to descend a tough slope before the motor road started. They waited for the doctor for an hour in the dispensary, who upon coming regretted the lack of amenities for a C-section and referred her to the nearest town. It took two hours to get there, and again she was referred to another city. On reaching there after a further gap of three hours, a daughter was born to her normally without a C-section. When her mother-in-law arrived, the first thing she said was, “All this trouble for a daughter.” Now the mother-in-law insists that the next delivery will be at home under her supervision. In the whole process, the pregnant woman herself had no say and an opportunity to include the family in the organized health system was lost.
Another woman went into labor at 3 am.6 To call the ambulance, her relatives went uphill seven kilometers for a network signal. However, the ambulance refused service because of worn tires. She had to be taken four kilometers in a palanquin and then by private taxi, finally reaching a dispensary at 11 am.
In another case, a thirty-year-old woman died during delivery.7 She had been very weak during this, her fourth pregnancy. After the onset of labor, the call to the ambulance could not be connected because of signal issues. As her condition worsened, her extremely poor family had to hire a private cab. She gave birth in the cab on the way and died moments later.
Unfortunately, the problems faced by these women are not isolated and have become worse in the last few years. According to government statistics released in 2018, infant and under five mortality have both increased and sex ratio and institutional deliveries have decreased in the state of Uttarakhand.8 As many as 37% of deliveries are managed at home by inexperienced and unregulated midwives. The lack of doctors and of critical instruments is also substantial. Moreover, the region is poorly connected and transportation facilities are inadequate.9 All this results in high maternal and child mortality rates. Also, since pregnant women are neither listed nor followed, it is easy to hide female infanticide when births occur at home.
The problems related to pregnancy are only a manifestation of the lack of a basic standard of living. From birth onwards women face social biases. Girls are often left illiterate or poorly educated and are hurriedly married. Many are anemic and suffer from its consequences, making conception and pregnancy quite dangerous. Talk about menstruation, pregnancy, and family planning is a taboo. Many women are under the stress of being expected to give birth to a son, especially when the older children are females. Mental health issues such as postpartum depression are unheard of. There is no effective redress for domestic violence and no provision for counseling of any sort including substance or antibiotic misuse. Women deserve a decent and healthy lifestyle. For this they should have affordable and easy access to basic healthcare, nutrition, a fair legal system, counseling, education, contraceptives, safe abortion facilities, supplements during pregnancy, and a safe delivery. Most of these come under the fold of primary health care, which is meant to ensure social equality and inclusivity.10
Why is a vulnerable section of the population becoming further marginalised due to their sex and place of residence? When will people realize that women’s safety and security is not just a law and order issue? Why is this critical and universal women’s issue missing from the agendas of politicians and activists? What is the duty of the government and the larger society to put into practice the Constitution, the Universal Declaration of Human Rights, and the principles of natural justice? And when will we find the answers to the above questions?
References:
- 2011 Census of India, Ministry of Home Affairs, Government of India.
- Collins Dictionary. A member of the lowest class in India, whom those of the four main castes were formerly forbidden to touch.
- Interim report on the status of Migration in Gram Panchayats of Uttarakhand, April 2018.
- Hindustan Times. http://hindustantimes.com/india-news/growth-inequality-is-emptying-out-entire-villages-in-uttarakhand/story-8WKFLavV9OOkqR1uQslbWM_amp.html.
- Hindustan Times. http://hindustantimes.com/india-news/growth-inequality-is-emptying-out-entire-villages-in-uttarakhand/story-8WKFLavV9OOkqR1uQslbWM_amp.html.
- Amar Ujala. https://www.amarujala.com/uttarakhand/nainital/91555187889-nainital-news?src=top-lead
- The Quint. https://www.thequint.com/my-report/maternal-health-uttarakhand-state-policy-maternity-deaths
- Healthy States, Progressive India Report.
- First post. http://www.firstpost.com/india/migration-in-uttarakhand-25-of-villages- without-access-to-roads-residents-lament-lack-of-govt-accountability-forced-to-abandon-state-6037861.html/amp.
- World Health Organization. http://www.who.int/news-room/fact-sheets/detail/primary-health-care.
MEDHA PANDE has been published in magazines and newspapers such as The Hindustan Times, Down To Earth, The Quint, and Coldnoon. Her hobbies include photography, reading, bird-watching, and watching movies. She is fascinated by the “Zero Waste Lifestyle” and believes in the adage of Alvin Toffler, “Learn, unlearn, and relearn.”
Acknowledgement:
This work could not have been completed without the active participation of Neha and Vinod. I am indebted to Diksha for sharing her experience. Also, I am thankful to Pradeep Pande for the wonderful photographs. This piece is dedicated to Mamta Devi, whose death soon after delivery urged me to explore the issue in detail. May her soul be at peace and the little one healthy.
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