Mrinal Pande explores sexual reality in rural India through her new book, ‘Stepping Out’

In the 1980s, when I was working with the members of the Self Employed Women’s Association (SEWA) on the Shramshakti Report, I found two areas to be the biggest exhausters of women — healthcare and labour laws. Since I had no medical background, I was initially apprehensive about tackling a topic that dealt with women’s health issues. I spoke with some NGOs, and after being convinced about the need for someone outside the medical and social services field to write on this topic, I decided to go ahead.

Once the grant to write the book came through from the McArthur Foundation, I travelled for almost 15 days in a month for about two years to five states (apart from Delhi) — West Bengal, Tamil Nadu, Maharashtra, Gujarat and Rajasthan — and visited the projects of a number of NGOs including Child In Need Institute (CINI), Society for Education, Action And Research in Community Health (SEARCH), Mahila Sarvangeen Utkarsh Samiti (MASUM), SEWA and Action Research and Training for Health (ARTH). My aim was to get an in-depth view of the whole issue. Also, instead of just relying on available government and NGO data, I wanted to interact with human beings, the actual actors and actresses in this whole scenario and learn from them what it was like to be poor, sick and in need for medical guidance in India.

System Errors
My expedition began with visits to the many clinics run by NGOs. I observed their doctors attending to the women patients and spoke to most of them after their examination was over. The problems were recurrent — anaemia, white discharge, prolapsed uterus, poor nutrition, STDs, recto-vaginal fistulas, septic nipples, etc. The doctors painstakingly explained each case history to me and encouraged the women to answer my questions. This unlocked a lot of silences since by and large, Indian women are not very well-disposed to people who come asking questions about their fertility and reproductive health.

Be it hygiene-related advice, the importance of nutrition for pregnant women, educating the women about their bodies, or basic pre and post-natal care, every single area has been more or less ignored by government-run health programmes in favour of family planning. Perhaps the root cause of neglect of female reproductive health lies in the fact that the policy makers have paid more attention to controlling fertility (often by terminal methods like sterilisation) and very little to common gender-specific healthcare needs of women. In fact, a study by SEARCH in the early 1990s shared that a staggering 92 per cent of rural women in India suffered from reproductive tract-related problems but seldom sought professional help.

Contraception Chaos
Successive government-run family planning programmes have been putting the onus of family planning on women. However, they have completely overlooked the fact that in the traditional Indian family system, the woman has the least authority, economic feasibility or knowledge to take such decisions. Woman after woman spoke of how using the IUD was inconvenient because their husbands did not want it, or why taking the pill on a regular basis was tough because it made their husbands suspicious about their character. As far as condoms were concerned, whether it was a wife or a sex worker, the verdict was unanimous — it is next to impossible to get men to use them. Since ignorance about AIDS/HIV and STDs, and what causes them in women is near-total, the question of women getting men to use condoms to prevent these diseases from spreading does not arise.

Uncaring Caregivers
In villages, a common experience with government-run hospitals shared by women across states is lack of concern and unkindness displayed towards them by doctors and nurses alike. In some cases, the women (or their attendants), soon after giving birth, have even been asked to clean up the delivery room, or if they approach hospitals for a medical termination of pregnancy (MTP), the nurses yell at them, casting aspersions on their character. It is to safeguard their dignity that women in rural India prefer visiting an untrained ‘dai’ or quack or a private clinic for deliveries, abortions and other ailments.

The role of an auxiliary nurse midwife (ANM) at the public health centres (PHC) is restricted to distributing condoms and birth control pills on demand, giving iron supplements to pregnant women, and administering tetanus toxoid injections. Since most ANMs don’t stay in the village or some PHCs are too far for the women to access easily, all cases of gynaecological emergencies have to be taken to city hospitals.

In my travels, women everywhere, in Delhi, Gujarat and Maharashtra, pointed out that there was a huge unmet need for safe abortions. Most NGOs working with women in rural areas say that for every one legal abortion in the countryside, there are about 11 to 17 illegal backroom botched-up abortions.

And the most common methods for terminating unwanted pregnancies include letting a ‘dai’ insert a creeper or dried root in the uterus. The women know that a botched-up abortion can cause complications and even death, but in the absence of a system that ensures safe MTPs, they have little choice but to rely on local ‘dais’ and quacks.

Misconceptions Galore
In some areas, the common dos and don’t for young mothers-to-be advocated by mothers-in-law, ‘dais’ and older women includes deliberately withholding nutrition from young mothers. This ensures an easy delivery since the foetus remains small. So, at a time when a woman needs the best food she can get, items like milk, butter, ‘ghee’ and fruits are eliminated from her diet.

Infertility is as big a problem as fertility is but goes largely undisclosed. For women, it is a stigma and for men, a blow to their ego. Apart from low or nil sperm count, another reason for infertility is the fact that a large number of Indian males have STDs and uro-genital diseases. They are reluctant to get examined or treated and during unsafe sex, pass on the STD to their unsuspecting wives. This, in turn, causes secondary infertility in women.

Action Plan
Women in rural India on their part have come to accept ill health as their ‘karma’, especially if it is related to their reproductive functions. When unwell, they try home remedies, herbs and potions, prayer and delay seeking treatment for their illness as long as they can. To help them, it is important that before we get them to control their fertility, we give them the basic education and medical facilities that will help them live a healthy life. Care for gynaecological problems, safe abortion services and reproductive health and sex-related education must be included if health programmes are to have any relevance for women.

As Told To Seema Chowdhry Sharma