Women and health in a rural community in India

'Putting Women First: Women and Health in a Rural Community', published by Stree Samya Books

This book is as much about the lives and times of ordinary people as it is about social medicine. It is a doctor’s story about her practice, which lets her extrapolate about the realities of rural India for all Indians. Set in Gadchiroli, a district in central India, known for being an underdeveloped and backward area.

The introduction to ‘Putting Women First: Women and Health in a Rural Community’, tells us that this district is where Dr Rani Bang and her husband, Dr Abhay Bang, set up the clinic for the Society for Education, Action and Research in Community Health (SEARCH) and practised medicine that explicitly catered to the Raj Gond, Madiya Gond, Pardhan and Halibi, the dominant tribal groups, along with non-tribal poor people who live in the area.

This settlement goes back to prehistory and is a part of the ancient Dandakaranya forest mentioned in the Mahabharata and the Ramayana. Rani Bang’s research found that 92 percent of women in this region had no access to treatment for gynaecological disorders in the absence of women doctors. Such neglect was exacerbated by ‘development’ since rural families were, and remain, unprepared for the rapid changes wrought in the spheres of education, information, material enhancement and changes in lifestyle, which impact on relationships and health.

The book plays many roles: a commentary on the ‘chronic myopia’ of a planning process that refuses to see millions of Indians or to think of the ways in which their lives could be bettered;   careful observations on the enormous social changes that impact on tribal society where  traditional kinship and ecological systems being sorely stressed; and a logbook of case medicine.

In their own way, the Bangs have set in motion a type of revolution that equips people, communities and administrators with the tools to ‘build an indigenous expression of development, one in which the fundamentals of healthcare, interdependence and sustainable economics are paramount’. The last chapter of the book summarises the author’s views on recommendations for policy makers.

I was associated in a small way with the early work that went into ‘Putting Women First: Women and Health in a Rural Community’, and was then asked to write the foreword, a signal honour. I have extracted a few paragraphs of the foreword below, and you can read the full foreword [pdf] here. You can order the book directly from the publisher, Stree Samya, here.

Adivasi 'dais' (traditional birth attendants). A picture from 'Putting Women First'.

From the foreword:

In shifting to another section of the Gadhiroli (and indeed of the rural Indian) canvas, ‘Putting Women First’ speaks sagely of the manifold aspects of the care our population needs: of regional disparities and critical gaps in the health care delivery system, of infant mortality, obstetric care, maternal and child health, of ‘dais’ and anganwadis, medical termination of pregnancy, and the desperate need for better-staffed primary health centres. “Meeting health needs of women through a system that is sensitive to the differential needs of men and women and their differential access to health care also needs to be taken into account,” recommended the National Commission on Population. Bang-bai’s clinic practices that sensitivity, day in and day out.

The differentials that Search grapples with routinely are daunting. The very premise of girls’ education, especially education of poor girls, is based on an understanding that education is critical to social development, that it leads to lower fertility rates and better child-rearing practices for example. On the one hand, the benefits of women’s education are compelling yet all too often, the struggle for the right of girls and women to education gets reduced to issues of access alone. In general, it has been easier for women’s groups and voluntary groups to work with girls outside the system of formal education, especially the government system of education which is notoriously inflexible.

If one was to describe a large circle around the Search campus, of say 50 kilometres, one would see in the nearby settlements of Aheri, Brahmapuri and on the Raipur road the assembly-line blocks that in rural India purport to be schools. What does it mean to be ‘schooled’ in one of these miserable containers? Conditions in these schools are hardly conducive to meaningful learning – none possesses the very basic set of facilities such as adequate classrooms, toilets and drinking water, teaching-learning materials and libraries. As is the case elsewhere in India, physical inaccessibility, irrelevance of curricula, repeated ‘failure’ and harsh treatment in schools contribute to children dropping out or never enrolling. According to a National Sample Survey Organisation survey (1998), about 26 per cent of those who had dropped out of government schools cited reasons other than poverty – unfriendly school environment, doubts about the usefulness of schooling and an inability to cope with studies. Among girls in rural areas these factors accounted for over 75 per cent of dropouts.