Friday, April 01, 2005

The health of a nation

March 14th:

After a leisurely morning, I got a ride to the Sahayog office where I was to meet Abhijit Das. I met some of the staff of Sahayog and Kriti Resource Center, its documentation wing, including Ganesh Dey who does most of the illustrations for their publications as well as for CAC in Uttaranchal. Some of the staff sat around a table to discuss various issues Sahyog is involved in.

Firstly a little perspective on UP was provided – it has the highest population in India and the dubious distinction of 1/12th of the world's maternal deaths – 40,000 women every year. Where Bihar suffers from anarchy, UP is oppressed by structural violence. In Bundelkhand, the southern part of UP, the problems are caste-based violence, dacoitry and lack of access (see notes from Vanangana). In eastern UP, an extremely fertile area, deaths from hunger still occur due to huge inequities, with people high up in the feudal hierarchy owning hundreds of acres while weaker sections of society are comprised of landless laborers. In western UP, yet another form of violence – that of village 'elders' exerting control over the community. The murder of a young couple who chose to marry against their parents' wishes in Muzzaffarnagar is a case in point. All these forms of violence, in their own right, have had an adverse impact on health, especially women's health.

And then there is the state-sponsored violence. When the average operating time for a female sterilization operation is two-and-a-half minutes, how can the government family planning program be considered even remotely humane? I mentioned watching 'Something like a war' recently – it is a horrific expose of the situation, including the quota system where government officials have to show proof of sterilization operations arranged by them before they can get their salaries. This movie is 20 years old, but it still holds true, I was told. I received a DVD which is a more recent production by Kriti Resource Center.

There was also a lot to be said about polio programs. As Abhijit put it, “Maternal deaths are a subsidy for polio eradication programs.” To elaborate, Rs. 13 crore is spent on each round of polio immunizations. And there are numerous every year. All government officials – PHC staff, village level officials, even teachers - are caught up in the activity. So where is the time or money to devote for other programs? Even regular vaccinations – DPT and BCG have been affected. Malaria and TB are on the rise, as well as maternal mortality. “To be able to say that polio has been eradicated, we are sacrificing the health and lives of countless people.”

Therefore, Sahayog, with the help of its partners in the field, has been demanding accountability. For example, Prayas, a spin-off group working in Nainital and Rudrapur dts. in Uttaranchal, has been partnering with village women to demand more from their health services. A maternal death audit was undertaken in UP – it listed 8 lakh cases. On the basis of this and other reports, the group has been fighting for improved quality of care and increased surgeon qualifications. Finally, compensation for deaths by negligence is a demand of HealthWatch, a network of groups facilitated by Sahayog.

On population control, there was again a lot to say. I, like most middle-class mainstream people, grew up thinking population rise is the root of almost all the problems in India. As the folks at Sahayog put it, “We are 'educated' to think that.” Sahayog has been working to increase awareness of the issue and the problems such single-minded focus on one 'problem' at the expense of all others has on the 'beneficiaries' – rural women. In one district, 1400 women were sterilized in 2 days. Some of them were unmarried, others past childbearing age. 99% of the interventions for 'family planning' are directed towards women and an overwhelming majority are sterilization operations. Recently, vasectomies or male sterilizations are again receiving attention – in the last 6 months, there have been cases of boys being intoxicated and operated on. And all of this inspite of the fact that there is a shortage of contraceptives in many parts of the state, so that families that want family planning approaches aren't getting them. Finally, there are so many factors that lead to families having more than 2 children – infant and child mortality, women's lack of control of their bodies and sexuality and so on.

With all this evidence in hand, various health and human rights groups successfully intervened in Himachal Pradesh, with the result that the government withdrew a plan to ban jobs and rations to families with more than 2 children. Also, the national government was forced to say that they do not endorse the 2-child norm, even though it is in the Common Minimum Program of the UPA. On the flip side, the Supreme Court passed an order to enforce the norm. So its a constant struggle... 8 months ago, Dwiji and I had a long discussion on this issue with staff members of Vanangana, based in Chitrakut dt., UP and a partner of Sahayog. Some of these women have more than 2 children and during a group meeting, the more vocal and 'radical' women in Vanangana convinced two women to go in for sterilization operations. They are still having health problems a year later as a result. Others who were contemplating sterilization were too scared to go in for it. Yet others, this the staff of an NGO fighting for women's rights, are contending with husbands who believe that more children is a sign of 'mardangi'. As they told us, this is not an easy problem to deal with.

On the role of NGO's – Kriti Resource Center relies on NGO partners to provide information from the field as it does not have a field presence itself. In Abhijit's opinion, 'Small is beautiful' as far as NGOs are concerned. One thing NGOs should NOT do is make the government redundant. “NGOs are in an area only for a few years. 'Sarkar aur samaaj' – government and society – these are the only sustainable partners in any effort.”

After the Sahayog staff left to continue their various tasks, Abhijit and I continued talking. We discussed his report on HIV/AIDS in Uttaranchal in 2000 and the subsequent arrest of 5 members of Sahayog (including Vasundhara, his partner) for distributing obscene literature. “We didn't anticipate the reaction to the report and should have,” he commented. Ironically, or maybe logically, he felt that the book 'Sangtin yatra' shouldn't have been written. “It upset a lot of people in the NGO community here and affected relationships.” He hadn't read the book, so couldn't comment on specific aspects of it. Incidentally, Kriti Resource Center has worked with Sangtin on their most recent campaign, after 'Sangtin yatra' was released.

Abhijit also expressed happiness that I was spending so much time in the region. “Not many AIDers visit UP,” he remarked. Working in the region was very hard, with the violence, caste and gender discrimination and everything else, but the inequities that exist between the North and South of India have to be tackled. And that requires more presence in the area. We discussed ways of further educating people in AID about population and health issues and I ended up adding a huge stack of Kriti Resource Center publications to my collection!

From the Sahayog office, I went to the railway reservation center to reschedule my Mumbai-Bangalore ticket. Only then did I realize that my ticket was for 27th February, not 27th March. Yet another loss by the Nagavarapu-Guru combine in travel, though mine is definitely not as expensive a mistake as Dwiji's last year!

Back at Madhavi's home, we talked about the activities she has been involved in. She moved from Karvi to Lucknow a few months ago and while she still continues to support Vanangana's activities, she has taken on new tasks such as helping the Dalit Women's network in UP with case work. This involved preparing briefs on about 200 cases in a couple of days, picking out some cases for highlighting and working with the group to organize an event that brought out the continuing oppression of Dalits in the state. She continues to work with groups in Gujarat – a tuition center started in Kalol town is into its third year of operation (and we're still waiting for the proposal!). The legal work they did so far has resulted in one case – Bilkees Bano's. Huma and Madhavi are among a group of people supporting Bilkees through her struggle. Madhavi was in Mumbai for about 10 days during when the case was postponed twice. She talked about Bilkees' courage and how important it was that a rape case in this country receives a favorable verdict. We talked about the adverse impact of the developments in the Best Bakery case. “But Bilkees has made her deposition and has stood firm. Now only time will tell.”

Some sightseeing, shopping in possibly the biggest chikan market in the world and more great chaat (7 different flavors in pani puri) and kulfi brought the day to a close.

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