With ASHAs striking work since March seeking better wages, newborns and pregnant women die in rural Madhya Pradesh due to lack of timely medical intervention
Vidisha, Madhya Pradesh: “Had I been at work, I would not have let this happen,” regrets Sharda
Kushwaha (29), an Accredited Social Health Activist (ASHA) from Neh Pipariya
village in Vidisha district.
On April 13, a village woman lost her newborn shortly after delivery as
the child was in breech position (bottom down and head up) in the womb. The
family could not figure out that something was amiss and couldn't seek timely medical
intervention. All this, as Sharda and thousands of ASHAs have been on an indefinite strike in Madhya Pradesh since March 23, demanding that they
be given a fair increase in their monthly stipend and assured of permanent
employee status.
ASHA supervisor Vinita Sharma claims three women and four newborns died
in Vidisha district ever since the strike — a reminder of how rural health services rely heavily on the ASHAs in
their role as providers of crucial outreach services under the Reproductive,
Maternal, Neonatal, and Child Health and Nutrition (RMNCHN) strategy of the
National Health Mission.
“Ever since the strike began, non-institutional deliveries are on the
rise. If we take the last
one-month period, seven deliveries have taken place at homes
in my block. I feel this number would have otherwise been zero as the pregnant
women would have been shifted to a hospital or health centre,” says Preeti
Raghuvanshi, an ASHA supervisor from Tyonda block of Vidisha.
“Pregnant women go to the government hospital only because of the ASHAs.
In fact, no one wants to go there without an ASHA’s escort. They think there is
a lack of resources in government hospitals, and that people will not provide
the required information or behave well. So women do not want to
go to the hospital alone,” Lakshmi Korav, the president of Madhya Pradesh ASHA/ASHA
Sahyogini Shramik Sangh, tells 101Reporters.
Admitting that non-institutional deliveries have gone up ever since the
strike, Korav says, “Even check-ups and monitoring of pregnant women have
stopped. The ASHAs used to get them medicines from health centres or check their
blood pressure during door-to-door surveys. After delivery, they are encouraged
to breastfeed. The ASHAs take care of the newborn in the first 28 days and
constantly monitor their weight. All of this has stopped.”
Nargis Bi of Sirnota is pregnant, but she will have to go alone to the
primary health centre (PHC) for check-up. "The ASHA always accompanied me
for check-ups. Everything went well when she was around. Sometimes, she would take
me to the district hospital for an ultrasound. She can better articulate my
problems to the doctor, which makes treatment easier.”
For now, the ASHAs have been instructed to verbally keep in touch with the women and explain what they should necessarily do. “These are the people of our community; we have no enmity towards them. We care about the people we look after. We have told them that right now we are on strike and cannot come to take care of your child. It bothers us that we cannot help them while we are fighting for our rights,” says Korav.
Why strike work?
There are three working cadres — ASHA, Urban Social Health Activist (USHA), and ASHA Sahyogini.
Currently, the ASHAs and USHAs receive a monthly payment of Rs 2,000, while ASHA
Sahyoginis, who perform supervisory duties, get Rs 10,000. They want the honorarium to be raised to a minimum of Rs 18,000 and Rs 26,000, respectively.
“After working tirelessly for hours together, we are paid less than a
daily wage worker. My family has seven members. Tell me how I will run the
household with this meagre amount,” asks Sharda. Korav emphasises that they are
only demanding a living wage. “We need at least Rs 18,000 per month,
which is the minimum wage a trained worker in Madhya Pradesh should get as per
the government mandate.”
However, the current focused demand relates to an agreement reached
during talks with a government delegation headed by Chhavi Bhardwaj, the then
NHM Mission Director, in 2021. “On June 24, 2021, when we were protesting in
Bhopal, the government team engaged in talks with us, and it was agreed upon
that the ASHAs would be given Rs 10,000 per month and Sahyoginis Rs 15,000. We seek
the immediate implementation of this agreement and payment of arrears from that
date," Korav explains.
NHM State Director Priyanka Das did not respond to repeated attempts to contact her.
Justifying the demand for a better honorarium, Sharda says they are on
call 24x7. “We leave everything to tend to a woman in labour in the middle of
the night, yet join routine work early morning the very next day.”
The ASHAs maintain a register of pregnant women, newborns and other
target beneficiaries. Every day, they go through a checklist and mark the areas
that need home visits — like
pregnant women in the last trimester or breastfeeding mothers — and set out on foot for door-to-door visits
as soon as they are done with the work at the PHC. These visits facilitate
early detection of diseases, maternal and child healthcare, nutrition education
and immunisation campaigns.
The ASHAs are like an extended family, intimately involved in the lives
of the villagers they serve. They not only provide essential healthcare but
also act as sources of support. “Being part of the local culture and customs makes
it easier to tackle sensitive health topics. We counsel the residents on
numerous issues. We talk about family planning and encourage sterilisation… We
know which house has what issue, and how it should be addressed,” says Usha
Sharma, an ASHA from Sirnota.
Pooja Kushwaha from Ahmedpur is forever thankful to the ASHA who
supported her during pregnancy. “I was underweight, had low BP and suffered
from bouts of nervousness… Arti Lodhi, our ASHA, checked upon me regularly, and
sometimes accompanied me to the PHC for check-up. She gave me iron tablets.
After her counselling session, I was no longer anxious about the delivery,”
says Kushwaha, who also
got maternity assistance under the Janani Suraksha Yojana (JSY) with her help.
The JSY is a centrally sponsored scheme that integrates cash assistance
with delivery and post-delivery care. The scheme has recognised ASHAs as an
effective link between the government and pregnant women. It aims at promoting
institutional deliveries and reducing maternal and neonatal mortality by
providing cash incentives to those who give birth in healthcare institutions.
“She (ASHA) has been with us from the beginning of pregnancy. She
advised me about both maternal and child health. After the baby’s arrival, she
only took care of the vaccination, weight, nutrition and everything else,”
attests Sunaina Bairagi, a new mother from Ahmedpur.
The ASHAs hold weekly sessions with the women and children
at anganwadis to ensure holistic
development and well-being of children, pregnant women, and lactating mothers. “We are trained in providing assistance during childbirth in both home
and institutional settings. No one knows exactly when a delivery will happen,
so we are always prepared when a woman is expecting,” says Usha.
They also maintain a record of the children’s growth and development.
“Ever since the strike, the data on nourishment levels of children have not
been shared with the government. No one is tracking nutritional intake. These
children are walking a fine line between undernourishment and malnourishment,” cautions
Korav.
The ASHAs were to start
the registration work for the
newly-launched Madhya Pradesh Mukhyamantri Ladli Behna Scheme, but they have not been part of it due to the strike. The referral system has been affected as the ASHAs play a critical
role in facilitating timely and appropriate referrals for emergency obstetric
care.
Around March-April, they conduct a malaria survey to check the presence
of mosquito larvae on household premises. Vaccination drive against Japanese
Encephalitis is also carried out during this period. None of these activities have
been taken up this time.
No doubt, the ASHA strike has crippled rural health services in Madhya Pradesh. The only thing left to know is how long the government will take to intervene.
Edited by Tanya Shrivastava
Cover photo - The ASHA strike has crippled rural health services in Madhya Pradesh (Photo sourced by Satish Malviya, 101Reporters)
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