How soaring silver prices are reshaping wedding traditions in Rajasthan

In Bhil communities of Banswara, rising silver prices are prompting families to scale back wedding rituals and other traditional practices.Banswara, Rajasthan: “Fathers leave silver to their sons. It is cheaper than gold and available by the kilogram. It is practical,” Pandit Uttam, who conducts rituals for several Bhil families in the district, told 101Reporters.In Banswara district of Rajasthan, where a large Bhil population lives, silver is the most valued metal. Its presence is visible everywhere, from everyday wear to wedding rituals.Deepika Katara, an Adivasi woman and social worker from Vasuni village in Kushalgarh block, said: “Not just at weddings, even at fairs and weekly markets, women wear full ornaments…Daily wear includes pale on the hands, payzeb on the feet and nose rings. Silver is both economic security and stree dhan.”According to Katara, women traditionally wear hansali around the neck, bor on the forehead, tagali, armlets and toe rings. Silver amulets are tied around children’s necks to ward off the evil eye. Men, too, wear silver bracelets.In Bhikli village, Rekha Maida, Leela Dodiyar and Sita said silver carries emotional value beyond its price.“We love silver. It is our adornment,” they said. “It gives confidence that it will help in times of crisis.”It also acts as a buffer in times of financial stress, said Lachu Bamniya of Wadlipada village.“In difficult times, it can be loaned or sold for quick cash. This security is passed down from one generation to the next,” he said.Rekha said her sister-in-law was given three-and-a-half kilograms of silver about a decade ago. “Three years ago, when the wheat crop failed, one kilogram was sold to cover the losses,” she said.Traditionally, at the time of marriage, the groom’s side gives silver jewellery to the bride’s side. Silver is also exchanged on other auspicious occasions. In recent years, residents said, social media has contributed to a renewed interest in wearing silver anklets among tribal women.However, there has been a sharp rise in prices since January 2025. According to Vishal Dosi, president of the Banswara Sarafa Association, silver is currently priced at around Rs 2.4 lakh per kilogram in the district. On January 19 and 20, the price touched Rs 3 lakh per kilogram. By January 29, it crossed Rs 4 lakh, reaching a high of Rs 4.17 lakh before gradually declining.Some residents told 101Reporters that this volatility has begun affecting social and religious practices.Women wearing the silver jewellery (Photo - Laxmikanta Joshi, 101Reporters)Shifting traditionsMohan Maida, almost 80 and a senior member of the Bhil community from Kushalgarh block, has seen the older era of these traditions.“There was a different time,” he said. “When our daughters-in-law entered the house, the sound of their silver jewellery filled the house.”Maida said he purchased silver for his children’s weddings nearly 25 years ago when prices were around Rs 7,000–Rs 8,000 per kilogram.He has four sons and seven grandchildren. His sons migrate seasonally to Gujarat, to cities such as Vadodara, Vapi, Surat, Valsad and Ahmedabad, where they work in construction and pipeline digging for daily wages of Rs 600 to Rs 800. Three daughters-in-law stay in Kushalgarh, while one lives with the sons in Gujarat.Maida said silver has often provided financial fallback for his family.“When crops failed or money was needed for medicines, we mortgaged silver,” he said.Harsingh of Amlipada village said farming is rarely profitable. “Most farmers own one-and-a-half to two bighas. Input costs are high. Even if 30% remains after expenses, it cannot feed a family for a year,” he said, adding that in some of these situations silver acts as a safety net.Rising silver prices are prompting families to scale back wedding rituals and other traditional practices (Photo - Laxmikanta Joshi, 101Reporters)New wedding ritualsTraditionally, three to four kilograms of silver, locally called daapa, are exchanged at Bhil weddings, residents said.But with prices rising sharply this year, some families are reconsidering the scale.Dosi cited a recent wedding in a village near the Mahi Dam backwater area where both families agreed not to exchange heavy silver ornaments. Instead, the bride was given a gold mangalsutra and silver toe rings, costing around Rs 1.5 lakh. A fixed deposit of Rs 2 lakh was made in her name.Anchi of Vasuni village said her family sold nearly one kilogram of old silver for Rs 2.85 lakh during her brother’s wedding.“With that, we bought a gold mangalsutra for Rs 1.6 lakh and silver toe rings and anklets. We did not need to take a loan,” she said.Dosi also said that earlier, families would often take silver on credit before weddings and repay the amount after collecting funds through notra, a community contribution system. With rising prices and volatility, such arrangements have become difficult.“In earlier years, some families pawned silver for small loans and did not return for years,” he said. “Now that prices have risen, they are coming back to settle accounts and reclaim their silver.”He added that price fluctuations have also led to occasional disputes as rates continue to change.In villages such as Barwas, Bhagatpura and Thumar, discussions are underway to limit wedding exchanges. Dinesh Chandra Dindor said a 21-member committee has been formed in parts of the Kushalgarh constituency.“In some villages, families have agreed to limit it to one or one-and-a-half kilograms,” he said. “The tradition continues, but with adjustments.”Cover photo - In Banswara district of Rajasthan, where a large Bhil population lives, silver is the most valued metal (Photo - Laxmikanta Joshi, 101Reporters)

Jhabua’s answer to tackling child malnutrition begins at home

The Moti Aai programme relies on trusted women to bridge the gap between nutrition schemes and everyday care.Jhabua, Madhya Pradesh: In the villages of Jhabua district, women carry the weight of families across seasons of scarcity and migration. Pregnancy does not slow them down. Neither does illness.Days begin before sunrise, with fetching water, tending to livestock and household chores, before women head out for daily wage labour. Even during pregnancy, rest is rare. Health, often, comes last.This routine has led to a public health crisis. According to the National Family Health Survey-5, 58.8% of women in Jhabua are anaemic, while 80.1% of children aged six to 59 months are malnourished.It is within this landscape that Moti Aai, a community-based initiative centred on women caring for severely malnourished children, took shape in Jhabua. The idea was simple: if nutrition was failing inside homes, care had to return there.“Women here prioritise daily wages over their own health,” said Priyanka Gamar, a supervisor with the Women and Child Development Department. “Even during pregnancy, work does not stop.”Many pregnant women remain outside the reach of health systems. “When we find them, we try to ensure check-ups at nearby anganwadi centres and with ANMs,” Gamar said. “But we do not reach everyone.”The consequences are intergenerational. Women who are undernourished often give birth to undernourished children.Despite anganwadi centres, subsidised rations and nutrition rehabilitation facilities, malnutrition indicators in Jhabua have remained stubbornly high for years. The gap lies not in the absence of schemes—but in what happens beyond them, inside homes.Moti Aai is a community-based initiative centred on women caring for severely malnourished children (Photo - Laxmikanta Joshi, 101Reporters)Why the system fell shortIn November 2024, district officials organised 294 health and nutrition camps across Jhabua’s six development blocks. Data collected showed that 1,110 of the district’s 2,706 anganwadi centres reported cases of severe malnutrition, affecting 1,950 children.Children were regularly weighed, monitored using mid-upper arm circumference tapes and, in critical cases, hospitalised. Yet malnutrition persisted.Joint reviews by the Health Department, Women and Child Development Department and AYUSH officials pointed to three structural reasons.First, migration. Large numbers of parents migrate seasonally to Rajasthan and Gujarat for labour work, leaving young children in the care of elderly grandparents.Second, food practices at home. “Anganwadis provide supplementary nutrition,” said Ajay Chauhan, an ICDS official. “But at home, children often eat only roti and chilli. Nutrition is seen as the anganwadi’s responsibility.”Third, uniform menus. State-wide anganwadi diets do not account for local needs. “Jhabua households have access to kodo and kutki, cheap, nutritious coarse grains,” Chauhan said. “But these are not always used for child feeding.”It was against this backdrop that the district administration moved to formalise a community-based response.When girl from Khardu Badi village, was brought to the nutrition rehabilitation centre, a kind woman there gave her a massage and provided her with nutritious food (Photo - Laxmikanta Joshi, 101Reporters)Bringing care back homeSoon after taking charge, collector Neha Meena said she realised the problem could not be addressed through schemes alone.“We had all the systems in place,” she said. “But despite years of effort, the situation was not improving.”In November 2024, the district launched the Moti Aai Campaign, shifting part of the responsibility for child nutrition from institutions to women within the community.Moti Aai, meaning “elder mother,” refers to women from the same village who take responsibility for one severely malnourished child alongside existing government systems.“This is not a replacement for anganwadis or hospitals,” Meena said. “It fills the gap between nutrition on paper and care at home.”The women selected were economically stable and socially trusted. As of March 2025, 1,325 women were working as Moti Aais across the district. The work is voluntary, with a one-time incentive of Rs 1,000.Their responsibilities include monitoring daily meals, accompanying children for check-ups, maintaining hygiene and providing massage. “They watch the child the way a mother would,” Meena said.Riyansh, son of Vijay, who recovered from malnutrition (Photo - Laxmikanta Joshi, 101Reporters)‘Just like family’Ayushi (4) from Moradungra village in Meghnagar block was one of the children identified as severely malnourished. Her parents had migrated to Kota in Rajasthan for labour work. She lived with her grandparents.“My wife tried her best,” said Ayushi’s grandfather, Hakku Vasuniya. “But old age and lack of proper guidance made it difficult.”Ramu, a woman from the same village, was assigned as Ayushi’s Moti Aai. She monitored meals, massaged the child, and often cooked food herself and brought it home.Ayushi’s weight gradually improved. She was later declared free of severe malnutrition. Ramu continues to visit her regularly.A similar story played out in Kalyanpura village. Two-and-a-half-year-old Sunil’s parents worked as labourers in Rajkot, Gujarat. He lived with his grandmother and was severely malnourished.Habba, his Moti Aai, took charge alongside the family. “She didn’t replace us,” the grandmother said. “She guided us.”Sunil is now out of the severe malnutrition category.According to data shared by the district administration, within five months of the campaign’s launch, 1,163 children were assessed as having recovered from severe malnutrition following repeat measurements at anganwadi centres and nutrition rehabilitation facilities.As of April 2025, officials said 81 children remained severely malnourished. For these cases, the administration launched Moti Aai–2 in May 2025, involving closer medical supervision.District programme officer RS Baghel recalled one case that surprised even health workers.“Yuvraj, aged one year and five months, weighed 6.6 kg when admitted,” Baghel said. “In just four days, his weight increased by 210 grams. Earlier, he had been in a nutrition centre for a week with little improvement. Regular feeding and massage under a Moti Aai made the difference.”In another case, Lakshmi, a one-year-old from Khardu Badi, weighed 4.25 kg when admitted. Her mother had died. Under Moti Aai–2, her weight increased to 5.21 kg by discharge.“These are not isolated cases,” Baghel said. “We saw consistent improvement when home care became structured.”Limits and lessonsSupervisors from the Women and Child Development Department say the work was not without resistance.“Many women already work long hours in fields,” said Priyanka Gamar. “Nutrition is still seen as a woman’s responsibility. Men often do not cooperate.”Money remains a constraint. “Families feed what is available,” Gamar said.Yet, officials say visible administrative support helped sustain the initiative. “When women see the collector visiting villages and homes, they take the work seriously,” Gamar said.Moti Aais were issued identity cards and their names were displayed at anganwadi centres. “It made them feel part of the system,” she added.For many women, the role also reshaped how they saw their place in the community.Sixty-year-old Sama Vasuniya, a Moti Aai from Dhandhaniya village, said she decided to take responsibility when she learned about Shivani, a severely malnourished child whose mother was unwell. “The grandmother was alone,” she said.Shivani’s weight rose from 3.1 kg to 9 kg over time. “I fed her supplementary food, massaged her, and followed what doctors taught us,” Sama said.She receives no payment from the family. “People trust people they know,” she said. “That makes the work easier.”Public health experts caution that long-term evaluations are still needed, and independent assessments have not yet been conducted.But for families who had exhausted options, the impact feels immediate.“Earlier, we didn’t even know our child was malnourished,” said one grandmother. “Now we know what to feed and why.”For collector Neha Meena, the campaign reflects an acknowledgement of the limits of bureaucracy. “Nutrition doesn’t improve on paper,” she said. “It improves when someone cares every single day.”Whether Jhabua’s experiment can be replicated elsewhere remains an open question. For now, it stands as a reminder that community care,long carried by women without recognition, can become the most effective intervention of all.Cover photo - District Collector Neha Meena visits different houses and feeds the children with her own hands (Photo - Laxmikanta Joshi, 101Reporters)

In Jhabua, a police‑led campaign is pushing back against the 3Ds – daaru, dowry, and DJs

How a series of village‑level dialogues is bringing back tradition to tribal weddings Jhabua, Madhya Pradesh: In the courtyard of the Government Primary School of Negadiya village in Jhabua district, rows of plastic chairs have been laid out under a large tent. Women in bright sarees are seated on one side, their eyes fixed on the stage. On the other side, young men lean forward, listening intently. It is only nine in the morning and the sun beats down on the mud paths around the school. Superintendent of Police Padma Vilochan Shukla stands on the stage, addressing the crowd. Behind him, a banner reads Jan Samvad or public dialogue. But this is not a law-and-order session. Instead, the senior officer begins narrating the story of Angulimal, a feared dacoit who transformed into a monk after a meeting with the Buddha. The audience listens in silence as he draws a parallel with present-day customs. From the story of Angulimal, the conversation shifts to rising costs of marriage and the practice of dowry, the harmful effects of alcohol and the blaring music of DJs that has become common at celebrations. The SP asks the villagers to take a pledge: to give up these practices. This is the scene from one of many such meetings being held in villages across Jhabua, a tribal district in western Madhya Pradesh. The district police, along with community elders and panchayat members, have launched what they call the 3D campaign, targeting three common practices: DJ (loud music), Daaru (alcohol), and Daapa — a form of dowry where the groom’s family is expected to give money or jewellery to the bride’s side. SP with the villagers in Jhabua (Photo - Laxmikanta Joshi, 101Reporters)DialogueThe idea for the campaign, according to SP Shukla, came not from a policy directive but from conversations. During meetings with local police personnel and panchayat members, a pattern emerged: disputes, debts, and even crimes linked to these practices. Young couples were starting their married life in debt, having spent lakhs on wedding DJs or paying daapa. Alcohol-related violence was common during celebrations. Initially started in mid-2024, the campaign gained momentum after a large conference in January 2025 where panch-patels or tribal village elders from across the district pledged their support. The idea was to not rely solely on enforcement but to create social change through participation. “We realised that if people don’t see these customs as harmful, any ban will only bring resistance,” said Shukla. The campaign is currently active in tribal districts like Jhabua, Alirajpur, and Ratlam. It is not part of a wider state government initiative, and SPs are implementing it at the local level. Discarding DaapaIn many villages, the impact is beginning to show. According to Prakash Chauhan, who handles public relations at the SP’s office, over 55 weddings have taken place since January without the 3Ds.In Kalakhunt village, Dawala Ninama decided not to accept any daapa during his daughter’s wedding in May. Instead, he printed a message on the wedding card: “A daughter is the pride of the family. Daapa is not the price of a daughter.”Of the three ‘Ds’, daapa is perhaps the most deeply enmeshed in the society and financially damaging. In tribal weddings, it traditionally refers to the jewellery, cash, or goods given by the groom’s family to the bride’s. In practice, however, it often reverses direction. The bride’s family is expected to give large sums—anywhere between Rs 3 to Rs 5 lakh, sometimes more—to the groom’s side. This has led many families into debt.When daapa isn’t paid in full, it strains the marriage. Sometimes the bride is harassed; more often, both husband and wife begin their married life under pressure to repay a loan. “We’ve seen people migrate the very next day of marriage, just to start earning,” said social worker Bahadur Hatila.Ninama recalls how, when he got married in 2006, he had to borrow Rs 60,000 for daapa. The debt pushed him and his wife into years of labour work in Gujarat. He didn’t want his daughter’s marriage to start on the same note. The public conversations led by the police gave him the confidence to go ahead with his decision, despite community pressure.In another instance, Pallavi Baria and Manoj Bamnia of Lakhpura village married without daapa. The sound of the DJ was replaced by traditional instruments. As a ritual, only ₹1.25 was exchanged in the name of dowry.In Gehlar Badi village, Vasna Bhabor arranged her daughter Lassu’s wedding without DJ or alcohol. The baraat was welcomed with dhol-mandal, and guests were served a simple meal. The SP attended the ceremony and handed Bhabor a certificate of appreciation.Similarly, in Bochka village, the superintendent of police attended the wedding of Galu Dindor’s daughter Durga, who married without alcohol, DJ or dowry. The SP brought a citation as a gift from the police department and was welcomed with drums and a ceremonial turban. Families who organise such weddings are being recognised publicly. The SP or his officers often attend in person, greeting the couple and acknowledging their decision. Before participating in such ceremonies, officials verify the age of both bride and groom.“The idea is to make it a moment of pride,” said Chauhan from the SP’s office. “If someone gives up alcohol or doesn’t use a DJ, they shouldn’t feel like they’re doing something small. We want the community to support it.”The police are calling on every couple who got married without dowry. They are being garlanded with flowers, applauded, and their experiences are being heard. This has become more of a social celebration than a government program. The campaign is now receiving support not just from the police, but also from religious groups, youth organisations, and panchayat leaders, Chauhan said.SP Shukla added, “Good wishes and letters of appreciation can be sent through police station or outpost in-charges, but going among the villagers and talking has a wider impact.”The campaign is active in tribal districts like Jhabua, Alirajpur, and Ratlam (Photo - Laxmikanta Joshi, 101Reporters)Drums over DJsInstead of DJs that once cost up to Rs 1 lakh per wedding, families are returning to dhol-mandal music, Chauhan said. Artists like Prema and Varese Damor, who play drums in Jhabua town, say demand for their work has increased. “Earlier, we were only called for rituals. Now we’re playing during the baraat and main function too,” said Prema. “The money is the same, but at least we’re getting work again.” Women like Reena Bhabhor note a change in the atmosphere. “Earlier, boys used to dance to DJs, and fights would break out. Now we women also dance, to our songs, in our rhythm, with open hearts.” Driven by communityThe most notable aspect of the 3D campaign is that it functions more like a community-led social movement than a top-down directive. While it was initiated by the police, it has grown through local participation. Panch-patels, religious leaders, schoolteachers, social workers, and youth groups have all been involved in spreading awareness in Gram Sabhas and village meetings.To sustain the momentum, police teams visit schools and colleges, asking young people to take a pledge: not to drink alcohol, not to misuse DJs, and not to demand dowry or daapa. Youth who publicly support the campaign and help spread the message are recognised as “3D Warriors” and awarded certificates and letters of appreciation.The campaign's first large-scale district conference, held in January 2025, brought together over 600 community members. According to those involved, it served as a turning point, encouraging more families to break with long-held practices.The campaign has no official budget or formal monitoring system. However, the SP’s office is keeping an informal record of weddings and public responses. While it may be too early to quantify the long-term impact, some police station areas have reported a small dip in crime, police said. Officers also said that the activity has helped in building trust among the community. Damage That said, not everyone welcomed the campaign. When the police cracked down on DJs earlier this year, DJ operators protested, blocking the highway and clashing with police on March 5. Over 30 people were booked, and several officers were injured. Local news reported that nearly 188 DJ operators faced action. The police maintain that they’re not banning DJs outright, but asking families to avoid them voluntarily, especially at high volume or with vulgar songs. SP Shukla said: “The drive is about reducing debt, noise pollution, and alcohol-related violence. The tribal region has its own rich traditions. We are just creating space for those to return.”While the campaign has gathered momentum, it still faces limitations. Practices like daapa are culturally entrenched. Alcohol remains widely accessible. And many families still hesitate to break from social expectations unless others do so first. Cover photo - SP attending one of the wedding ceremonies (Photo - Laxmikanta Joshi, 101Reporters)

Where is our free time?

Girls in the tribal village of Hevdadama Kalan in Madhya Pradesh have an all-encompassing role — of a student, homemaker, livestock rearer and farm labourer  — which leave them with no time for studies or skill developmentHevdadama Kalan, Madhya Pradesh: Surta Maida (15) is already up and chasing the household tasks, though it is only 5 am. In the Garasiya tribal village of Hevdadama Kalan in Bajna block of Madhya Pradesh’s Ratlam district, this is the story of every elder girl in the family.Surta’s parents are farmers, so they leave for the fields at dawn. It is Surta’s responsibility to prepare lunch for them. She has to pack the bags of her younger siblings — Krishna Maida (10), who is in class 5, and Mukesh Maida (4), who goes to anganwadi — and get them ready. She also has to set out around 9.30 am for the Government Higher Secondary School in Bajna, where she studies in class 10. Her classmates Sushma Gamar, Jeevi Maida and Rambha Ninama give her company during the four km walk to the school, which takes almost half-an-hour.The school hours are from 10.30 am to 5 pm. As soon as she gets home by 5.30 pm, Surta feeds the cow and buffalo in the house and three-four chickens. She also has to make food and feed her siblings. Occasionally, she cleans the entire house.In the evening, she tries to spend half an hour outside the house talking to her friends. Her study time is from 8 pm to 10 pm. On holidays, she not only does household chores but also works in the fields with her parents.Surta’s family has a two-bigha farm, where gram, wheat, onion and garlic grow. There are several tasks for the family members, including watering and spraying the fields. Children are assigned the job of deweeding or pulling out garlic and onions. Every year, more than Rs 30,000 is spent on sowing these crops alone. Yet, Surta, like other village girls, plucks cotton during holidays, which brings in Rs 200 to 300. During summer vacations, she also works as a farm labourer.A girl plucking cotton in the fields when it's a school holiday (Photo - Laxmikanta Joshi, 101Reporters)Surta says that sometimes she has to take her textbooks to the fields as well. “During examinations, I do not get time to revise, so I take my books to the fields. Sometimes, while cooking, my book remains open so that I can revise something,” she says.“This happens often,” she adds. “There is no restriction on the education of girls, but due to financial constraints, they are made to work in the fields,” interjects Surta's mother Durga Maida.Surta is the third among five siblings. She has an elder sister and brother, who are both married. The brother works as a labourer in Gujarat along with his wife, who also has four children. Elder sister Nirma Maida (16) left her studies after class 8 as she had to take care of her younger siblings.Despite earning money through labour, tribal children do not have much freedom to spend on themselves. At most, they are given Rs 10 to 20 for biscuits or chips, etc. Neither are they addicted to mobile phones as seen mostly in urban communities."Where do they get time to use mobile or play? She studies, that is enough. She has to do the household chores too. Wheat has grown in our field right now, I have to go there," says Durga, when asked whether Surta plays games on the only Android phone that the family possesses. If she ever gets free time, Surta plays traditional games, including Satoliya and hide and seek, with her friends.  Hevdadama Kalan has a primary school, where Eran Ninama (10) studies in class 5. She is the third among four sisters and one brother. At the break of dawn, she is out to fetch water from the hand pump, located around 500 m from her house. After that she does dishes and gets her younger siblings ready. Her younger sister is in anganwadi, while the brother goes to school with her. She reaches the school by 11 am.Eran's father works as a labourer in Gujarat and her mother is a construction worker. On holidays, she works as a farm labourer picking cotton. She does not skip games, which include rolling old tyres, once back from school.The difficult routine combining studies with household chores and working in the fields is not unique to Surta and Eran, but to hundreds of tribal girls in this region — be it Sushila of class 3 or Angoori of class 5.  Climbing trees and having fun is still reflected in their daily routine. Sometimes, they start playing without changing their school uniform because they know that once they change their uniform and start doing household chores, they will not get time. Children in the presence of Anganwadi supervisor, who were given information about nutritional food (Photo - Laxmikanta Joshi, 101Reporters)Dreaming big despite roadblocksEducation has become a tool for dreaming big in Hevdadama Kalan, thanks to the motivation that children get from school teachers and non-governmental organisations (NGOs). Unlike the earlier days, girls aspire to become something through education. Most of them want to become government teachers, but responsibilities come in the way of realising this dream.In contrast, most of the boys leave their studies after class 10 and start earning. Moreover, boys don't need to clean the house or take responsibility for younger siblings. However, they do work in village farms. Tribal girls are given school uniforms and books from the school itself. Sweaters and shoes are mostly distributed by NGOs. Boys, on the other hand, get only scholarships. There is a provision of scholarships for tribal girls as well, under the Balika Shiksha Protsahan Yojana.  However, tribal girls live under the shadow of malnutrition. There are six anganwadis in Bajna block, where the health of these girls and anganwadi children are checked on the fourth Tuesday of every month. The testing is conducted compulsorily by the Women and Child Development (WCD) Department and the Health Department.“There is a problem of malnutrition in tribal areas. Besides timely checkups, packed nutritional supplements and medicines are arranged for them. Sometimes, anaemia is very worrisome. However, awareness is being created on the maximum use of millets. The situation has changed a lot now,” Ehtesham Ansari, supervisor, WCD Department, Bajna Sector-1, tells 101Reporters. He adds that a campaign is being run for the nutrition of children from pregnancy to two years, in partnership with IIT Bombay.The responsibility of monthly testing lies with the auxiliary nurse midwives (ANMs) of the Health Department. At anganwadi level, medicines are given to girls who appear malnourished. If necessary, they are also admitted to hospital, but this has reduced these days. Instead, the ANM administers an injection. Every girl is entered in a register, her health report is reviewed every one and three months.Social worker Renuka Porwal says that the problem of malnutrition among girls has been there for many years, but now irregular menstruation also affects girls.  “We want the girls to study, but there are family responsibilities. When girls discontinue their studies, we try to convince them but their families do not listen. We will talk to the authorities in this regard and get them enrolled in schools,” says Ramesh Gamad, the husband of Hevdadama Kalan sarpanch Nani Bai.Block Education Officer Upendra Singh Rathore tells 101Reporters that 16,886 girls are enrolled in schools of Bajna block. “The worrying aspect is that many girls leave school after class 4 or 5. In the 2024-25 academic year, 4,035 girls left their studies midway,” he informs.“The government distributes laptops and bicycles along with scholarships, but still the enrolment is low. My school has only 65 students in class 12 and 64 in class 11. Girls from dozens of nearby villages come daily. There has been some improvement as compared to earlier,” says Indira Pandey, Principal, Senior Secondary School, Bajna.On why girls from Hevdadama Kalan are not given bicycles, Pandey said, “There is a provision to provide bicycles at a distance of more than five km only.” Upskilling mattersRaghunandan Singh Gautam, block coordinator, Ekal Abhiyan Prakalp running in Bajna area under RSS Ekal Gramotthan, says that tribal girls who do not go to school show interest in skill development. Most of them are interested in sewing, though they are trained in computer operation as well. “At present, 35 women and girls are being trained. This can make them self-reliant and also provide some respite and freedom from household work. Most of the trained persons stitch blouses or other clothes and sell them in the market. However, after marriage, the sequence of skill development breaks,” Gautam says. Kailash Satyarthi Children’s Foundation is working in Bajna block to prevent child marriages. Its block coordinator Shankar Singh Maida says that girls here are generally married at 15-17. “We are administering an oath to parents to not conduct child marriages.” Parmesh Patidar of Vagdhara, an NGO working for the tribal community and agriculture in the area, says, "We have formed Bal Swaraj groups to connect children with all things traditional — be it crops, food or sports. We also raise awareness on menstrual hygiene and where to get pads from. We advocate self-employment measures, which include saving seeds at local level, growing fruits and vegetables at home and consuming them. We also make girls aware of their rights." Are girls aware of the programmes being run for them? NGO workers disseminate such information, but most of the tribal girls say that they do not have time left to attend such programmes and develop their own skills.   A girl cooking while studying (Photo - Laxmikanta Joshi, 101Reporters)Madhya Pradesh government encourages self-employment through Deendayal Antyodaya Yojana-National Rural Livelihood Mission, through which a woman of Hevdadama Kalan has started poultry farming. However, despite several NGOs operating in the place, skill development is not up to mark.  Cover Photo - Girls on the tree after recess in the school premises (Laxmikanta Joshi, 101Reporters)

Ratlam's risky rides: The struggle for safe commute to remote villages

In the absence of public bus service to the remote villages of Ratlam, commuters are forced to rely on overloaded autos, vans and unregulated private buses to reach their destinationsRatlam, Madhya Pradesh: The sight of women from the Bhil community sitting on the rooftop of an overloaded van — hanging on to their luggage and dear life as the van ascends the hilly roads — is pretty common on the 50 km stretch of the Ratlam-Shivgarh-Bajna road, traversing a predominantly tribal area bordering Rajasthan.An old joke about an RTO officer telling an auto-driver that he will not levy a fine on him if he shows how he managed to accommodate 20 passengers in a seven-seater auto still makes residents of Ratlam laugh, even as they live this reality every day.The roads are damaged and steep, and covering 50 km takes over two hours. The private bus service that starts at nine in the morning ceases after five pm, the two villages of Bajna and Shivgarh being the last stops.Those who live in the villages farther away have to rely on the overloaded autos and vans. This includes government and private employees who have to commute to and from Ratlam every day for work. The hilly, potholed roads are frequented by these overloaded vehicles many times a day. Everyone, including women and children, boards these crammed autos, some sitting in the trunk while others even climb atop the mini-vans and sit on the luggage racks on the roof.Ahtesham Ansari, a supervisor with the Women and Child Development Department in Ratlam, commutes to Bajna to oversee the functioning of the village anganwadis every day. She catches the bus at nine in the morning, reaching the village a little before noon.She tries finishing off her work before five in the evening to take the last bus home.“This is a remote area so I cannot miss the five o’clock bus, else I have to shell out over Rs 2,000 to book a private cab or take the crammed autos or vans, which do not look safe,” she says.Capitalising on the situation, autos charge arbitrary prices whereas bus charges are capped at Rs 50.“When I have to go to the centres beyond Bajna, where the buses don't go, I have to pay Rs 100 per trip to the shared autos, even though the other villages are less than 10 km away. The anganwadi workers based in Bajna prefer to travel to these centres in the remote villages riding pillion on their husbands’ motorcycles as it is more economical for them,” Ansari adds.A worker commuting her daily up-down routine on the bus (Photo - S R Pareek, 101Reporters)Hakru, a resident of Kelkachh — the last village in Ratlam before the state border with Rajasthan — goes to Bajna to work as a daily wage labourer. To catch the bus to Bajna, she commutes to Gadkhange Mata area, 13 km away by a shared auto, and then boards another one to Bajna, 20 km away.“There are only two buses on this route and the ticket costs Rs 30. But we travel in the shared auto, even though it is crowded, as we can bargain with the drivers. When they see we are labourers, they charge us less. But in the bus, even if the fare is two rupees short, the conductor asks us to get off,” says Geni Bai, his wife.“Besides, the bus drops us at Bajna and we have to take another auto or van to reach the village where we find work. These shared vehicles drop us to the exact destination, eight or 10 km beyond Bajna,” adds Hakru.Also, some commuters even prefer these crowded vans and autos as they can ask the drivers to stop or slow down at random locations so they can spit out their gutka — a luxury they do not get while on the bus.The situation is even more challenging for the residents of 24 villages lying on the other side of the Mahi River. Residents in the dhanis (small cluster of houses) of Raipada and Jholi Chandragarh panchayat rely on boats to cross the river, and then catch shared vehicles to reach Bajna, from where they can avail of the private bus service. The lack of a bridge over the river makes the situation more challenging as boats are the only sources of commute to the other side. Paying Rs 10 for the boat ride and Rs 20 or above for the van, Anganwadi worker Kavita Dodiar says that it takes her around two hours to travel 15 km to Bajna. The boat ride from Raipada to reach Bajna (Photo - S R Pareek, 101Reporters)Raipada Gram Panchayat Secretary Babulal says that the Setu Nigam (Madhya Pradesh Rajya Setu Nirman Nigam Ltd) has sent a Rs 30 crore proposal for the construction of a bridge across the river but it is yet to be approved by the state government.No check on dilapidated busesAs per RTO records, over 20 private buses ply this route but the actual number is close to 35 as private bus operators run more buses than they are permitted to. There is no one to keep a check. Besides, there is no public transport on this route. The buses on this route are in a dilapidated condition and, according to locals, they do not even have fitness certificates. Running on hilly, uneven roads, these shabby buses pose a considerable risk to the safety of the passengers. Instances where passengers are asked to push the bus to the side of the road after a breakdown are pretty common here. According to sources, there have been over a dozen incidents of breakdown this year alone. In the last four years, three major accidents have taken place where buses have overturned and landed in a ditch, though there were no casualties.“It is not like the department and officials responsible for this are not aware. The district administration turns a blind eye to the issues barring once or twice a year when there is a state-level campaign. They confiscate some buses and levy fines on the drivers or the bus operators for the public eye and things go back to normal once the buzz dies out,” said a local of Bajna village on condition of anonymity.He adds that the overloaded autos and vans pass in front of the police station every day but no police personnel ever bothers to intervene.Speaking to 101Reporters, Ratlam District Transport Officer Deepak Manjhi said the Regional Transport Office (RTO) had confiscated and cancelled the license of seven buses on this route that were no longer fit for use.“There is a shortage of staff here at the district office as there are just two people — me and a clerk — who manage everything from licence tests to renewal of licences and registrations etc. This makes it difficult for us to keep a tab on the situation and spare time to go out on the field for an inspection,” he says.He adds that while the route was unserviceable these run-down buses and overloaded vans are the only way residents of the remote villages could commute to work.“The proposal for transportation prepared by the gram panchayat has to be approved by the government as many private operators do not want to operate buses on these routes given the shabby conditions. We cannot start cancelling the bus licenses unless there are alternatives in place,” he says.Speaking about the allocation of routes to private bus operators, Manjhi explains that usually Panchayats, after assessing the demand from their constituents, send a proposal to the Zilla Panchayat which is then passed on the RTO. While the RTO may issue permits and allocate these routes to private operators, they may still refuse to ply these routes if the roads are bad or there aren’t enough passengers, he says. Further complicating the matter, it has emerged that certain groups of auto/van drivers may even pay off private bus operators so they can monopolise transport options along that route. Edited by Shuchita JhaCover Photo - Overloaded vehicle on the streets of Ratlam (Photo - S R Pareek, 101Reporters)

Ailing hospitals: No doctors, medicines in Ratlam’s AYUSH hospitals

Most village centres are run by one or two staff members; some housed in old buildings with leaky roofs  Ratlam, Madhya Pradesh: Sunita Patidar of Jaora town believes that regular intake of kadha (a herbal decoction) has kept her out of harm’s way when COVID-19 peaked. So impressed was she with the medication that she decided to rely only on ayurveda for any future treatment.So when she developed a cold and cough a few days ago, she headed to the AYUSH hospital in Jaora, located 30 km from Ratlam district headquarters, in hope of getting some relief. Much to her dismay, neither the doctor nor the compounder was present. Two days later, she managed to meet the compounder, who informed her that medicines were not available. She had to return empty-handed, still sick and coughing.As many as 39 AYUSH centres are present in Ratlam district, but most of them function in the same fashion as the hospital in Jaora does. In the state Budget for 2023-24, a total of Rs 342 crore was allocated for AYUSH hospitals and dispensaries. One look at any of the centres in Ratlam, and it becomes difficult to understand where all the money is going! ‘Fully-functional’ clinics are locked up or ‘ailing’, when the core idea of establishing them under the Central government’s National AYUSH Mission (NAM) is to promote and develop traditional systems of medicine and healthcare, including ayurveda, yoga and naturopathy, unani, siddha and homeopathy. Compounder keeps dispensary afloatA compounder runs the AYUSH hospital in Jaora from a nearly 80-year-old building that leaks when it rains. The place has a musty smell and the frayed wires keep one in permanent fear of fire and electric shock.When 101Reporters visited the place, around 10 patients were at the hospital. As expected, the compounder attended to them one by one. She is the one and only person who works here, though the hospital has two sanctioned posts of doctors to cater to a population of 75,000 in the Jaora Assembly constituency.  Two sanctioned posts of women AYUSH health workers also remain vacant with one transferred and the other attached to the Collector’s office. There are two chemists at the dispensary, sitting before the empty shelves awaiting medicine stocks that never arrive.District AYUSH Officer Dr Balraj Singh Chauhan admits to 101Reporters that compounder Anita Vyas only treats the patients coming to Jaora hospital. “Yes, there is a shortage of doctors. But the compounder consults with the district doctors before giving medicines,” he claims.A medical compounder is like an assistant to a doctor with practical knowledge of dispensing drugs. They are health professionals, but do not have the power to prescribe medicines. Meanwhile, the patients treated by Vyas claim they have never seen her consult any doctor!As many as 39 AYUSH centres are present in Ratlam district, but most of them are locked up or ailing (Photos - SR Pareek, 101Reporters)Likewise, the AYUSH Department-run Ayurveda hospital in Hatnara village of Ratlam is also dependent on the compounder. “The hospital has approved posts of a doctor, compounder, women health workers, pharmacist and a part-time sweeper. Of them, doctor and health worker posts are lying vacant,” compounder Anil Mehta tells 101Reporters.The building is in such bad shape that the hospital now operates from two rooms of a village school, after the panchayat took necessary steps to shift the facility.   Having a building, however, does not mean everything will operate smoothly. When this reporter visited another dispensary in Nagra village, located five km from Ratlam city, it was empty.A woman rushed in after 15 to 20 minutes, saying she was in charge of cleaning. Two gunny bags found lying inside the dispensary had medicines in them. Those responsible for maintaining the stock had not even opened and sorted them. On the other hand, patients perennially complain about the drug shortage in this dispensary.As per the records, a doctor, compounder and chemist were appointed here. The out-patient department register did not have any entries after March 29, the last record was about the visit of 13 patients to the dispensary. Surja Ram, a villager, claims that doctors and compounders are mostly unavailable.37 needed, just seven availableAt present, only seven ayurveda doctors work under the AYUSH Department in Ratlam district against the sanctioned 34 posts. Similarly, only five of the total seven community health officers are in service.“We will appoint more doctors across the state soon. The recruitment process to select 710 doctors is on,” said Dr Chauhan, when asked about this severe staff shortage.During a recent visit to Ratlam district for audit purposes, Divisional AYUSH Officer Jyoti Panchal had ordered that drugs should not be dispensed without consulting a doctor. Ironically, most of the dispensaries in the district — Khajuri Deora, Semliya, Madhopur, Asawati, Upalai, Naugaon Kala, Riyawan, Rattagarh Kheda, Umran, Malwasa, Birmawal, Talod and Kelkachh, to name a few — are run by Class IV employees who do not have the authority to prescribe medicines.Patients perennially complain about the drug shortage in the dispensary and drugs that do come are not sorted and stored properly (Photos - SR Pareek, 101Reporters)“The district AYUSH officer says if the patients are not treated, then class IV will not get any salary. If we give medicines, action will be taken against us. If we do not, then also our fate remains the same. The shortage of doctors is really affecting us,” a Class IV employee tells 101Reporters on condition of anonymity.Budget allocation  The AYUSH Department does not seem to be in need of funds, if the state Budget announcement is taken into account. Of the total Rs 5,608.63 lakh provided under the NAM in 2020-21, the government spent over 90% (Rs 5,142.49 lakh). Of the Rs 3,123.80 lakh sanctioned in 2021-22, Rs 2,575.19 were utilised. The allocation rose to Rs 11,441.78 lakh in 2022-23, of which 82% was utilised. Ratlam district too allocates a quarterly budget for the AYUSH Department. Recently, the department organised special camps for women, with a set budget of Rs 40,000 per camp.Not just the local dispensaries, even the AYUSH wing in Ratlam city has been sequestered in such a way that most of the patients are unaware of its existence.Edited by Tanya ShrivastavaCover photo - The AYUSH Department-run Ayurveda hospital in Hatnara village of Ratlam is in such bad shape that the panchayat shifted the hospital to two rooms in the village school (Photo - SR Pareek, 101Reporteres)

Ratlam farmers still await insurance payouts for crop loss incurred years ago

Their inability to properly follow directives, official apathy and issues in bank payments have made the Pradhan Mantri Fasal Bima Yojana an inconvenienceRatlam, Madhya Pradesh: In 2018, when heavy rains destroyed his soybean crops, Sunil Patidar of Shivpur was not worried as he had insured his crops under the Pradhan Mantri Fasal Bima Yojana (PMFBY). He filed for mid-seasonal crop loss claim immediately, expecting to use the money for the next crop cycle. Four years on, he still awaits the insurance amount.“I had taken a loan to sow soybean on my six bighas, but rains destroyed everything. The Patwari (revenue officer) surveyed the place and sent a report to the insurance company. Subsequently, my compensation of Rs 4,500 per bigha was approved. In total, I was to receive Rs 27,000,” Sunil tells 101Reporters.Everything was in order, but the ICICI Bank allegedly misnamed Shivpur village as Sevria while submitting the claims information to the insurance company. Result: Sunil is yet to receive his money.“The input cost of my soybean crop was around Rs 5,500 per bigha, but the insurance amount will barely cover it,” laments Sunil, who has moved the consumer court in Ratlam to get the insured amount. “They keep asking us what the compensation was for when there was no loss in Sevria,” he adds.For Ramesh Patel of Dhamedi village in Ratlam, the payout for 2018 crop loss came to his bank account. But when it came to 2019 crop loss, the insurance company said the claim amount will be deposited only in the account of the land owner. “Our family owns a total of 35 bighas in the names of my wife and father Badrilal. When the insurance claim for 2019 was processed, my father’s Aadhaar number linked to his bank account was used. The claims money was apparently sent to his ICICI Bank account, but it was returned as the account was blocked due to KYC non-compliance,” says Ramesh.Completely damaged soybean crop in Dharod (left) and Piploda (right). (Images sourced by SR Pareek)"Now, I have opened a joint account with my father to avoid further delays," he says.Speaking on the issue, ICICI Bank's Ratlam branch manager Satyanarayan Dangi tells 101Reporters that the land belonged to Badrilal, but the premium was deducted from Ramesh's account. "In the first place, the insurance company should tell why it deducted money from Ramesh's account. Not just that, Ramesh's name is registered as Rameshchandra Patidar with the bank. We can give compensation only to the bank account of the land owner, so the matter got stuck at our Ratlam head office. Their new account is now ready, so I will release the money in two to three days."Ramesh, who has also not received the insurance payout for crop loss in 22 bighas for the year 2020, says he initially hoped to sell his small stock of soybean spared by rains for a higher price later. However, due to the non-receipt of the claim amount, he had to sell it at a low price for arranging seeds and fertilisers for the next crop cycle. “Otherwise, jewellery would have to be mortgaged with the moneylender at high interest rates.”According to reports, 38 complaints related to the 2020 kharif season remain unresolved till date.How PMFBY worksLaunched by Prime Minister Narendra Modi on January 13, 2016, the scheme aimed at reducing the insurance premium burden on farmers who take loans for their crops, besides protecting them from the vagaries of weather.A uniform premium of only 2% for all kharif crops and 1.5% for all rabi crops will be paid by the farmers and the remaining premium will be paid by the government, so that the farmers are provided the full sum insured for crop loss in the case of natural calamities. There is no upper limit on government subsidies. Even if the remaining premium is 90%, it will be borne by the government.The PM-FBY website serves as a one-stop platform for all stakeholders of the insurance scheme — farmers, insurance companies, banks.Premiums are automatically deducted from farmers’ bank accounts and non-loanee farmers pay them in cash. Farmers can inform the insurance company on its toll-free number when they incur losses due to unseasonal weather. The company then will send a representative to the site for damage assessment and filling up of an intimation form. Patwari is also expected to be present at the site. Based on the uploaded form, the compensation amount is processed.According to guidelines, after receiving the claim amount from the respective insurance company, the financial institution/bank should transfer the claim amount to the beneficiary account within a week. A farmer getting insurance payout on time is dependent on every official completing his/her task properly at every step. Poor management, negligence of officials and lack of accountability have all led to the insurance scheme becoming an inconvenience. Farmers complain that they do not get the desired response from the insurance firm. They also claim there is no official at the local level to help them. Online submission is an insurmountable barrier for many.Most farmers in the district resorted to the CM helpline number to air their grievances. There are several farmers who got the amounts two to three years later. Manvendra Rajendrasinh Jodha from Lunera got Rs 5.20 lakh this year for the crop loss he suffered in 2020. Similarly, Rahul Mohan Patel of Dharad received Rs 90,000 in May for the 2020 loss. All these involved persistent lodging of complaints with both the CM helpline and agriculture department.Farmers of Ratlam district with their damaged crops (Images sourced by SR Pareek)Delay in surveys, portal entryFarmers complain that crop loss surveys are not conducted on time. Often, there is a delay in updating information on the insurance portal also. “Floods damaged my soybean crops. Patwari came on time to survey the loss, but the insurance company employee did not reach out for verification. I complained to the tehsildar and he contacted the insurance company. Subsequently, an employee came and assured me that verification will happen soon. Fifteen days have passed, nothing has happened,” says Rameshwar Lal of Sejavda village in Ratlam district.Banshilal Patidar of Bhimkheda village says banks are the main cause of contention. “They neither update Aadhaar nor share information with farmers on time. They also delay uploading of information online.” However, Mahendra Singh Dhanpal and Shantilal, both from Alot Tehsil, say they were inconvenienced by the agriculture department staff’s action of delaying online entry of claims.“We staged a dharna at the Collectorate under the banner of Bhartiya Kisan Sangh. That did get us an extension in 2020 from March 1 to March 10 to make online portal entry. But even then, the insurance amount was not received,” the farmers say.Since they are transferred every two years, the bank officials in question could not be reached for comments. Meanwhile, Vijay Chaurasia, Deputy Director, Agriculture Department, says, “After the banks deduct premium amounts, the information has to be uploaded on the Union government’s portal. If not done, the claims cannot be processed.”Acknowledging that 38 farmers in the district have lodged a complaint with the CM helpline, he says the amounts were not received mostly due to closure of bank accounts. “In such cases, banks return the amount to the insurance company. We are making efforts to get the money back.”Loss in soybean crop in Ambah, Madhya Pradesh. (Image sourced by SR Pareek)Errors and negligence have led to many farmers opting out of the PMFBY. In 2021, 1,58,229 farmers got their crops insured, but the numbers dropped to 1,42,476 in 2022. To this, Chaurasia says they have decided to solve issues that farmers face with insurance by holding workshops from time to time. A kisan rath will also be taken out through villages to exhort people to adopt Fasal Bima Yojana. Farmers, however, say there is a need to decentralise the functioning of insurance companies by launching offices or help centres at the local level.Edited by Tanya ShrivastavaThe cover image is of crop damage assessment being carried out by insurance company officials and patwari in Birmawal village of Ratlam.

Ailing PHC: No place for institutional deliveries in this MP village

The PHC in Sukheda used to conduct 20 deliveries a month almost three years ago, but has no trained staff to deal with such cases now. Vacant posts, lack of trained staff force pregnant women to travel 60 km for medical aid Ratlam, Madhya Pradesh: Sukheda Primary Health Centre (PHC) in Ratlam's Piploda block stands for everything that is wrong with the rural healthcare services in Madhya Pradesh. The six-bedded PHC, which used to manage 15 to 20 deliveries a month almost three years ago, sees none at present, all thanks to the transfer of the lone trained Auxiliary Nurse Midwife (ANM) in 2019.Now, the village women have to travel 60 km to the district headquarters, or 20 km to Jwara or Piploda villages for even basic healthcare. Sukheda has a population of almost 7,000.Anita (26) of Sukheda shivered as she relived the ordeal she underwent before her second child’s delivery. “I was in the eighth month of my pregnancy. One evening, I suddenly began to experience pain. My family members got worried, and they rushed me to Sukheda PHC. Much to our dismay, the staff there redirected us to Ratlam citing lack of facilities.”“I was in extreme pain. Though my family repeatedly called 108 ambulance to take me to Ratlam, the service was not available. They then began to frantically search for a private vehicle. Finally, we got one for Rs 2,000, and just as we crossed 10 km, the baby came out. We then decided to return home,” Anita told 101Reporters.The old Primary Health Centre at Sukheda (Photo: SR Pareek)Essential services missingMedical services at Sukheda PHC are in a disarray not just due to the lack of trained ANMs. The posts of lab technician, pharmacist and male supervisor are also empty at present. In short, lab machines are useless as no tests can be done in the absence of trained manpower. Even something as common as medicine for high blood pressure is mostly unavailable here.As per the National Health Mission guidelines, outpatient department service, 24-hour emergency, inpatient service, antenatal and postnatal care, newborn care, medical termination of pregnancies, laundry and food services for indoor patients are among the essential services that the PHC should offer. However, Sukheda PHC does not have even a provision for food supply!A source linked to the PHC said that food was not being provided as the PHC saw no deliveries. “No delivery means no admission. For those who come to get small ailments treated, hospitalisation is not prescribed. That explains the non-availability of meals,” she explained. The PHC does wash bed sheets and covers regularly, for which it gets funds from the patient welfare committee.Sukheda PHC got its medical officer only a month ago, after a gap of one year. Talking to 101Reporters, Medical Officer Dr Seema Chouhdari said, “It is true that women have to travel 20 km to Piploda community health centre (CHC). I have already notified my senior officials about the issues affecting the PHC’s functioning, though I have taken charge here only a month ago. I have been told that an ANM will be appointed soon, which may help restart delivery services here.”Sukheda has two ANMs at present, but they are not trained in dealing with deliveries. One of them is under training for maternity care at Piploda CHC. As of now, the PHC is handling vaccinations, intravenous therapy, and treatment of viral and seasonal diseases. According to Dr Seema, about 55 pregnant women coming under Sukheda PHC limits now depend on Jwara and Piploda health centres.The new Primary Health Centre at Sukheda (Photo: SR Pareek)While many village women are anaemic, five have low haemoglobin count. All of them have to go to Piploda to get iron injections. As per the National Family Health Survey (NFHS-5), 7.9% of women in Ratlam district need medication for BP. They also have to rely on Jwara and Piploda centres.It is the same case with family planning advice and services. Parvati (36) (name changed) and her husband had visited the PHC seeking family planning information, but were redirected to Piploda. "Considering the distance and time to commute, we decided not to go there for a vasectomy."The condition of the washrooms in the PHC is beyond unhygienic (Photo: SR Pareek)Officials feign ignoranceFormer medical officer Dr RC Verma claimed the facilities were satisfactory during his tenure. “Now, almost 20% of pregnant women prefer to go to private hospitals," he said, adding that a trained ANM’s presence was crucial to ensure the PHC’s functioning.“Patients and their families bear the brunt of staff crunch. We are ready to support the health department to improve the situation. But they have to start first,” said sarpanch Mahavir Mehta.Claiming that he was unaware of the situation on the ground, MLA Dr Rajendra Pandey assured of action after speaking to the health officials concerned. Block Medical Officer Dr Yogendra Gamad said except for a trained ANM, Sukheda had all facilities. He, however, refused to comment on the non-functioning of the lab. “Soon more resources and trained ANMs will be appointed,” he said. Edited by Tanya Shrivastava

To-be mothers wilt as water crisis worsens in Madhya Pradesh’s Ratlam

The problem impacts everyone but is more personal for pregnant women, who are mostly anaemic and distressed.Ratlam, Madhya Pradesh: Parvati Parmar goes out to fetch water three times a day — and it is just enough to meet the daily needs of her family of six. In total, she walks around 3km every day, carrying two pots of water from a nearby hand pump every time. Parmar (26) lives in Mangrol village, located 7km from Ratlam in Madhya Pradesh, and is expecting her third child. She has to do the chore regularly, and her two children are always in tow.“If I do not fetch water, work at the household will come to a standstill. Both my in-laws are aged, and my children are three and two years old. After their birth, water consumption in our household increased, and so did my trips to the hand pump,” says Parmar.Pregnant Parvati Parmar walks back after fetching a bucket of water from the handpump near her house in Mongrol, Ratlam, Rajasthan (Photo: SR Pareek)She wakes up at 6 am and rushes to the pump, located 400m from her house. The two pots of water that she brings back are used for activities related to making breakfast and lunch. In the afternoon, she is back at the pump to fetch more for washing clothes. Another trip ensues in the evening for cleaning utensils. If the family needs more water, she takes more trips.Parmar is anxious about the child in her belly. “I get tired easily, and my body is weak. There were no complications when the first two were born. But this time, I was told during a check-up at the Anganwadi centre that I am anaemic.”Sometimes, she has to stop to catch a breath midway; sometimes, she takes a break at the hand pump to gain her strength before starting her walk back home.Bearing the bruntNot only Mangrol, other villages and development blocks — Dharad, Sailana, Bodina, Bajna and Dhabaipada, to name a few —  in Ratlam district have the same story to tell.According to Urmila Pal, an auxiliary nurse midwife (ANM), around 200 women go through pregnancy annually in Dharad. Of them, 80% are anaemic.In rural Ratlam, pregnant women are over-burdened by the monotonous task of fetching water (Photo: SR Pareek)In Mangrol, for example, 20 anaemic women walk to hand pumps, and queue up for two to three hours to fetch water. This, when pregnant women, especially in the first trimester, are advised against carrying heavy loads.Satyendra Rajavat, the medical officer at Dharad’s primary health centre, however, does not see it as a problem. He says a pregnant woman may find it difficult to fetch water, but it still serves as an exercise.“If she has to carry around five litres of water every day, it is not that much of a problem. Pregnant women need to be cautious during the first trimester, but they are also advised to exercise regularly,” says Rajavat, while warning that lifting more than 50kg elevates the risk of a miscarriage.ANM Pal, however, says carrying heavy pails of water every day, while not getting enough rest and nutrition, exposes women to an array of pregnancy-related complications.Rest and relaxation, a luxuryRanu (25) from Bodina had to walk to a nearby tube well every day to get water, while also taking care of her family and performing daily chores. She suffered a miscarriage, according to accredited social health activist (ASHA) worker Madhu Goyal.Another pregnant woman in the village, Kajal Nat’s haemoglobin has never gone beyond 9 gm/dL, despite taking iron tablets and injections. Her doctor has advised rest, but she still walks to the hand pump, though takes multiple breaks.But neither Nat nor others have the luxury of rest. It is more important to quench the thirst of the families than to worry about probabilities.Bodina ANM Sudha Rathore says neither illness nor pregnancy stops these women from doing their daily chores. Many women are taking care of the households alone as their husbands are out-of-station for work.While richer families have tube wells, the marginalised women continue to bear the brunt. The scourge of malnourishment“It is my responsibility to ensure their well-being. But I can only do so much with the unavailability of basic resources like water. Even if you tell them not to, they will have to walk and exert themselves to fetch water. I still try to spread awareness on the importance of proper rest and care,” says Goyal.The health indicators of women in the district are poor and, on top of that, there is a lack of basic awareness. “They do not boil water or strain it before drinking,” she informs, adding that most women in the village have low haemoglobin levels, which tamper with the body’s immune system and make them more susceptible to diseases.In addition to the distance-induced troubles, women are also bound to consume the flouride-contaminated water, worsening their hemoglobin levels (Photo: SR Pareek)Bodina’s ASHA worker Sangita says most among the 12 pregnant women and four breastfeeding mothers who registered last month at the Anganwadi centre have low haemoglobin.Social worker and gynaecologist Padma Shri Leela Joshi, who has been working for women’s health for the past 30 years, says, “There is no direct link between water crisis and malnourishment. But, a pregnant woman walking long distances for water, that too in an anaemic condition, is definitely not right for her body.”Professor Rekha Gupta, a gynaecologist at Ratlam Medical College, states that 80% of the outpatient women are anaemic. As per the National Family Health Survey, 77.2% of children in the four to 59 months age group are stressed due to low haemoglobin. Also, 72.7% of pregnant women are anaemic in rural Ratlam.Cascading effects of stressIn addition to physical stress, women facing water crisis also face mental stress. Result: hypertension, blood sugar and blood pressure are common ailments among them, which is more harmful to would-be mothers.NFHS-5 conducted in Ratlam district found that 7.4% of the participating rural women had high blood sugar.Also Read: So near, yet so far: Village near nature’s cradle Kokernag suffers without waterIn addition, excess fluoride content in water triggers bone-related diseases and anaemia in Ratlam. As per the standard specifications, fluoride content in drinking water should range from 1 to 1.5 mg/l. However, in Bajna and Sailana development blocks, it is 8 to 9 mg/l. Not just Ratlam, another 43 districts in the state have recorded high fluoride content.Dharad gram panchayat secretary Jeetendra Singh Chouhan says only 35 to 40 out of the 110 hand pumps are functional in the village.While acknowledging the crisis, sarpanch Vijay Kunwar Rathod maintains that the panchayat polls have just concluded and “the newly-appointed team will ensure that water crisis does not hit us in the coming summer”.“Though tube wells were installed in Rateetlai, Nyaykheda and Nyaypura, in addition to six new hand pumps, water problem got aggravated as the former stopped functioning,” claims Dinesh Gehlot, the former sarpanch of Dharad.In Sailana development block’s Bodina village, efforts to bring tap water were made twice, and lakhs of rupees were spent, but in vain. “Now, we are forced to fetch water from Sailana,” rues Kanhaiyalal Patidar, a villager.Earlier, a well was dug and a supply pipeline of one km length was laid under an irrigation project. Now, under the Jal Jeevan Mission, projects worth Rs 1.56 crore have been okayed, work for which is presently on.Bodina’s sarpanch Badri Meena exudes confidence that the water crisis would end once the pipeline installation is complete.Edited by Tanya ShrivastavaThe cover image is of Parvati Parmar, who is pregnant and anaemic but is forced to fetch water multiple times in a day from a handpump 400 metres away from her house, captured by SR Pareek.

High accident rate, no emergency care: Madhya Pradesh healthcare reels from insufficient facilities

Pregnant women, children and critical accident victims in Ratlam endure substandard health centres that desperately need a facelift.Ratlam, Madhya Pradesh: "June 10 was a dreadful day for us. My nephew, niece and daughter-in-law were injured in a bus accident at Dudh Talai, near Nipania village. We frantically dialled 108 for an ambulance, but none were available. Hours later, we finally managed to rent a private vehicle for Rs5,000 and took them to Ratlam. But my niece Maya Bai (26) died due to excessive bleeding," says Badrilal, a resident of Palasia village, breaking down as he recounts his family's horrendous ordeal.Abysmal health centres with inadequate testing facilities, shortage of medicines and non-existent ambulance services are the bane of many villages in the district of Ratlam in Madhya Pradesh.Four accidents a week, zero paramedic assistanceThe Lebad-Nayagaon four-lane national highway became an accident-prone zone due to heavy traffic density, since train connectivity in Indore, Ujjain, Ratlam, Jaora and other parts of northern Madhya Pradesh were affected due to the pandemic. There are three to four accidents on the highway weekly; yet, there's  no arrangement to rush the injured to nearby Primary Health Centres (PHC). In most situations, they are referred to the district hospital. Piling onto the misery of the accident victims is the near 15km to 50km distance between ambulance services and the healthcare centres. For instance, ambulances are 30km from the Kalukheda PHC, 25km from the Birmaval and Berda PHCs, and 35km from the Bajna Community Health Centre (CHC). Recently, Chief Medical and Health Officer of Ratlam Dr Prabhakar Nanaware wrote to the mission director of the National Health Mission in Bhopal to take some positive action.  (Above) A lab in Kharwa Kalan, Ratlam, Madhya Pradesh lies vacant. (Below) The Primary Health Centre (PHC) in Birmawal village, now a Community Health Centre (CHC) has just 6 beds at the moment. Inadequate amenities, lack of trained medical personnelThe CHC in Kharwa Kalan village, built on an exorbitant budget, lacks even the most basic facilities. This centre is the only government hospital in the vicinity, and the people of 25 villages and dhanis depend on it for all their health needs. However, there's neither a doctor to take up the sanctioned post nor a competent testing facility here. Ironically, even though an ambulance was procured through the MLA fund, a driver and diesel fuel were denied due to lack of funds. There's no X-ray or ultrasound machine here either.Kharwa Kalan, a shorter route to Indore and other cities, sees more than average traffic, resulting in more road accidents. The CHC, however, is only equipped to provide first-aid as there are no ICU wards for critically-ill patients. The hospital also has a solar panel worth around Rs40 lakh for electricity purposes, but it remains unused."A total of 26 ambulances are approved in Ratlam district. Of these, 11 vehicles are under 108 and 15 vehicles are under Janani Express. Now, 21 more ambulances have been demanded. For the ambulance bought from the MLA fund, a driver and diesel were not arranged due to lack of budget. We've instructed the transfer of seven such ambulances from 108 call centres to Kharwakalan," says Dr Nanaware.The PHC in Birmawal village, about 40km from the Ratlam district headquarters, which was only a six-bed hospital, was recently upgraded to a CHC. A separate building is under construction near the existing structure. Here, Kiran, a nursing staff, told 101Reporters, "This PHC has the highest inflow of women, who come in for antenatal consultations. On average, we see more than 500 patients every month. Anaemia is a common complaint. Iron is administered through injections if the haemoglobin level is above 7mg. But if the levels are below 7mg, then blood transfusions are required. We have no choice but to refer the patients to another health centre as we are ill-equipped for such treatments." "Earlier, the blood tests were done here in the lab. But after the lab technician was transferred, the testing equipment was put away and locked up. A technician from another PHC visits our centre every three days and takes samples. The reports take another three days. This defeats the purpose of an emergency healthcare centre, as every check-up, test and report has a long waiting period," the nurse explains the state of affairs. There are two vacant posts for doctors, two for operators and sweepers, and one each for a pharmacist, pathologist and ward boy Birmawal. The medical officer here, Dr Rohan Kanthed, says that a letter had been written to the district headquarters regarding the shortage of medical staff and a budget for a driver and diesel for the ambulance. Six doctors were sanctioned, of whom three posts for a surgeon, gynaecologist and paediatrician are still vacant. There are three junior doctors, of whom two are on contract.  (Above) The way to restrooms for Dharad Primary Health Centre (PHC) is loaded with garbage and dirt. (Below) Ambulances without diesel and a driver stand's outside the Kharwa Kalan CHC. (Below) Birmaval has now been upgraded to CHC, a new building is being constructed for CHC in the hospital premises.Pregnant women bear the bruntMany PHCs do not have sonography and diagnostic facilities, leaving women with no choice but to travel 10km to 50km to the district headquarters. Even for prenatal check-ups, patients are forced to travel back and forth to different health centres.There are 27 to 30 sonography centres in the district, including at government and private labs. However, there are only three at the government level. One is in the district hospital at Ratlam, where ultrasounds are conducted daily on 80 to 100 women. There's a waiting period of a week since patients from across the district come here for scans performed free of charge; private centres charge between Rs900 to Rs2,200. The other two government hospitals are in Alot and Jaora, but Alot has no ultrasound machine installed, and Jaora has no radiologist. Therefore, the burden falls on the district hospital."With a population of 37,000, the number of anaemic women and malnourished children in this region is markedly higher than in other areas. Despite these statistics, there are no competent diagnostic facilities available," says Dr Mahendra Singh Panwar, Medical Officer, Bilpank Health Center. "Patients must go to Ratlam, 20km away, for an ultrasound. There's also no gynaecologist or paediatrician available. The lab technician comes to the Dharad, Namli, Birmaval and Bilpank PHCs thrice a week, and the reports are available only when he returns."For the past 23 years, social worker and Padma Shri awardee Dr Leela Joshi has worked for the health of tribal women and girls in Ratlam. She has organised free camps in villages for health checkups and treatment. "Although the problem is prevalent in the whole of Ratlam, women from rural areas are more prone to anaemia," says Dr Joshi. "If they are not given proper medical attention and care during delivery, it puts the health of both the mother and child at risk. One of the main reasons for the number of malnourished children here is that prenatal and postpartum care for mothers is lacking. The situation hasn't improved without proper sonography centres and the absence of gynaecologists and paediatricians.""The affluent somehow find a way to get an ultrasound at private centres, but women of lower means are left to fend for themselves. Sometimes, in villages, women are offered glucose bottles for weakness. This is dangerous, especially during pregnancy, because the likelihood of gestational diabetes increases, affecting the unborn baby's health."Birmaval is on its way to upgrade the original PHC into a CHCHealth centres on paper vs realityA population of 5,000 warrants a sub-health centre. However, in the tribal belt, the limit is 3,000. The government opens PHCs for a population of 20,000 to 30,000, while CHCs are sanctioned for a population of 80,000 to 1.2 lakh.CHCs in Madhya Pradesh have a staff section of 17 members, including five doctors, surgeons, paediatricians, gynaecologists, anaesthesiologists and a medical officer. Yet, most healthcare centres do not have the services of a gynaecologist, paediatrician or anaesthesiologist.  Currently, Ratlam has six CHCs — Namli, Sailana, Bajna, Piploda, Tal and Kharwa Kalan — 24 PHCs and 220 sub-health centres.At present, hopes rest on the formal opening of a CHC in Birmaval. A 30-bed health centre is being set up at the cost of about Rs5.74 crore. Ratlam District Incharge Minister OPS Bhadauria performed the bhoomi pujan on May 17.Edited by Grace Jayanthi