These women are curbing maternal deaths in Upper Assam

Tinsukia, Assam: Hemanti Dhara Das was severely underweight and anaemic at the time of her pregnancy. Her weight had dropped to 32kg and her haemoglobin level had dipped to 6 gm/dl. While she managed to deliver her baby, she died three months later because of complications arising out of childbirth.Das, who stayed in the Tinsukia district in Assam, is not alone to meet such a cruel fate. Hundreds of women die in Upper Assam every year because of anaemia, blood pressure and malnutrition. In fact, according to the latest National Family Health Survey report, Upper Assam records the highest number of maternal deaths in the country — 229 per 1,00,000 births. This tally is double the national average. But a group of women from 20 villages of Upper Assam are on a mission to save their kind from the clutches of death and promote institutional — and safer — deliveries. Since 2014, their intervention has brought down the number of maternal deaths in these villages from 18 to 2 last year. The instances of home delivery have also reduced from 134 to one in the same period. They are all homemakers, who volunteer in their free time.Attitudes changed, lives savedIt’s the job of the government-affiliated ASHA (Accredited Social Health Activist) workers to supervise the health and hygiene issues in rural India. One ASHA worker is mandated to look after a population of 1,000. But in Upper Assam, “they are more often swamped with work,” says Nitumoni Gogoi, a resident of Nagajan village in the Tinsukia district.That’s why women from the community decided to step up in 2014. They were acting on intervention by Schoolnet, a social organisation that works in the area of health and women empowerment. It had trained female volunteers from 20 villages of the Tinsukia and Dibrugarh districts over a week under a CSR program called Arogya. After the training, these women took an exam, post which they were entrusted with the responsibility of tracking the health of pregnant, newlywed and adolescent women in their villages.These women haven’t replaced ASHA workers — they are complementing their efforts. Volunteers such as Gogoi assist the ASHA workers in spreading awareness on women's health and maternal care in her village Nagajan, which has a530 males and 554 females. Nitumoni is responsible for monitoring the health of 14 pregnant women, 38 adolescent girls and 42 children.However, these ‘field workers’ have an advantage over ASHA workers. They are familiar with the women and their families because they live in the same neighbourhood and have known each other for years. Despite this, the unwritten rules of patriarchy that tend to govern women’s bodies and their reproductive rights posed a big challenge for them. They faced resistance every time they tried to recommend vitamin supplements to women. A lot of elderly members, particularly in-laws, in the region believed that the consumption of vitamin tablets and immunisation may complicate the pregnancy. Eating banana flower prevents the birth of twins and other myths are also prevalent here. "In the beginning, it was difficult to convince them. But since we have been interacting with the families for many years now, they listen to our advice now," says Nandita Baideu, a field worker from Tinsukia's Bapuhola village. It also took them some time to drive proper menstrual hygiene practices among young girls and married women — from how to use sanitary pads to how to dispose of them. Either they used to wear the same cloth pad without washing and drying it properly or they would use a store-bought sanitary pad for over 24 hours. These would give rise to vaginal infections and other hygiene-related issues among them. Their intervention spanning nutrition to hygiene has saved the lives of women such as Monisha Manjhi. "My weight was 30kg when I was pregnant. At that time, these women would visit my home regularly and prescribe me tablets and healthy food like colocasia, ferns, moringa leaves, guava and amla.”  Manjhi gave birth to a healthy child in a tea garden hospital last September.360° monitoringGoing door-to-door is one of the many ways how these ‘field workers’ interact with women and their families. They also organise meetings with women and girls to discuss the issues related to anaemia, hygiene, nutrition and pregnancy. These meetups are called ‘Saathiya Club’. These women were trained to become field workers in 2014. Credit: Monika MandalThey also track the health of the children and pregnant women using an app. Nivedita Barathakur, the zonal program head of the Schoolnet initiative informs 101Reporters, “Around 1,467 pregnant women in Tinsukia and 789 in Dibrugarh are constantly monitored by the field workers using an in-house app called Survey CTO. Apart from this, 1,323 children in Tinsukia and 721 in Dibrugarh have been tracked to administer immunisation on time. We have seen exceptional changes [in the health] of these families.”Trouble over tea While these women are doing their bit with full enthusiasm, the challenges ahead of them are multi-dimensional. The high maternal mortality in Upper Assam is a result of a host of financial, historical and cultural reasons.With over 800 tea estates and 1,00,000 smaller tea gardens, Assam is the second largest tea producer in the world after China. Which means, a large population of Upper Assam works in tea estates. The violation of labour rights on these estates, in terms of the lack of water and proper pay, has been widely reported.  This leaves women and girls with poor sanitation facilities and inadequate nutrition, making their growth delicate and pregnancy fragile.Add to this, the tea workers drink saltwater and salty tea, locally called nimok sah, multiple times a day to fight lethargy and dehydration. This habit was introduced by the British and has been detrimental to the health of the tea-farming communities. “As a result, high blood pressure, abnormal haemoglobin levels and weight loss are common in this region. During pregnancy, the problem of hypertension and anaemia aggravates,” says Sumi Dowarah, who’s a project consultant with the said social organisation. So acute is the salt tea-drinking habit that the Assam government in its 2019-20 budget had proposed to distribute free sugar to the lakhs of its tea workers to help them transition.

Vulnerable — we were, we are, farmers say as agri bill protest crosses 100 days

MicrosoftInternetExplorer402DocumentNotSpecified7.8 磅Normal01111 New Delhi: It’s now been over a 100 days since farmers across India began protesting the three farm laws. Despite 11 rounds of talks, the government and farmers’ unions are still at a stalemate, with the latter holding onto their demand that the laws be repealed entirely or Minimum Support Price (MSP) be brought in for all crops. While farmers are now fretting over the new legislation, their occupation has been fraught with tension over generations. They have always been exposed to exploitation due to rampant corruption at mandis and by middlemen.Rajesh Madnawat, a farmer from Uttar Pradesh, recalls having faced one such corrupt trader back in 2016. In the summer of that year, he was mighty pleased with his harvest of urad dal, expecting it to fetch him a good price in the market — the crop was going for as much as Rs9,400 per quintal in the state at the time. While the government has specified a MSP for 23 crops, including urad dal, the absence of any legal protection means that the actual prices at which they are sold are determined by market forces. The lack of any buyback commitment for crops other than rice and wheat leads farmers to often take the risk of growing other crops, such as lentils and vegetables. The ever-fluctuating prices, however, leaves them with the hope of earning more when the market supply drops. Madnawat refers to newspaper columns, market indices as well as DD Kisan TV to figure out the right crop type to sow and its price. Back in 2016, he had all reason to be happy about his investment in urad dal. “Fortune was in my favour,” the 55-year-old farmer believed, after harvesting 10 quintals of quality grain from his 3.5 acres in Shekhupur Madan village. He had estimated his produce to earn him some Rs94,000, which he planned to invest in his next crop. But things didn’t go his way — inadvertent reasons delayed his trip to the mandi by three days, and when he finally made it to Navin Galla Mandi in Hathras, 9km from his field, a trader named Umesh Kumar claimed that the price had fallen to Rs7,200 per quintal. Lack of cold storage facilities — a testament to India’s inadequate agricultural infrastructure — and the fear of a further drop in prices forced him to sell his crop then and there and return disappointed and in loss.Rajesh Madnawat owns 3.5 acres of farmland in Shekhupur Madan village in Uttar Pradesh. Source: Rajesh MadnawatA relative later informed Madnawat that lentil prices were still as high as Rs9,500 per quintal at a nearby mandi. The same trader who cheated him told him the next day that urad dal was currently priced at no less than Rs12,500. Madnawat presented the recorded conversation to the mandi sachiv (secretary), who then sent a notice to the trader to summon him. “The trader’s license could have been taken away for what he did but after he visited me at my farm with a group of people — and due to pressure from society — I settled for compensation,” Madnawat says. “Farmers are vulnerable to such traders and are also very busy. It's not possible for us to waste time following dates and hearings or challenge traders,” he adds. ‘Farmer-middleman relationship is complex’While mandis are very convenient for farmers, they are also where they get exploited due to several hidden charges and commissions, explains Ramesh Veluru, who works at the Meghalaya Secretariat as an Agricultural Livelihoods and Rural Development Consultant. “The farmer-middleman relationship is very complex. Arthiyas (middlemen) help farmers in times of need. Banks are not always the feasible option for availing quick loans but we can always turn to arthiyas”, tells Veluru.Navin Galla Mandi in Hathras. Credit: Rajesh MadnawatSuch malpractices are commonplace in Indian markets, leaving destitute farmers with measly income. More than 80 per cent of Indian farmers are small- and medium-scale producers; their monthly income from farm and non-farm activities stands at Rs 6,426. Moreover, the 2016 census found that small and marginal farmers receive lower prices than relatively larger farmers due to a number of issues such as bargaining capacity and social strata, among others. Such is their financial insecurity that it drives them to suicide — a 2019 report by the National Crime Records Bureau found that of the 1,39,123 suicides that year, 10,281 (7.4%) were by farmers. Fear of licence-less middlemenBefore the advent of the much-contested farm laws, every trader at a mandi had to have a licence issued to be able to purchase produce from farmers. But the farm laws have made these licences redundant. Today, anyone with a PAN card can buy a farmer’s crop anywhere.Although Prime Minister Narendra Modi has emphasised numerous times that “MSP will continue, mandis will continue, and private and public mandis can co-exist”, Dr Darshan Pal of the Samyukta Kisan Morcha worries that Agricultural Produce Market Committees — better known as APMCs — will bypass the acts and “ultimately try to end government mandis and bring in private sector monopoly". Pal explains this concern in the context of the healthcare system in India: "Aren't there government hospitals in India? Don’t AIIMS and Fortis hospitals run parallel? What should the government do? They should open more AIIMS.” VM Singh, convenor of the All India Kisan Sangharsh Coordination Committee, says, "Opening the agriculture sector to the free market could prove detrimental for a majority of farmers because of undue pressure from competition and quality of produce that the private sector might seek.”Now, the reason why Madnawat chose to narrate this incident: the new farm legislation doesn’t make the situation any better for farmers. "I don’t know how we can benefit from the new laws since there’s still no price assurance and we are still vulnerable in the market," he says.And his case isn’t exclusive either; there are other such victims in his own village. One Ram Babu Singh complains of not receiving the entire payment while selling his produce. “I often have to wait for a month or two before receiving the full payment," he says. During this period, the interest on his Kisan Credit Card rises, which puts him in debt. Brajesh Kumar, another farmer in Uttar Pradesh, owns 20 bighas. “Two years ago, the MSP of wheat was at Rs1,840. ITC was buying the crop at Rs1,750 but my cousin cheated me by quoting Rs1,550," he recalls. When asked why he didn't lodge a complaint about the fraud, he explains, “Neither does anyone listen to us nor do we really know where to go to complain."Farmers have been protesting against the new farm laws in Delhi for over 100 days now. Source: Kisan Morcha Press RoomIn the absence of adequate farmer organisations and clout of strong trader groups, a conciliation board under a Sub-Divisional Magistrate is an impractical dispute resolution mechanism. “I tried to investigate my case and found a remedy for my troubles but I know other farmers who could never do the same,” says Madnawat, referring to how the trader compensated him fairly after he complained to the mandi sachiv.The Farmers' Produce Trade and Commerce (Promotion and Facilitation) Act now allows cultivators to sell their produce at larger mandis in nearby markets like those of Aligarh, Agra and Mathura. But there’s still valid concern over the prices that the new licence-less traders will set. Lack of awareness and means to check the quality of the produce make the sale of the produce susceptible to insecurity. Though Madnawat believes that the functioning of mandis can be improved by bringing in strict regulations and price assurance.*Lead picture used for representational purpose only