Deep in Drudgery: Women and Health in Uttarakhand..!!

Source Posted by ANON

The consequences of the ever-increasing workload of hill women can be directly witnessed in their declining health status. They tend to suffer in isolation and become accustomed to several of their physical complications. But, on unlocking their silence, immense ordeal regarding their health conditions is revealed, in addition to the mental affliction they have been undergoing timidly. In Uttarakhand, women of varied ages undertake severe physical work in the coarse environment of the mountains. Besides, the cultural conditions have created a biased ambience, which has made women to fail to realize their basic rights.In spite of undertaking hard physical work, a hill woman’s intake of food is always low and less nutritious. The food intake is never balanced to her energy spent on daily activities. Anaemic cases in the hills are found at every other step. Stressful work has also led to muscle pain, back pain, foot pain etc and has severely affected their reproductive health (this will be discussed later). The specific health risks occurring due to women-related work include respiratory problems due to long hours spent indoors on cooking with fuel wood; sore and pain in the hips, shoulders and legs for carrying heavy loads of fodder and water; and bearing infections while working at unclean cowsheds – the tradition of girls sleeping in cowsheds during menstruation is commonly found in the hills.Examining the social aspects of women’s drudgery, the situation is found to be far worse from the mental health perspective. Traditionally, women are denied their basic rights and freedom. Special cultural practices such as women washing the feet of the family elders every night overburden them with more work. The issue of violence against women is vastly spread over the hills and the terai region. The most common factor found in all cases of women abuse is liquor and for this reason, women generally identify liquor as their deadly enemy spoiling their family peace and devouring the household economy. Submissive women are beaten up and harassed by dominant alcoholic husbands. Besides, such beatings are regular and, at times, criminally violent. A woman, who has spent all day in undertaking strenuous tasks, indoor as well as outdoor, is mercilessly battered at night. She barely succeeds in protecting her small children from the husband’s abuse, facing damaging consequences on her physical and mental health. Mental stress during times of reproductive period has its irreparable impact on infants and may lead to mortality or psychological setback in later years.Village women have explained the disastrous effects of liquor taking over them and their subsistence economy. The country-made liquor made of chemicals, sugar lumps, toxicants and dirty water of open streams directly harms the health of the person who uses it. Men usually resort to drinking because of personal socio-economic problems and become addicts. They start spending their limited earnings on buying liquor. The household economy falls down and women are burdened with the task of earning income for the survival of their children and themselves. Prevalence of tuberculosis, liver problems and stomach ailments reduce the working capacity of men. The economic situation deteriorates with increased borrowings and landlessness; all taken away by liquor.In the hills and the terai region, girls are married at an age between 14-18 years because people believe in the traditional thinking that a girl’s real home is with her husband and not with her parents; so she is married off as early as possible and sent away to her husband. But the serious impact causing on the reproductive health of these girls is hardly estimated or known. These girls are expected to bear children from the age of 17-18 years onwards to the detriment of putting both mother and child at the threshold of morbidity. The RCH (Reproductive and Child Health) programmes of the government are still lacking behind with elements of quality and outreach. ANMs’ (Auxilliary Nurse Midwives) inaccessibility to remote villages and community’s low awareness on RCH-related issues have denied a greater number of women with the facility to undergo ante-natal care. Anaemia cases have shown no reduction in spite of good distribution of IFA (Iron and Folic) tablets. Village women have a tendency to either throw away these tablets or leave them behind at the subcentre due to dubious reasons that these tablets cause giddiness or headache. The lack of awareness and low-level of information are visible reasons for entertaining such kinds of beliefs. The ANMs’ lack of motivation and poor knowledge dissemination during distribution is responsible for poor information resources of the community.The sweeping number of non-institutional deliveries in Uttarakhand is a compelling issue to be addressed. More than 80% of deliveries are conducted by untrained dais (local name for Traditional Birth Attendants) following age-old methods and practices of labour. The research study has shown that this act is steeped in ignorance, misinformation and superstition and has led to the occurrence of several reproductive health complications including maternal and infant mortality and morbidity. The untrained dais undertake deliveries amidst unhygienic surroundings. The method of forcefully pulling the child out of the womb has made the women suffer from prolapse. Dais are always incapable of handling high-risk deliveries in villages and, during such helpless times, suggest taking the pregnant woman to hospital. Most of the maternal and infant deaths in the hills take place while they are being transported to hospital during delivery times; the distance and inaccessibility issues again emerging at such points. In order to reduce the high infant mortality cases, it is important to address the issue of non-institutional deliveries in a holistic manner.Child immunization practices were found to be low during research. Women usually avoid taking their children to immunization camps or subcentres either because of lack of awareness, no availability of time due to heavy workload, long and inaccessible distance and cultivating of false notions that immunization is harmful to children. Huge drop-outs are seen in rural areas and the maintenance of immunization cards is a mere act of formality, rather than signifying facts on immunization status.Colustrum feeding in the hills is quite low and out of practice. Again, complete absence of post-natal services and prevalence of superstition prevent mothers in providing first milk to infants because “it is dirty and not good to the new born.” Traditional practices such as nobody should take anything eatable offered by a woman soon after delivery is profoundly set in the minds of both men and women.Adoption of family planning methods is mostly done by women. The data in the hills on female sterilisation is high. Men avoid using condoms as they are usually under the influence of alcohol during acts of sex. They do not take up sterilisation because of the prevailing myth that “men work harder and they should not be asked to undergo vasectomy.” This is, though, contradictory to the entire hill scenario, but these very words of assumption have come straight out of women. They think it is justified if men do not follow family planning principles and women bear the burden of it as well. Use of oral pills is low because women believe that they cause headaches. IUD insertion is avoided because there is no follow-up care given at government health centres.Women in the hills have a propensity to take up work within 10-12 days after giving birth to a child. This is just another reason for women suffering from prolapse and other reproductive health problems. The prolapse of uterus is so widespread among women that it can be said that it is one of the major causes for their poor confidence-levels and constant mental stress. This problem keeps interfering with their daily work and it discourages them from going out of the village or being in front of men. Some women hardly know what it is although they complain that “something keeps coming out of the vagina” while they walk or work.They adopt the habit of stopping for a while and putting it back, rather than consulting someone on this due to the fear of facing embarrassment. They fail to seek treatment on this either because there is no lady doctor at the PHC (Primary Health Centre) or the cost of it at a private clinic is very high.The ANM (Auxiliary Nurse Midwife) is hopeless in this matter as she just refers the patient. “We are afraid to go out of the village, so how can we go to hospital. And, by the way, there is no lady doctor at there to look into our problem,” says a woman suffering and representing this problem.Prevalence of reproductive and sexual infections is largely seen in women. This is not only because biologically they are more susceptible to the infections, but also because they do not follow hygienic practices during menstruation. They fail to consult to the doctor at the first stage of the disease and, thus, give way to more complications. High chances of contracting HIV exist when their migrated husbands return back home carrying infections. The socio-cultural norms do not allow them to spend the household economy for their treatment, as a woman’s illness is not a matter of serious concern. Women also end up in hiding these problems and thereby, husbands and in-laws remain insensitive to these severe complications and their consequences.

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