Poor Urban Women Fight for the Right to Reproductive Health

Suguna Solanki is a Bhil tribal anganwadi or creche helper under the Integrated Child Development Scheme of the Government, residing in the Jeet Nagar slum in Indore city in Madhya Pradesh. She is a versatile person as she also works as a part time health worker for an NGO and has along with some other anganwadi workers registered an NGO of their own. When asked what motivated her to become so active she says, “Once, a few years ago, I took a 16 year old unmarried girl from our slum to a quack doctor for an abortion when she was five months pregnant. The quack gave her some potion to drink and also pressed her lower abdomen with his hands continuously and aborted the foetus. Later on after coming home she began bleeding profusely and then we had to be rush her to a government hospital where the doctors removed her uterus and somehow saved her. That made me think that just serving as an anganwadi worker was not enough”. This horrendous incident underlines the following serious obstacles that prevent poor urban slum women in Indore from successfully addressing their reproductive health problems – 1. A taboo on discussing reproductive health problems unless matters go out of control. 2. A taboo on discussing sexuality issues with adolescents leading to unwanted pregnancies among unmarried girls. 3. The lack of access to good and certified reproductive health treatment. The poor women living in slums in Indore have traditionally remained outside the purview of qualified medical help and it has mostly been left to NGOs to deliver what little service they can to them. The most important of such efforts was undertaken by the Urban Health Resource Centre, New Delhi (UHRC) with funding from USAID in collaboration with five local NGOs of Indore from 2003 onwards in 75 slums. The main thrust of this programme named the Environmental Health Programme (EHP) was on involving the community in the access of the government’s reproductive and child health services so as to improve the health of women and children and reduce the infant, child and maternal mortality rates. 87 Community Based Organisations (CBO) were formed in the slums and these were grouped together to form 9 Lead CBOs. Suguna along with a few other anganwari workers from nearby slums like Rekha Patode of Rajeev Gandhi Nagar, Ranjana Gangle of Bhavana Nagar, Urmila Javre of Pavanpuri were trained as para workers in reproductive and child health and given the task of mobilising the communities to seek better health services. Apart from creating reproductive health awareness among the slum women the NGOs also held monthly health camps in which doctors came and did check ups and provided medicines to the women. However, this programme following the general trend in India provided only help for maternal and child health and skirted the larger issue of reproductive and sexual rights of women and the way they are denied due to patrarchy. Rekha said, “Menstrual hygiene is a big problem for poor women as in most cases they wash and use the same cloth and they are not able to dry it properly due to taboos against public display of the cloth. So the cloth has to be dried secretly in the shade and this leads to various infections. Most women complain of white discharges and pelvic inflammation which come from lack of menstrual hygiene.” When the women para workers mooted this problem before their superiors in the NGOs they were gruffly told to ignore it as the solution was not easy. The para workers were frustrated by this rejection but then suddenly a fortuitous turn of events showed them a way out. The UHRC which was the coordinating NGO decreed that these field level health workers should be made to form an NGO of their own so that they would be able to carry on the work even after the project ended. Urmila says, “Seven of us women field workers were grouped together and helped to form and register an NGO by the name of Parivar Sahayog Samiti (PSS) under the Madhya Pradesh Societies Act. We were given training on how to run it and we told the trainer about our desire to work on women’s reproductive rights against the prevailing patriarchy”. The trainer relayed this to the bosses in UHRC and so the monthly health camps were reoriented towards treating gynaecological diseases and a plan was made to supply cheap sanitary napkins to the women. The first monthly camp held on these lines got a tremendous response from the women as for the first time they were properly examined in adequate privacy by gynaecologists and given appropriate medication. The medication helped tremendously as did the use of the sanitary napkins and within a space of three months there was tremendous improvement in the health of the women especially in the cure of white discharge and pelvic inflammation which are a persistent complaint of most poor women. Suguna and her colleagues were very enthused with this success but the happy state of affairs did not last for long. The funding for the EHP stopped in 2009 and their jobs as para health workers came to an end. Simultaneously a male manager in the NGO for which they were working tried to take over their own NGO, PSS, which had some Rs 70,000.00 odd deposited in it from their salaries. They fought with the manager under the leadership of their chairperson Chandrakala Porwal who says, “The manager used to look after the accounts and the administrative paperwork of our NGO and he threatened us that he would get our registration revoked. At first we were scared that all our savings would go but then we got legal opinion from another NGO worker and have taken all the papers and the bank account in our control.” All this just shows how difficult it is for poor women to improve their reproductive health on a sustained basis. Asked as to what they propose to do now Suguna says, “We have heard that someone in Tamil Nadu in South India has invented a cheap sanitary napkin making machine that can be bought for about Rs one lakh and that small NGOs are buying these machines and selling the napkins for as low as Rs one a piece. Lakhs of women have benefited from this already. We will try and get funding from some agency and buy one of these machines and continue our work.”