It was the last week of July, 2018. Dalsinghsarai, a block in Samastipur district of Bihar was dealing with a critical issue of maternal and new born deaths. These deaths had instigated a series of investigations like social autopsy, analysis of existing events along with evaluation of the responses by various stakeholders. All this was being done to prevent such future instances by an organisation called Innovators in Health (IIH). It was the organisation’s third year working on Maternal and Newborn health in 48 most vulnerable wards of Dalsinghsarai. The shocking analysis had not disclosed something new but age-old practices prevalent in the region.
Here are some of those, combined with lack of institutional insulation in Dalsinghsarai:
Crisis of Institutionalized Myths and Patriarchy
The major cause of the two maternal deaths was Post-Partum Haemorrhage (PPH)*. Both the women had lost their lives on the way to the closest district governmental hospital in Samastipur. The fact that women have been bearing this fate has a number of reasons. One of the primary reasons is the high prevalence of anemia in the region. Haemoglobin at 9 g/dL points is considered to be a good level in this region when it should be around 13 g/dL. Most women here have an average weight ranging between 35-45 kg during pregnancy barring a handful of outliers touching the 50 kg mark. They have innumerable myths associated with the low haemoglobin and body-weight, like:
- The child will become heavy and huge in case pregnant women eat too much or too many times.
- The child will be thin and unhealthy (showing bones), if supplements are taken regularly.
Owing to the above myths, women eat only twice a day, once early morning and then late in the evening. They don’t even take the Iron and Folic acid tablets during their pregnancy. Consequently, in case of heavy bleeding after delivery, saving their lives is contestable. This is because due to heavy bleeding, the haemoglobin levels dip to even 4 g/dL points. It can also be attributed to a few patriarchal traditions, as follows:
- The women eat in the end, after feeding everybody. With little or no food, they satisfy their hunger.
- In case of excessive weakness, when women confess difficulties to their mothers-in-law, they are coerced to think of this as a generic issue around pregnancy for which they are not taken to the doctors.
- The practise of not eating salt, vegetables, or protein post-partum.
The belittling of such important issues is a product of long existing patriarchal beliefs where not just the men but even elderly women, knowingly and unknowingly, become the torch bearers of inequality. As Ani-Di-Franco rightly said,
“Patriarchy is like the elephant in the room that we don’t talk about, but how could it not affect the planet radically when it’s the superstructure of human society.”
Role of IIH in deinstitutionalising the patriarchal belief systems
At IIH we try to break these barriers through a two-pronged approach. The first amongst these is a door-to-door counselling model. Since, our team consists of people from these villages they have a rapport in their respective communities. Capitalising on this rapport, our team members work hard to convince and push people to identify and break the viciousness of these myths.
The second way by which we try to engage with these belief systems is by the way of our community meetings called Mahila Mandals. These monthly meetings are conducted in each village for our pregnant and lactating mothers. We use different elements like games, storytelling and nukkad nataks to attract and start a conversation at village levels with women of different age groups. These are targeted around all girls and women who fall in the reproductive age groups. Mother-in-laws are also included in these meetings owing to the power dynamics in the community. These meetings are facilitated by active women called community counsellors that have volunteered from these villages. Hence, with this behaviour change model IIH aims to empower communities from within.
Finally, since the community engagement models as mentioned above have a greater gestation period, there always are high risk cases that our team has to keep a tab upon. These cases where haemoglobin levels are extremely low, our team even helps with blood donation as the last resort since the sub-division does not have a blood bank facility. Since, anemia is just not a medical condition but has its roots in the prevailing social evils and it takes a while for the community to adopt new, healthier practices, the least that can be done is to have some activism around getting a blood-bank in the region to save mothers. With deepening advocacy with the government, we aim to insulate the system as a short term goal.
*PPH is a condition where the pregnant mother experiences excessive blood loss after delivering her child.
Blog by: Uttara
Cover Picture by: Amrit Vatsa
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