Health Issues Of Rural Women In The Himalayas
Guest Post by Dr Khushwant Singh
A note from the editor
Today 15th October is being celebrated as “International Day of Rural Women” and we at IWB too are including a very important aspect of what we had been talking about throughout… Health issues of women. We had been discussing various aspects of health issues related to urban women, but today is the right moment to pay tribute to the most hard working of all Indian women; the rural Indian women.
Here we have a guest post by Dr Khushwant Singh who had been observing all aspects of health in rural India since the day he started practising as a full fledged doctor. I am personally thankful to him to send his thoughts and experiences within an hour of given time. Here, I must not forget to mention that Dr Khushwant Singh along with being a doctor is, an avid biker,a ferocious reader, a sensitive artist, a personal blogger himself and a super wonderful photographer….(I consider myself his biggest fan) and yes of course I can’t ignore the proud feeling of being his English teacher when he was in class 12th. So here is a special post by Dr Khushwant Singh on International Day Of Rural Women. Hope it makes you think about the plight of rural Indian women.
I have been working in a village a little ahead of Mussoorie for more than 6 months now and most of my beliefs about villages in the mountains have changed drastically. We see movies or pictures of the hills, where women are working, carrying huge loads on their heads, working in tea plantations and almost everywhere else as well. What we fail to answer, is why do all these movies or pictures have women in them? Where are all the men? And when I started working in the mountains, the same picture presented itself. Women were working in the fields, bringing their families to the hospitals, look out for cattle, fetching water and every other possible work. Surprisingly, men were absent everywhere. The only men that were found are drivers or shopkeepers. This is when a local told me, that in almost all these areas, men are either in the army, or addicted to country liquor. And in both these cases, men are not there for their families. The responsibility shifts to a woman, and coupled with illiteracy and early marriage, there begins a vicious cycle of ignorance and neglect. As far as health issues of women in the mountains are concerned, I believe, that they should be the focal point of all planning and execution.
The health issues of rural women
There are various health related issues rural women face and I have realised that most all of them are the result of ignorance and illiteracy.
Because of illiteracy and difficult terrain, the knowledge about methods of contraception eludes these women. The women are in general neglected, as the families having no issues with a woman bearing 5-6 children on an average in her lifetime. The health risks with repeated pregnancy are obviously not known to the families. The major contraceptive method in these areas is condoms, and still, somehow, the men don’t care to buy one as they are not bothered about their wives getting pregnant time and again. Surgical methods still evoke fear, and hormonal contraceptives and IUDs are too much of headache. So contraception becomes really difficult. The only rational approach seems to be providing condoms to the women and educating them about the importance of contraception. Studies have shown, that men do not buy condoms but many of them use when their partner asks them to. I think that the women should side by side be taught about other, more reliable methods of contraception so that a gradual shift can be made.
A very successful approach used by the NGOs in these areas is, to take one woman from each village in confidence, give her a fixed stipend, teach her about the methods of contraception and give her condoms and contraceptive pills. And since this woman is from their village, the womenfolk listen to her and are more comfortable discussing their problems.
lack of proper hygiene, illiteracy, neglect, multiple sexual partners and lack of knowledge are all contributing factors to poor sexual health among these women. I have treated women who have had vaginal discharge for years and thought it was normal, before coming to the hospital. They are in general neglected, and that carries on with their sexual health also. The problems are same as in cities, menstrual problems, infections, infertility etc but lack of knowledge makes all the difference. Whereas in cities a woman come to the doctor for something as small as an itch, in villages, these women, due to neglect, burden of work and lack of knowledge, will not go to any health care professional till the time it becomes a matter of life and death.
In a society where a woman works out doors all day, cooks food for the family and eventually is forced to please her husband also at night, proper nutrition becomes a major concern. And sadly, this is where she suffers the most. She is neglected here as well. A good healthy balanced diet is never made available to her as she lives in a male dominated society where she is the last one to eat, completely depriving her of all the nutrition. This coupled with repeated childbirth and menstrual problems, drastically shortens the life span of rural women. Most of the women are anaemic, and when asked to take care of their nutrition, they say, “humko kaun poochta hai?”
Child marriage and female foeticide
As common with the rest of the country, this is a problem affecting women in the hills as well. They are married early and pushed into a long life of work and neglect. Early childbirth puts them at a risk for a lot of health issues, but the people here believe in marrying off their daughters as soon as they attain sexual maturity (read: adolescence). As far as female foeticide is concerned, other than increasing the male to female gradient, also puts the mothers at some serious risks. More often than not, midwives use local abortificants, usually plant toxins to abort the foetus. Sometimes it is too late for abortions and sometimes the toxins prove toxic to the mother as well. I have myself seen cases with very serious burns and local reactions because a toxin was applied locally to abort a child.
Thankfully, this one aspect of their health is improving, with more women coming for Ante natal check-ups and opting for deliveries to be conducted in the hospital. But still, a lot of deliveries are being conducted by untrained people putting both the mother and foetus at risk
Extremely common in these areas is the physical abuse of wives by their husbands. Cases of wives attempting suicide by consuming poison because of the domestic violence are extremely common as well. Most of these rural women remain the usual silent victims of an illiterate male dominated society before taking such a drastic step.
Now, there are certain issues that are common to the population in these areas, irrespective of the gender or age. But since a woman is the most important member in the family, working, providing and caring for the whole family, her role becomes extremely important.
- It might be hard to believe, but women are surprised when I ask them to boil water before drinking. They have no idea about infections and how important is proper sanitation.
- Washing hands with soap after defecating is also not common. Most of the diseases in these areas are infectious diseases, unlike cities where lifestyle diseases are more prevalent.
I treated an outbreak of typhoid two months back, where almost every second patient was diagnosed with having typhoid. I have seen mothers bringing their whole families with the same problem, all eventually diagnosed as typhoid. Now typhoid is a disease that can very easily be prevented by proper sanitation and hygiene. But the lack of knowledge contributed to the outbreak.
- Other common problems are diarrhoea, gastritis and vomiting, all more often than not related to infections.
Educating women in such a setup, can bring a drastic change in the living and health conditions of the whole family as far as infectious diseases are concerned. A woman at least teaching her children about use of toilets, soaps and proper hand washing can bring about a massive change. She has to know that just boiling water can eliminate half the diseases.In fact, I believe, every intervention against infectious diseases in these areas should primarily focus on women, because they can bring about a massive change.
Well the root cause of all these problems is, lack of education. Education may not bring immediate results, but it will surely bring sustained results. Knowledge about their health, their rights and healthy habits can drastically change the complete health scenario in these areas.
What can be done?
Education is one thing but picking up a few women in confidence from every village,and asking them to convince other women of their villages that works well. they can be made to take interest in this work by giving them stipends and providing them with necessary medicines and materials. They can be asked to spread knowledge and this seems to be the only practical approach for fast results. In fact, this is exactly the same strategy followed by the Government of India, employing ASHA and Anganwaris in imparting health education. A many NGOs also are trying to fill in the gaps left by Government agencies. But difficult terrain and the sheer volume of population is bound to make things difficult. The problems are not difficult, just that the resolve isn’t strong enough!
Do you have any suggestions about the health issues of rural women?
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