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Women's Day Special

Blog: Can Rural Health Investments In India Empower Women To Shape Their Own Destinies?

It is time to reimagine a system of care designed around rural women’s voices, and agency, integrating healthcare with our social systems

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Blog: Can Rural Health Investments In India Empower Women To Shape Their Own Destinies?
Only 67.9% of all mothers in rural India receive early antenatal check-ups, as per National Family Health Survey 5

Rumi harboured dreams from her student days, envisioning a future filled with continuous learning and exploring her passions. However, her family had a different trajectory in mind for her – one marked by marriage, caring for an unchosen husband, and raising children. Her journey unfolded as a struggle, lacking celebration from those in her immediate surroundings. Leaving behind her familiar place, customs, and rituals, she found herself amidst stranger neighbours who neither knew nor cared for her. Within a year of adjusting to this new environment, Rumi faced challenges beyond her initial concerns. Financial struggles plagued the family chosen for her, exacerbated by years of drought that forced her husband, once a farmer, to migrate to the city for work.

Also Read: Union Minister Smriti Irani On Women Health In India

Left with her in-laws, she confronted a reality she hadn’t anticipated. A new twist emerged when, after one of her husband’s visits, Rumi discovered she was pregnant. Though this wasn’t part of her dreams, others in her “extended family” celebrated. However, their joy was short-lived. At the age of 17, Rumi gave birth to a girl. Her health deteriorated and the newborn was identified as a Low Birth Weight Baby. The detrimental consequences of giving birth at the young age of 17, which created numerous biological hurdles. These include heightened risks of complications during pregnancy, childbirth, and postpartum recovery, exacerbating challenges related to maternal health and hygiene. Rumi found herself responsible for an ‘unwanted baby’ that was considered a burden and an additional expense for her in-laws. She wondered,

Why must I go through all this? Did my mother experience the same things? What about my mother-in-law? If not them, who can I talk to? Does anybody care about me?

Rumi’s story is not unique; she is not alone in her struggles, not in her new neighbourhood, not in India. Despite various women-centred programs by the Indian government, the ground reality remains challenging. Only 67.9% of all mothers in rural India receive early antenatal check-ups, and 46% have less than four visits. Iron folic acid consumption during pregnancy is at a low 23%. 13% of deliveries still occur at home, with only 4% overseen by certified healthcare professionals. In rural India, early marriages persist, with 27% of women aged 20-24 marrying before 18. This poses threats to maternal and child health. 23% of children miss out on their vaccinations. Early breastfeeding initiation is low at 42%. Disturbingly, child stunting, wasting, and underweight rates are high. Considering the National Family Health Survey (NFHS) 5 data, the screening rates for cervical cancer stand at just 2%, while breast cancer and oral cancer screenings sit at a mere 1% each. The scenario is indeed discouraging, yet it sheds light on the urgent need to revamp India’s approach to caring for women.

Also Read: Blog: Reimagining Contraceptive Choices Through Self-Care

For women like Rumi and countless other women facing potential barriers to healthcare, sanitation, and overall hygiene, the additional weight of stigma surrounding women’s sexual and reproductive health rights only exacerbates their challenges.

Despite their adversity, women persist as leaders in social justice and equity-focused work, driving innovation across neighbourhoods in rural India. It is time to expand our perspective and reimagine a system of care designed around women’s dreams, where their voices, agency, and power are amplified and their lives celebrated by their families, communities, and peer groups.

The Government of India and state governments run various programme for women like the Beti Bachao, Beti Padhao Programme; the Anganwadi Centers render services on nutrition, early childhood education, etc., the monthly Village Health and Nutrition Days bringing a bundle of services to the doorsteps of the people majorly targeted towards reproductive and child health services focusing on women. VHSNDs bring different services designed with community outreach. The Ayshman Arogya Mandirs also delivers services for women and children.

However the results are not optimal. All the programmes and services are segmented and miss addressing the nuances of the challenges faced by women when accessing reproductive and sexual health, as well as child health services. The investment in women needs to be more horizontal – beyond health – and more towards celebrating life.

What if a new system of care incentivised family members, including men and boys, to care for each other for the health of their neighbourhood?

Could this new caring system introduce capabilities to help women heal the cycles of stigma and receive healthcare designed to their needs?

Could it link health and social security systems within their workplaces and networks to better help women navigate their aspirational journeys?

And for those who cannot access the necessary resources in their neighbourhoods, could the same system offer routes to relevant institutions offering support outside their surrounding environments?

Imagine a future where new systems of care help women choose multiple pathways to be supported on their own trajectories. Imagine a future where Rumi and countless others are not passive recipients but active designers of their destinies, and find support from family, friends, and neighbours to achieve the freedom of choice over their life decisions. Imagine if Rumi saw the future as something to be celebrated, not to be afraid of. That is what democratic development design tries to achieve.

Now, consider the alternative – a future where she does not. What, then, is the future of India?

Also Read: Union Minister Smriti Irani Highlights Importance Of Normalising Conversation Around Women’s Health

(This article has been authored by André Nogueira, CEO of LEAP Design, an initiative of Transform Rural India (TRI) and Shyamal Santra, Associate Director – Public Health & Nutrition and Lead of Neighbourhoods of Care (NoC) at Transform Rural India.)

Disclaimer: These are the personal opinions of the authors.

NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which in its Season 10 is helmed by Campaign Ambassador Ayushmann Khurrana. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ populationindigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In a world post COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental well-being, self-care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.

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