“Only when women wield power in sufficient numbers will we create a society that genuinely works for all women.”
~ Anne-Marie Slaughter, American political scientist and public commentator
Over the years, women in rural India have risen to the forefront to play an important role in the rural ecosystem. They are now actively engaged as farmers, wage earners, and small entrepreneurs. Women are still actively engaged in household work as caretakers of their families, including the elderly and children.
In the past, the government’s development efforts sought to target men and women. However, the patriarchal system led to women being more marginalized and excluded from the benefits of programs. Later programs targeted women as child bearers and sustainers and still left out the issue of their empowerment and equitable access to schemes. More recently, India has shown a radical shift toward empowering women along with a growing realization by policymakers that the role of women, especially in rural India, could have a multiplier effect on economic growth. Given an atmosphere where they can emerge from constraints imposed by gender inequality, lack of education and healthcare, women can help to enhance productivity and efficiency and lead to more balanced and inclusive growth.
However, women are still constrained from participation in economic and developmental activity due to gender discrimination and social norms.
Women’s empowerment is being looked at now in an effort to enhance their position in the societal structure. The realization is that, if given the platform, rural women can play a major role in key areas such as improving healthcare quality and accessibility. Despite sincere efforts of the government, health is often a neglected subject in rural areas, especially for women and girls. The way forward is to empower them through proper education, training, and leadership. The health and well-being of rural womenfolk is now recognized as linked to their empowerment and assuming leadership roles in developmental efforts.
The concept of women’s empowerment has often been viewed with suspicion as society still grapples with ingrained issues of patriarchy. In this context, leadership roles assumed by women are viewed critically. Women in rural India remain major contributors to primary healthcare especially in the area of health education. Assuming leadership roles in healthcare enhances their self-esteem and belonging and leads to improvements in women’s health and of their families. In rural areas, given the right training and impetus, village women have proven to have a beneficial role to play in the health and well-being of their community
ISSUES FACED BY WOMEN IN RURAL INDIA
- Women in labor and remuneration. Agriculture sector employs 80% of all economically active women in India; they comprise 33% of the agricultural labor force and 48% of the self-employed farmers. However, they are poorly paid, have little income security, no social protection, and minimal access to healthcare. In some areas, young girls in significant numbers are engaged in child labor.
- Collecting water and firewood. Women and girls fend for drinking water and firewood in almost 80% of rural households. This work is labor-intensive, load-bearing, and often entails long walks.
- Healthcare. Improper sanitation and water lead to rampant illness in rural areas, and women bear the brunt. Lack of access to healthcare further exposes them to illness.
- Inadequate nutrition. Rural women have shown slow improvement in their nutritional status, leading to malnutrition and cases of girl child growth stunting. This neglect leads to nutrition-related chronic diseases and makes them vulnerable to long-term genetic defects.
- Access to government schemes. Lack of education and awareness means that government initiatives do not percolate down to the intended beneficiaries. Because of the societal structure, women in rural areas do not enjoy the benefits of these schemes.
LINKING WOMEN TO HEALTH SERVICES: VOLUNTEER AND FUTURE LEADERS
The National Rural Health Mission looks to provide every village in the country with a trained female community health activist ASHA (accredited social health activist). The ASHA worker is from the respective village and is thus accountable to it. ASHA workers are trained to act as an interface with the villagers and the public health system. Similarly there are anganwadi centers for child welfare and an auxiliary nurse midwife to take care of maternal health. Though the roles played by each overlap and are multipurpose, they are often overworked, considering the population size.
Women volunteers are the link between people and these healthcare workers. These leaders are an important cog in the wheel of the primary healthcare system and ensure smooth functioning by educating and following up with the masses. They also act in synergy with NGOs and CSR initiatives to carry out health education and promotion activities. These are the true leaders, individuals with a desire to make a positive impact for their family and community at large. The last-mile connection in rural healthcare is provided by these selfless leaders without financial consideration in mind. Many of these leaders aim to train their community members to become part of the volunteer program and act as catalysts to a healthy and educated community.
The National Rural Livelihoods Mission leads initiatives in educating the masses on the benefits of food, nutrition, and water, sanitation, and hygiene through volunteers and self-help groups. The progress has been steady and was able to cover over 50 million households by 2020.
Women Leaders in Health – The Indian Context
The role of women in rural India as primary caregivers in families and as health workers cannot be underestimated. About 40% of India’s workforce is female and about 30% of this workforce comprises nurses and midwives, and frontline health workers (ASHAs). However, this number dwindles as we go higher in the value chain. Only about 6% of doctors operating in rural areas are female. Thus, we have a situation where the potential of women in the healthcare domain is underexploited. As one looks beyond, the role of women in the field of health remains skewed. Most of the positions of authority are held by men and, as policies are formulated on issues of women’s health and well-being, women themselves have little or no representation. In the absence of proper healthcare across rural India, women bear the brunt as they suffer due to complications of pregnancy and childbirth, cervical and breast cancer, etc. This makes them sensitive toward supporting health facilities, antenatal care, immunization, etc.
The reasons for this paucity in health leadership have answers in the deep-rooted issues of gender discrimination, sexual harassment, and the dearth of networks and support/ mentoring structures, etc.
Promotion of women’s leadership in health services and across the spectrum is key to better health services. This requires enabling access to the tools and resources, social and political, to help overcome constraints.
The Role of Women as Health Leaders: The Way Forward
1) Through Social Organizations As Catalysts – The effects of focusing on education specifically promoting literacy and training health workers as catalysts in their village can lead to exceptional health outcomes at relatively low cost. Organizations that implement programs like health promotion and reproductive health clinics can help nurture women with leadership potential. Local women can be trained as community health workers; and these leaders can in turn, can be used to mobilize other women in their communities to promote health services and tackle health concerns.
2) As Community Health Workers – Accredited social health activists (ASHAs) have a major role to play as leaders in contributing to a better health service scenario. These women can spearhead health services to the grassroots level by serving as social activists and thus leading the way in basic health areas such as maternal and child health.
3) As Political And Policy Decision Makers – Women politicians are sensitive to the health issues encountered by communities across rural India and can play an effective role in the provision of equitable and accessible public healthcare services. Coming from the grassroots, they have withstood many health issues faced by their families and communities and thus prioritize increased access to better health infrastructure, policy formulation, and services.
4) Responsibility In Implementation – The spectrum of healthcare cannot be completed without women’s participation in implementation agencies responsible for health services. This has a multiplier effect, as it leads to a participatory and inclusive approach, breaking barriers and reducing gender disparity.
Women Volunteers, The Catalysts on the Ground
Women in rural India are being encouraged to take leadership roles in the fight against malnutrition. They now realize that they have a key role to play in providing nutrition through enhanced livelihood. Today’s volunteers will be the leaders of tomorrow as they spread the message. Being involved in various roles as Mahila Kisans or Pashu Sakhis will make them the champion fighters to lead India to meet Sustainable Development Goals and mitigating factors responsible for malnutrition.
S M Sehgal Foundation has been working on increasing the awareness of women in Samastipur, Bihar, on preventive and remedial health, timely vaccination of children, and menstrual hygiene.
For taking the message to the grassroots, S M Sehgal Foundation selected and trained 25 swasthya sakhis (women health volunteers) to take the message to the community through ward level meetings and family visits. After training, the women health volunteers conducted the following activities in 25 villages of Samastipur district, Bihar.
- Household level meetings. They visited the households of pregnant women and newborn babies to know the status of their vaccinations, reiterate the requirement of their having daily doses of IFA (iron folic acid) tablets, provide awareness on symptoms and preventive measures of pneumonia and Japanese encephalitis, as well as provide information on postnatal care including Kangaroo Mother Care (a technique of caring for a newborn with low birth weight, i.e., below 2.5 kg, by keeping chest-to-chest or skin-to-skin contact between baby and mother or guardian so there is proper transmission of body heat to the newborn).
- Ward-level meetings with women in the villages. The women health volunteers conducted ward-level meetings in the villages, covering the following topics –
1. Malnourishment–causes, and measures to mitigate it.
2. Commonly prevalent diseases–causes and prevention. (Diseases prevalent in this area are anemia, diarrhea, pneumonia, and malaria.)
3. Reproductive health–Menstrual Hygiene Management and ANC and PNC. Government schemes, and services provided by the ICDS center in the village.
- Information dissemination on phones and WhatsApp during lockdown
1. Disseminated information through phone calls. This was the primary method of being connected with the community during the complete lockdown. The community was made aware about precautions and safety measures to be taken pertaining to the pandemic. Follow-up calls were made on kitchen gardens and JalKalp water filters. Also, the causes of the disease Japanese encephalitis (JE) and its safety measures were explained to the families.
2. Imparted awareness through WhatsApp groups. Images and small videos related to health and hygiene, as well as information on government schemes and interventions, were regularly posted here.
3. Integrated communities with anganwadis. An anganwadi is the chief center for maternal and child healthcare at the village level, and the anganwadi worker is a key person for disseminating awareness on health to the women. The project enhanced the interaction between anganwadi worker, helper, and the community women.
4. Linked people with government. Many benefits were catalyzed such as Janani Suraksha Yojana (JSY) for institutional delivery and birth certificates, Pradhan Mantri Matritva VandanaYojana (PMKVY) for the first child conceived, Mukhya MantriKanya Suraksha Yojna (MKSY) for successfully completing vaccination up to two years for the girl child, reward for family planning, and the provision of iron and calcium tablets to community women and adolescent girls who were malnourished and underweight. There were 572 institutional deliveries, where vaccinations within 24 hours of birth were provided.
As part of the National Nutrition Week, observed from September 1 to September 7, the government works to make people aware of the value of nutrients such as essential proteins and vitamins in our diet. This is an integrated effort by all arms of the government to understand that proper nutrition is essential for the body and for mental health.
Clearly women health volunteers are the leaders who will take healthcare and nutrition in rural India to fulfil the objectives of the National Rural Health Mission. However measures must be taken by policymakers to appreciate women’s role. Culture building and valuing their activities for the good of the community is of primary importance in their retention. Women are the change agents, the leaders who can lead rural India to a healthier tomorrow.
It is imperative to foster women’s leadership in healthcare to enable them to realize their full potential; and for improving quality and access of health services. The need of the hour for improving health service quality and delivery is to improve hiring, mentoring, and enabling networks to bring more women in leadership roles.
The major challenges faced by women are imposed by social norms such as gender inequality, lack of education and healthcare that leads to their low participation in economic and developmental activity. An ongoing, continuous improvement in their social, economic and health status can enhance participation of women and help achieve sustainable rural development in India.
Women’s empowerment is a continuous process and does not have an end point or an outcome that can be measured. Experiential pathways that are not clearly defined may have different outcomes for women in a diverse setup like India and have to be viewed holistically.