Against All Odds: Three Unsung Women Warriors

The 23^rd of March was life tumbling for Suman, Sarla and Anita, and their families, residents of Basai village in Alwar district of Rajasthan.

That morning Suman’s contractor told her that the factory, where she worked in a nearby town, is closing and she is being laid off for the same. Not only her previous daily wages were denied but the future seemed even darker. Suman, a widower and a mother of two girls, recalls that she had just twenty rupees in her knotted torn cloth using which she was supposed to get vegetables for the family in the evening. But, knowing she has lost her only source of income, she went home empty handed and the only thing which was full was her eyes, with tears. That night she made one roti and fed her daughters, she hadn’t had anything since morning. Still she wasn’t hungry.

Sarla, wife to a migrant worker and mother of three, remembers when she received a call from her husband that he is returning home, for a brief moment, she was happy, though soon enough they were struggling to survive.  

Anita, an ASHA worker had to take up the key responsibilities during the COVID pandemic. When everyone was scared of getting out, it was her job to move around and make sure everyone stays indoors. All three women, teary eyed, recalled the toughest time of their life surviving the lockdown. Even though crippled by the situation, they sustained their family and they rose above their difficulties emerging as warriors of their own paths.  

Often when we think of leaders, we have celebrity names popping out in our mind but we overlook the battles and struggles of common women amidst this. The pandemic has exposed the increased burden faced by the women in terms of supporting family finances and managing household chores. We have heard about many Suman, Sarla or Anita during the pandemic, but as individuals how many of us have actually acknowledged them?  On March 8^th, we shall celebrate their challenges and achievements to demonstrate that they are more than mere survivors of their bad times  and struggles, but  leaders who truly builds up this nation.

FAO’s State of Food Security and Nutrition (SOFI 2020) reports on the extent of hunger, food insecurity and malnutrition all around the world. It has estimated that between 2018 and 2019, nearly 10 million people were added to the ‘undernourished’ category. Also, the number of undernourished people will exceed 840 million by 2030 which puts us off track to achieve SDG2 of zero hunger. This figure does not include additional numbers due to the negative effect of the pandemic which has only worsened the situation. It is of crucial importance to note that more than half of these populations reside in Asia and Africa. Suman, at a very micro level is one of these 10 million and could be among 840 million if her situation isn’t improved. When you look at her, she is pale because she is anaemic .Her children look extremely thin for their age and it was difficult to believe that one of her girls was 9 years old because she looked like a 6 years old.

According to the above report, globally 6.9% of children under 5 (47 million) were affected by wasting in 2019 – a figure significantly above the 2025 target (5%) and the 2030 target (3%) for this indicator. As per the National Family Health Survey (NFHS)-4 (2015-16), 35.7% children below five years are underweight, 38.4% are stunted and 21% are wasted in the country. Suman’s daughter falls under this category. Losing her employment and only source of income, made them completely dependent on PDS with negligible scope of buying any vegetables and fruits, which are important sources of vitamins and minerals.

Also, with schools being shut, Mid-day meals (MDM) were suspended for many months. It has been estimated that more than 3 billion people in the world could not afford a healthy diet in 2017. Most of these people are found in Asia (1.9 billion) and Africa (965 million). A healthy diet constitutes a balanced diet from all food groups to ensure proper nutrition. She was grateful to the increased PDS allocation due to Pradhan Mantri Garib Kalyan Yojana (PMGKY) but she did mention issues she faced while accessing it. The distributor used to give them less quantities and threatened them of not giving even this if they dare to complain.

Suman was anyway thankful for the grains because of which her daughters didn’t have to sleep hungry. In addition to this, she recalled that they consumed rice and very little dal for many months. This indicates that not only she was consuming less quantity of   food but less variety of food as well. This has been corroborated by the SOFI (2020) report that food insecure households consume less diverse diets which puts them at increased risk of nutrient deficiency. However, with MDM resumed the girls receive some variety but they are far from being nutritionally secure.

We have come across cases where life-saving treatments were halted due to the lockdown. She mentions an incident where she had to buy medicines for her diabetic mother-in-law but couldn’t get it on time due to absence of transportation and health care centres were far off. Her mother-in-law’s health deteriorated but she managed to help her using some traditional herbs for the time being. There was increased emphasis on washing hands and use of masks. It did sound like a privilege to them as they had limited supply of water but charity of sanitisers provided her family some relief. She mentioned stitching masks at home for her family, using old cloth. Further, she volunteered for families which were not enrolled under the PDS by getting their rations from charity and Sarla was one among them. Such incidents highlighted several leadership qualities of Suman, such as perseverance, being a visionary and a spirited fighter.

Sarla’s struggles were similar to that of Suman’s especially when it came to child rights or nutrition. But she faced an added layer of burden. Her husband used to work in Gujarat, in a marble factory and used to send money for her and children back at village. Due to loss of employment, her husband returned to the village. They were not part of the PDS due to documentation issues but had grains stored from previous harvest. However, she had no money to run daily chores. She decided to plant snap melon, or phoot (in local language) and sell it to houses in the villages for Rs 10/kg. This gave her the required push for sustaining the lockdown. All key decisions were taken by Sarla, the woman of the house which ensured the survival of the family. We saw a spirit of entrepreneurship in Sarla which determined her survival. In times of hardship such as facing domestic violence, she would turn to Anita who would lend her a shoulder of support.

But an emerging trend common in both their lives was a serious concern for children and their rights, from education to safety. They feared their elder children will leave studies and get recruited as labourers, or become victims of child marriage. Such turn of events are common among the poorer sections of the community. Loss of employment pushes them over the edge to employ their children for income and save money for household expenditure.

According to 2015-16 estimates of UNICEF, alarmingly 57% of children drop-out at higher secondary level of education. The pandemic is most likely to push these numbers to even higher proportion across all levels of education. Further, push factors for drop-outs are different for genders. While males become victims of child labour, it is the female counterparts who become victim of child marriage. ChildLine, a children's helpline, reported a 17% increase in distress calls related to early marriage of girls in June and July 2020 compared to 2019. Early marriages which lead to early pregnancy are often related to undernutrition of mother and child leading to poor health outcomes for both, mother and child. Further, we dismiss the mental trauma the victims go through.

But, as an ASHA worker one faces a different set of challenges. Anita is one of the lakhs of ASHA workers in the country, who work tirelessly with the vulnerable communities. Their struggles during the pandemic might be considered as ‘forgotten invisibles’, but their significance is beyond praise. Her set of responsibilities, with respect to the pandemic, can be classified under four categories- Identification, monitoring, enforcement and stability. These are in addition to her usual responsibilities related to distribution of tablets, immunization and periodic medical check-ups.  She ensured minimal social events and crowding, physical distancing and self-quarantine by the community.

She has bitter and sweet memories from the period, as in the initial phase, she faced hostile behaviour from the villagers but soon after realising the seriousness of the situation, community appreciation and engagement got increased. Further, she ensured that if anyone showed symptoms, they are advised to get tested at nearby healthcare centre. At a level where the government was unable to monitor, Anita and other ASHA workers acted like a strong bridge. Anita was seen as an Agent of Change by the villagers who catalysed their behavioural changes. Due to this, maximum number of cases in the village never increased more than 7. Her pro-active nature garnered the support of the Panchayat as well. Anita has been considered as a ‘warrior on foot’ during the times of COVID-19.

Pandemic underscored the crucial importance of ASHA workers in the Policy development for the Indian health systems.  Despite their contributions, they do not receive the much deserved attention. A survey by OXFAM which interviewed 306 ASHA workers from four different states- Uttar Pradesh, Odisha, Bihar and Chhattisgarh, revealed that though they agreed to receive monetary incentives,  only  64% respondents claim to have not  received incentives for the COVID-related responsibilities undertaken by them and only 43% ASHAs are receiving their monthly honorariums on a regular basis.

Similar was the case of Anita. On asking about the PMGKY, she responded that she is aware of something of this sort but not sure of the modalities. This highlights the importance of requisite knowledge about the scheme among the frontline workers themselves. Lastly, their role in COVID vaccine uptake will be extremely crucial but will only turn to fruit if they are recognised for their work.

World Bank has indicated that COVID-19 may add 150 million extremely poor by 2021. As a public health leader, against the backdrop of poverty, focus on access to healthcare and nutrition for the vulnerable communities becomes crucial. Suman’s and Sarla’s lives has shown us that during the pandemic a majority of vulnerable communities were at increased risk of poverty which had massive potential to cripple their access to healthcare and good nutrition. As a nation we are at increased risk of reversing gains against poverty, malnutrition and women’s rights.

We are moving towards the new normal but these risks still persist for many. All our policy decisions should be precautionary and not reactionary from now on. This will prepare us for the worst. A true leader enables others, for us, this women’s day we must acknowledge such individuals who may not fit into the conventional definition of leader but are true leaders in their own sense, and enable them to achieve their dreams.

While it is great to see an increase in the number of female parliamentarians and female CEOs, Suman, Sarla and Anita are the CEOs of their house and the policy maker of their family, a leader in her own way which will create strong women and their daughters and inspire many in their society.

While the pandemic has revived the focus on public health, it’s about time we look at it through a gendered lens. Strengthen health systems with a focus on accessibility and affordability for vulnerable communities. This includes stepping up the frontline workers especially in rural India who are not only key stakeholders in bridging the gaps at ground level but crucial in disseminating awareness. We have realised, any policy is as good as its implementation.  

Authors:

Priscilla C Ngaihte, Advisor- Health Transformation at PHFI

Ravneet Kaur, Research Intern at PHFI

(With ground inputs from Yavish Gupta)