Over the past month the Mata Jai Kaur team has been busy conducting this year’s village visits. These visits are a continuation of last year’s MJK Mother’s Survey which had us visit the communities we serve, gather data to help with our planning and due diligence, and to let people know what we’re offering.
There was, however, a shift in emphasis this year. In addition to gathering data and learning about the lives of village women, the main focus of this year’s village visits was education. We wanted women in our area to know exactly what the risks of pregnancy are in Sri Ganganagar and what they can do to mitigate that risk. This effort is fundamental to our mission of ‘empowering women with knowledge’ – i.e. to increase their agency in the decisions that affect their chances of surviving childbirth.
We know from last year’s survey that there are many obstacles preventing women from getting quality care such as a lack of transportation options or money. Often, however, the biggest obstacle is simply that many families do not know why, when and from whom they should get medical care.
Our objective was to let women know why they should seek antenatal care and safe delivery and that there is a high-quality option at the Mata Jai Kaur Maternal and Child Health Centre.
The second main objective of this year’s village visits was to encourage community buy-in of our intervention. Getting the community invested in what we want to achieve – as various examples elsewhere demonstrate (see: Jamkhed, Asha and Bangladesh) – is vital to improving the maternal and child health outcomes. We used these village visits to identify potential Community Health Worker’s – women in villages who might work with us to improve the health of their communities. At our education sessions we noted names and contact information and invited interested women to attend the first Mata Jai Kaur Women’s Meeting that occurred last week (more on this seminal event in the next post).
For our MJK team the village visits were at once exhausting, exhilarating and edifying. The unforgiving springtime heat and occasional sandstorms – unleashed from the recently harvested wheat and barely fields – could not dampen our spirits as community after community welcomed us, listened and shared.
Our team for the visits consisted of Arsh and Sandhya (our champions from last year’s Survey), Sandeep – our very own student nurse and clinic volunteer – myself, and Balwant Kaler (aka Banth Bhaji) the MJK-MCHC’s tireless Managing Director.
On our last couple days we were joined by CJ – aka Christie James aka Santro Bhanji – from Canada who came up to the village to volunteer her time. It was a treat for the team and for the village women to have someone come from so far away to lend a hand.
Every village we visited was different and we managed to gather women in a variety of ways. Sometimes we’d visit a village school and have the students and teachers gather their mothers, aunts and sisters from home or the fields. Other times we’d make an announcement over the loudspeaker at the village Gurdwara (Sikh temple). We also took advantage of unexpected opportunities – people offering their houses as meeting venues, women gathering for a wedding event, even a travelling shoe sale (where we unsurprisingly found many women)! Often, we’d get village leaders to canvas households and find venues – we used this opportunity to inform them of what we’re doing and get them on board.
Once the women were gathered and introductions made we provided them with a very straightforward statistic: 343 out 100,000.
That’s the number of women in Sri Ganganagar who die per 100,000 live births, commonly referred to as the Maternal Mortality Ratio (MMR). Of course, to the women we were talking to the statistic in itself didn’t mean much, so we provided a comparison:
- The state of Rajasthan as a whole as an MMR of 331/100,000
- The neighbouring state of Punjab’s MMR is 192/100,000
- Pakistan’s and India’s are 250/100,000
- and Canada’s is 5/100,000
Sri Ganganagar is worse then all of them and virtually all of the women we talked to had no idea why this should be the case.
I could only imagine what went through the minds of the women we talked to, most of whom know someone who has died in childbirth, lost a child or had major complications during pregnancy. It was fascinating to watch our hosts consider that there exists a place like Canada where women do not suffer from the same preventable causes of death and illness that they suffer through. If it’s possible to get such a low maternal mortality rate in other places, why not in Sri Ganganagar? Why, indeed. The truth is that for almost everything that kills a mother in Rajasthan there exists simple, cost-effective and proven solutions.
Major causes of death include obstetric emergencies like excessive bleeding, infection and eclampsia (convulsion and coma). In Canada and other developed countries where facilities and quality care is more accessible before and during pregnancy, the worst outcomes from such emergences can usually be prevented.
Other causes of poor maternal health outcomes in Ganganagar are related to certain behaviours. Nutritionally, almost all women in our region are anemic which puts both the mother’s and child’s life at risk. While talking about nutrition Banth Bhaji challenged the men and women listening to think about whether it’s right for a women to eat last and save expensive fruits (important sources of iron) for others in the household, as is usually is the practice in our region. Coming from an older Sikh man – not the type of person these women would expect to get the message from – the observation resonated. The women nodded their heads in agreement as Banth Bhaji subtly challenged the prevailing gender and power dynamics of village life that directly affect maternal and child health.
He went even further when he challenged the women on two other common behaviours – sex-selective abortion and early marriage. Abortion for any reason other than medical necessity is illegal in India, and for good reason. For many cultural and societal reasons girls are valued less than boys and pregnant women will often have female fetuses aborted. Since the abortion and sex-determination (i.e. with ultrasound) is illegal the entire industry is pushed underground and is enormously risky for the mother.
Girls getting married early – often before the age of 15 in our area – is another huge risk. Younger brides tend to have underdeveloped pelvises that are not yet able to handle childbirth – early pregnancy endangers them and their unborn children.
Banth Bhaji pinpointed exactly what needs to change for both sex-selective abortion and early marriage to end: the true value of girls needs to be recognized. Banth Bhaji would often point to the young ladies on our team – Arsh, Sandeep, Sandhya and CJ – as prime examples of what an educated girl can bring to a family and to society. He’d also point out the female teachers in the village schools we were visiting. Sometimes he’d get pushback – usually from women themselves who struggle with what they perceive as the economic burden a girl can represent for a family in the form of dowries and inheritance – but this opened the door for more discussion and debate – something Banth Bhaji was more than happy to engage in.
In witnessing these debates I learned of the immense value that discussion and an exchange of knowledge can foster. We learned a lot from the women we met as they did form us. I also learned that in Banth Bhaji we have a tireless champion for women’s rights and women’s health. As far as finding local leaders in maternal and child health, we couldn’t have found someone better!
Stay tuned for more on our first MJK Women’s Meeting.