Sunday, February 29, 2004

Unbearable burden of plenty

And then you have victims of fertility. A.J. Philip visits a basti in Jaipur where a dozen children are no big deal

Social workers on an awareness-raising mission in Bhatta Basti, Rajasthan.

IT was difficult to believe that Salma Rehman was only 40. She appeared to have crossed the Biblical three score. Her emaciated, drooping body, sagging facial muscles and halting voice spoke eloquently about her present pitiful condition. A three-year-old boy clutched at her dupatta as we spoke to her at Bhatta Basti, a cluster of slums not very far from Rajasthan Chief Minister Vasundhra Raje Scindia’s official residence in Jaipur.

Rehman knew the young social worker from Population Services International, a non-profit organisation, and his team of women volunteers and she opened out to him. I was almost scared out of my wits to know that she was pregnant for the 15th time. But where are her children? "Where else can they be? They are all here", said the lady looking around and stretching her legs to sit more comfortably. Soon, a small crowd of women and children gathered around us to know what was going on.

The social worker was pleased that there were more women and adolescents to hear him. "We prefer to speak to a group, rather than individuals as the message is disseminated more quickly in this manner" he rationalised while lending an ear to Rehman. Despite all her pregnancies, she had only four children – three girls and a boy. Infant mortality and miscarriage accounted for 10 fruitless pregnancies. She was too dejected to look forward to having another baby. But in a few months that baby is bound to come if no mishap occurs in the meantime.

Rehman was candid enough to tell us that her present pregnancy was totally unwanted. In fact, most of her pregnancies were unwanted. She laid the blame squarely at the feet of her husband, a rickshaw-puller who earns Rs 50 to 100 a day when he is able to work. It is his ceaseless pursuit of a son that drained out all the energy from Rehman and made her prematurely old. It is not that she did not make attempts to avert pregnancies. She used oral pills for two months. Since she did not know how to use the pills properly, she experienced some side effects and left them, only to realise that she had become pregnant yet again when she missed her periods.

She does not enjoy any respect among her neighbours, who mostly belong to her religion. In fact, they ridicule Rehman for her frequent pregnancies. She does not trust hospitals and plans to have her next baby too at home. Why does she have an aversion for hospitals? One of her first deliveries was at a government hospital. She believes that she lost her baby because of the negligence of the hospital staff. She never went back to the hospital as she felt more comfortable with the local ayah, who, in any case, is "just a call away". She never gave any thought to the possibility that some of the miscarriages and deaths could have been averted if she had obtained proper medicare.

Rehman is determined to use contraceptives after her next delivery. That is if she is able to survive the rigours of another delivery. The social worker explained to her in great detail the methods of spacing she could adopt and she listened to them with a vacant look on her face. Other women were more responsive and cheerful as they accepted the literature he handed out to them. They all believed that there should be a gap of at least three to five years between two children, although many of them could not practice what they believed in. Most of the women were illiterate and they did not have any control over their bodies. Everything was in the hands of their husbands and God, not necessarily in that order.

As we moved on to meet other groups of women, I realised that Rehman was not the only one to have suffered from multiple pregnancies in Bhatti Basti. "I have come across many women who have more than a dozen children." Sarita Devi is one of them. Her husband works in a stone quarry. Illiteracy and craze for a male child are what brought them to their present wretched state where they are unable to give even two square meals a day to their children, let alone provide them quality education. The same story was heard in household after household. It was difficult to believe that they lived in the capital of Rajasthan, whose people produce more wealth than any other in the country. But then it is also a fact that the state, known for its majestic forts and palaces, is one of the many north Indian states lagging behind in family planning.

The visit to Bhatti Basti opened my eyes to another grim reality. The state agencies have virtually stopped undertaking family planning work. They seldom visit the villages and slums where their services are required. Instead, they fudge records while family planning aids like condom, Copper-T and pills are allowed to rot in ill-kept stores. The social worker, who had a stint at Sirohi before he was posted at Jaipur, narrated an incident where a large quantity of condom was burnt causing a sensation in the village. "Every condom must have been recorded as having been given to an eligible couple", he said. There was another instance of villagers digging up a large quantity of Copper-T from the ground near a public health centre. This being the case it is no surprise that Rehman and Sarita have such large families, whom they cannot support.

Figures speak for themselves. Child marriages are rampant in Rajasthan with even ministers gracing such functions in wanton disregard for the Sarada Act that prohibits such marriages. As a result, the average age at which co-habitation with husband occurs first is a lowly 17, against the national average of 18. Incidentally, the minimum age for marriage is 18 for women. The high infant mortality rate is a major stumbling block for the success of family planning in the state. As many as 115 children out of 1000 die within the first five years of their birth, against a national average of 95 deaths per 1000. Parents are tempted to go in for more children as a safeguard against losing some of them to diseases and what they refer to as "misfortune".

In Rajasthan only 40 per cent of married women use some method of contraception. What’s worse, only 23 per cent of women have ever discussed family planning with their husbands, friends, neighbours or relatives. Small wonder that even now 14 per cent births occurs within18 months of a previous birth while 30 per cent occur within 24 months. Birth spacing, therefore, acquires considerable importance in making the family planning programme a success, though this is yet to register on the state agencies. Even educated people are not aware that spacing of children improves the health of both the mother and the child.

Talking to the women of Bhatti Basti, I realised that there is greater awareness among the women about the need for family planning. Not a single woman we talked to wanted a large family, though they craved for a healthy son. And they were unabashed in admitting their fondness for male children, who they believe will look after them in old age. They also knew that there should be sufficient gap between two pregnancies. Some of them even suggested on their own that the ideal gap is five years. Yet, they do not have access to the means of family planning or are simply ignorant of them steeped as they are in illiteracy. What they need is complete and correct information about modern methods of family planning. With the Central and state governments lacking in political direction to take the bull by the horns, Rehmans and Saritas have frequent deliveries they would only like to avoid.