My Attempts at Facilitating Change in Rural India

In my final year of medical school, as I was reading a chapter on Maternal and Child Health, I came across a table of mortality rates elaborating the health status of mothers and children of my country. They were dismal and though I could see that progress had been made, to my 20 year old brain, it seemed insufficient and too slow to be accepted. After all, these were lives and not just numbers! The rural-urban difference made the figures look worse. I was restless. How could I bridge this gap? I reasoned – a woman was the base of the society’s pyramid and if I could do something to strengthen her I could attempt to address this gap.

I was also convinced that since most of India’s population lived in rural areas, in order to make a significant impact, I should focus on rural areas. Though I had been reared in a city and had never seen what a village looked like, I was ready to learn along the way. Itching to materialise this dream, the month I passed my MD in Obstetrics and Gynecology, I moved to Bihar; a state with one of the worst reproductive and child health indicators.

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My first project there was to strengthen the quality of maternity services in the government hospitals through hands-on training of doctors and nurses. I knew things were in a bad shape, but nothing had prepared me for what I witnessed there.
I saw up close all the things that affected service delivery to mothers coming there from far-flung villages. They ranged from attitudinal apathy to infrastructural gaps to skill deficiencies, often leading to serious health consequences for women and their babies. Working on them was overwhelming and frustrating to start with, but we eventually succeeded in transforming the hospital dynamics. Significant gains were achieved in infrastructure, hygiene and skills. Our District Hospital later received the Prime Minister’s recognition for its radical transformation. It convinced my young heart that no matter how flawed, every system was capable of change.

My next project involved setting up a health center for women and children in a village which housed some of the poorest communities, was hard to reach and had poor means of transport. It is here that I witnessed firsthand the fate of women who never reached a government facility.

It was immensely humbling for me as a woman and as a doctor to see what happened to their childbirths, to their family planning needs and to their children battling with malnutrition and pneumonia. Maternal and Childhood malnutrition was rampant and with the nearby government health centre non-functional, most deliveries were aided at home by unskilled birth attendants. Women of the village had no access to contraception and one could easily find women with up to ten deliveries. Prenatal checkups were not considered important as pregnancy was seen as a natural event, not a ‘disease’ that needed a doctor.

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I saw how quackery quickly proliferated in such places to fill the void created by a struggling government health system and how unscientific beliefs and taboos easily gripped such rural societies, vulnerable by poverty and ignorance. I also saw how the deep seated caste and gender divisions led to disempowerment of women and their children. A range of psychological issues and non-specific aches and pains in these women revealed to me their deeper emotional turmoil, isolation and loneliness, as a result of living most of their lives alone. The child bearing and the child rearing shared just with other women, while their husbands were away at better paying jobs in cities. I had to pinch myself when I saw young women being restricted to the confines of their homes due to fear of being seen by other men. With such ground realities, I had to reorient myself to move beyond providing safe childbirth and contraception to using healthcare as a tool, as a medium towards initiating deeper discussions with women, urging them to find their individuality.

I am glad I followed up on my dreams of medical school early enough. I feel happy that I am spending the most productive years of my life doing something that I find meaningful and worthwhile. Working for rural areas, its women and children, has given me my most precious moments as a doctor and as a woman.

Braver, Stronger and Smarter – Sustainable Development Goal 10

“You think we can make it?”

“We have 10 minutes and we are 6 blocks away.” 

“I think we have to run.”

“Let’s do it!”

And so two women ran the streets of New York (with tiny heels on) just to make it to the United Nations during the its 71st General Assembly.  Some things are too precious to walk towards, you just have to run even in your heels. The Sustainable Development Goal (SDG) number 10 isn’t quite focused on running in heels, but it is focused on inequalities. And women and girls face a multitude of inequalities especially within the refugee population. In spite of their perilous situations, these girls have a thirst for education and eagerly run towards it.

Women and girls need a myriad of things from love and support to opportunities and mentors. We need access to resources, quality education and initiatives that foster and highlight leaders within the family unit, the community, and society as a whole. Most importantly we need education – and by education I mean good education. The type of education that makes you think critically; it emboldens you and makes you believe you can solve any problem. Quality education will mold leaders, thinkers and advocates that are empathetic and tell you:

Think about what you think will inspire others and let’s do that!

Julia Wiklander, Founder, Girls’ Globe

Zaynab Abdi is a refugee of Somali and Yemeni descent. In a radio interview and at the Social Good Summit she told the audience about the tumultuous details of her journey to the U.S. and the various roadblocks she encountered along the way. She left her home in Yemen after the rapid deterioration in 2011, and stayed with family in Egypt. However, the conditions in Egypt were also unsteady. So, she sought refuge in the U.S. and many years later she reunited with her mother. In her interview, she discussed the need for a sense of normalcy among refugees. After experiencing so many devastating things, she just wanted to be reminded of the happy things in life.  Her happy thoughts consisted of returning to high school. Once she returned she excelled; her story is just one of many examples of refugees and displaced people seeking a small sense of hope and calm in the elements of life that we often take for granted.

According to Under Secretary of State Anthony Blinken, “this is largest wave of global displacement since WWII.” The UN High Commissioner for refugees states that we are now witnessing the highest levels of displacement on record which consists of 21.3 million people. This large group of diverse people may include young women and girls who are innovators, great thinkers and thought leaders; however, without access to sustained periods of quality education reaching their full potential may be deterred. “Only 1% of young refugees end up in universities, and a small percent go to secondary school,” says BBC journalist Alan Kasujja.  This is a stark and evident inequality and although the short term effects may not highlight this, the long term effects will surely spotlight the millions of people without hope. Because education is simply that when you say to yourself – if I just had the chance, the possibility, the opportunity. Hope in a classroom.

My aunt once told me something that I think every women and girl needs to hear every once in awhile:

You are braver, stronger and smarter than you think! 

Zaynab Abdi told everyone how brave she was and expressed her desire to continue her education. She reminded the audience that she had key skills and she is worth investing in.

So now it’s your turn. Remind someone today that they are braver, stronger and smarter –  they are Girls’ Globe.

Cover photo credit: India Girls Banner on Flickr

SDG 10: Let’s Not Leave Adolescent Mothers out the SDG Talks

On September 25th the United Nations adopted the 17 new Sustainable Development Goals (SDG) that reflect global ambitions to reduce inequality and create more prosperous societies. Goal #10, which aims to reduce inequality within and among countries, will not be achieved without empowering women and girls. The targets under this goal are closely related to girls and the laws and policies that affect them.

In order to ensure that the targets for the SDGs are met, where it concerns girls, one must take a look at the policies and discriminatory laws that affect this population. Two policies to take a closer look at are those that prevent adolescent mothers from re-entering school and mandatory pregnancy testing. These laws and policies explicitly discriminate against girls and do not provide equal opportunity for them to receive an education and have a positive economic outcome.

In many developing countries when a girl becomes pregnant she is expelled from school. The stigma she undergoes and the educational policies do not support her re-entry into the educational system after she has had the baby. There are a few countries, however, that have re-entry or reintegration policies that support adolescent mothers returning to school. These policies were intended to support them, but due to the stigma associated with becoming an adolescent mother many girls do not return. Most of these policies are very general, lack sound implementation and evaluation, are not properly enforced and often are not supported by educational authorities.

Also in many developing countries girls undergo mandatory pregnancy tests or medical screenings. These mandatory screenings are a way to identify those who are pregnant and subsequently expel them from school. Girls are often forced to undergo poking and prodding of breasts and other areas. These screenings are normally done without parents’ consent or knowledge. Moreover, girls are left to feel ashamed, embarrassed and afraid. There is also no support in place for girls who are identified as being pregnant or any protocols in place to address any potential trauma.

It is important that these SDGs don’t become just goals, but that they include plans at the local level that are executed to meet the target. Organizations and policy experts must take a look at these policies remove laws that discriminate against girls and adolescent mothers. Educational authorities must also evaluate and assess re-entry and reintegration policies to see if they are truly supporting the adolescent mother in the pursuit of her education. It’s pivotal that leaders bring together the different sectors that impact girls and include girls themselves in the policy development and conversations. This will ensure that the policies are truly meeting the needs of the girls. Lastly, these policies have one thing in common- they have an effect on girls’ education. It is key that educational authorities be held accountable for the proper implementation of the policies and continued success of girls.

If we are to achieve SDG 10 by 2030, local leaders and national policy makers need to account for how their decisions regarding girls’ health will affect inequality both immediately and long-term. A community will cease to prosper until preventative and supportive reproductive resources are available to girls and women.

Illustrations for the SDG campaign have been made for Girls’ Globe by artist Elina Tuomi.