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Among the seventeen Sustainable Development Goals (SDG) set up by UN to be achieved by 2030, health and well-being stands at the number three positions from the top. That means ensuring healthy lives and promoting well-being for all is a top priority of SDGs worldwide. The highest attainable standard of health is a fundamental right of every person. Many countries have committed to universal access to health for all in general and sexual and reproductive health for women in particular. However, gender-based discrimination have been undercutting this right. Discrimination renders women more susceptible to sickness and less likely to obtain care, for reasons ranging from affordability to social conventions keeping them at home.

Assam has been acknowledged as the first government anywhere to adopt and implement

SDGs. Formally adopting the SDGs on 1 January 2016, the Government of Assam, launched “Assam Vision-2030 Initiative” in August, 2016 towards achieving the goals. Significantly it has selected Char areas of the state as models in particularly identified deprived and vulnerable areas for preparing model SDG plans and implementation. The Char areas of the Brahmaputra valley has a unique feature of development exclusion coupled with geographical isolation, hostile terrain, naturally disaster prone with a society afflicted by poverty, illiteracy, population explosion and heavily gender biased. Lack of healthcare services and the distances the Char dwellers have to cover to access them is a major challenge that the state has to face to achieve the SDG of health and well-being. The issue of women related to healthcare in Chars is of prime importance as it transcends SDG 3 (Gender Equality).

Char and Chapori are colloquial Assamese words for river-islands or mid-channel bars in and off the Brahmaputra. There are 2,251 villages in the Chars and most of the Char lands are temporary in nature, often prone to severe flood and frequent erosion, as their formation depends on the shifting courses of the Brahmaputra. This implies impermanent, volatile existences for the people living in these areas. Char population comprises nearly 8% of the total population in Assam, with a huge 67.88% among them being below poverty line despite being the main source of agriculture economy and food supplier of Assam.

The public health system in the Char areas of Assam is almost non-existent and its people are unaware of the community measures to be taken for healthy living. Anaemia is very prevalent among Char women in Assam. Most of them drink contaminated water, take contaminated food, walk bare footed on damp soil containing hook worm larvae and spend most of the time in unclean and unhygienic environment. Moreover, almost all people of the Char areas go for open defecation.

As a part of a media fellowship programme under the ageist of National Foundation for India, New Delhi, a study has been made on women in Assam’s Char areas and SDGs covering 9 districts of Assam—Dhubri, Barpeta, Darrang, Marigaon, Nagaon, Sonitpur, Lakhimpur and Dhemaji districts. The existing health care scenario vis-à-vis women found in a pathetic state in Char areas of Assam.

In Dhubri district the status of health services in Char areas is very pathetic. It has Primary Health Centres in Bhogdahor Char, Boraibari Char, riverine PHCs in Airkata, Birshing Pt-1, Katlamari, Mahamaya Char, Nayaralga, Masaneralga and at Geramari (MPHC) and Kachokhana (SD). But they are too far from the villages scattered in remote Chars to extend medical and health care services on time. The present study indicates that 92.2% of the deliveries of the Char mother are taking place at home. Only 9.7% of the women from the Chars, are giving birth to their child in Government hospitals with a negligible 1 per cent in private hospitals.

Regarding assistance in delivery of child the respondents were found relying more on the untrained dhai (58.9%). The percentage of delivery under the supervision of the doctors or trained midwife is not encouraging in Dhubri district’s Char areas.

In Barpeta district there are PHCs in Baghbar and Alopati Chars and one riverine PHC at Baghmara Char and they are unable to cater healthcare demands of thousands of people living in faraway villages in Chars of the Brahmaputra. Regarding assistance in delivery of child the respondents were found relying more on the untrained dhai (55.87%). The percentage of delivery under the supervision of the doctors or trained midwife is not encouraging in Barpeta district’s Char areas.

In Drrang district there are PHCs in its Char areas, namely Magurmari and Arimari, Chereng Chapari, Saihar Char, Nangli Char (Non-functioning), Bherpori Char, Rowmari Char and in Badli Char. The study reflects that Char women have less access to government and institutional facilities for delivery of child. Just about 12% Char women use government facilities for delivery in Darrang district. More than 86% Char women deliver their babies at home assisted by untrained dhais. The percentage of Char women (44.4%) receive pre and post natal care is also very low in the district.

Morigaon district has two PHCs in Kathani Char and Ulubari Char and one SD at Sialmari. The district does not have any riverine health services despite having number of Char areas. Only places like Jengpori Bali Char, Dolonghat, Majorbori, Kolmoubari, Boralimari, Sialmari, Goroimari, Falihamari and Lengribori has some health centres like sub-PHCs. In most of the PHCs of the Char areas of Marigaon district the assigned medical and health officer is an Ayurvedic doctor. The present study indicates that 79% of deliveries of the Char mother are taking place at home. Only 19% t of the women gave birth to their child in Government hospitals with a negligible one per cent in private hospitals. The study revealed that in respect of assistance in delivery of child, the respondents were found relying more on the untrained dhais (61.6%).

In Nagaon district state health centres in Char areas are available in Jawani and  Kandhulimari (Riverine) in Dhing Revenue Circle. The study conducted in Char areas of the district indicates that in most of the cases the 89% of women make deliveries at home. Only 10% of them make it to institutional deliveries. As regards of assistance in delivery, most of the women (86%) and opt for untrained dhai for delivery of their baby.

Sonitpur districts have one PHC each in Kumalia, one riverine PHC in Bhojkhowa Chapori and one health sub-centre in Burha Chapori Char. There are sub-centres at Adabheti and Tenga Basti, two major Char areas of the district. The rest of the Chars have to come up with nearby centres which are miles away with no direct communication. The study conducted in Char areas of the district indicates that in most of the cases the 91% of women make deliveries at home. Only 9% of them make it to institutional deliveries. As regards of assistance in delivery, most of the women (87%) and opt for untrained dhai for delivery of their baby.

In the Chars of Lakhimpur and Dhemaji district, there are no health centres. As a result the health scenario in Chars of Dhemaji is discouraging with only one health Sub Centre at Kobu Chapori for which people have to come in boats to access it. Same is the case in Lakhimpur district where only one health Sub Centre is there in Katori Chapori.

The study has found that in most of the cases deliveries in Char areas of the districts are taking place at home. This trend is in conformity with the findings of the NFHS 3 (2005-2006). In the case of sample families home delivery is found to be above the national average of 51.3%. As such dependency on untrained dhais is evident from the study. Similarly very few women were seen to receive pre and post natal care. The benefits of the ICDS scheme are found to be utterly insignificant. People also feel that the benefits of the ICDS have remained inaccessible to the inhospitable terrain of the Chars as only a few are benefiting from the scheme. The birth control concepts are also not popular in the Char areas of Assam despite relentless effort by Dr. Elias Ali, a Padmashree Award winning doctor from Darrang district who have on a mission to check population explosion amongst Char people in Assam.

The biggest burden that the women in Chars in Assam carry is the early marriage and and frequent and high childbirth. In the surveyed villages there are three generations of women who have been married at their tender ages of 13 to 15 years and having given birth children as many as ten times. The phenomenon in most cases is that both the mother and daughter give birth at the same period. Besides causing a huge impact in their health and well-being, it turns their life a mere tool of reproduction and satisfying the wishes of their husbands. In most of the cases they are impregnated to have a male child—a discrimination that the girls and women face in every steps of their lives. In that process a woman is found bearing child multiple times until she delivers a male one. This has contributed towards high number of maternal mortality deaths among Char women in Assam.

Secondly rampant polygamy reduces the status of women in Chars to a state of indignity. Taking advantage of a very narrow interpretation of Islam, polygamy has been in practice since a very long time in which some males are found married to as much as 9 women. The rampant misuse of the Triple Talaq system is also attributed to this evil practice in Chars. The influence of global fundamentalist Islam and its preaching available easily through online has created more trouble for women in Chars of Assam. There was earlier no dress code for women in their societies. But the latest global trends and its strict adherence by the clerical class in the Chars has forced its women to wear black head-to-toe Middle-Eastern burqa along with hand gloves, shoes and glasses in hot, humid conditions making them further alienated from the rest of the mainstream society. The Taliban-ISIS styled kangaroo courts and their sentences are also being reported in some Char areas where the victim is always a woman, lashed publicly for alleged adultery.

In case of hygiene and wash issues only 1.4% of households in Char areas have sanitary toilets. As a result women in Chars are still living in conditions where hygiene and sanitation are absent. Foe their everyday response to the call of nature or for their menstrual periods, women endure hardships and are found to be there without the minimum dignity they deserve. As a result open defecation is still very common and girls and women using sanitary pads are nil in Chars. During flood their situation becomes more troublesome as they have to use banana tree rafts to survive or to move on and have to defecate on water. This causes epidemics in post-flood Char landscape.

The Government of Assam, in a bid to achieve SSDGs within the timeframe launched “Assam Vision-2030 Initiative” in August, 2016. A nodal department, Transformation & Development (T&D) has been formed since January 2016 for coordinating all the activities within various state departments for achieving the SDGs in Assam. Working groups have been formed with all state departments for plan preparations and Capacity Building trainings have also been organized so far. In the Economic Survey of Assam (2016-17) a chapter has been included on indicators and targets for monitoring the progress of achievements of Assam Vission-2030. These indicators and targets have been designed in sync with the SDGs. A 7 Year SDG Strategy Paper and 3 Year Action Plan (SPAP), as desired by NITI Aayog, was initiated in mid-2016 and an Outcome Budget has been taken with strategic mapping of SDGs for the first time in Assam. Five state conclaves on various goals of the SDGs have also been held so far in Assam. However, the most important part of implementing the SDGs is monitoring and documentation of progress. Government of Assam has been working on identification and determination of state-specific core SDG indicators and benchmarks for SDG targets. A set of 59 State-specific Core Indicators have been identified and are planned to be monitored at regular interval at different disaggregated levels. For SDG Good Health and Well Being state department of Health & Family Welfare is synergized with Education, Public Health Engineering (Water and Sanitation) as primary and Excise, PWD (Rural Roads and Road Safety) and Transport departments as secondary supporting departments. From these developments there is optimism about a change and transformation concerning life in general and for women’s health in particular in Char areas for Assam.

(The writer is a fellow at National Foundation of India, New Delhi)

 

 

 

One Comment

  1. K SHESHU BABU says:

    Many tribal people of Assam live below poverty line. The government should take steps to alleviate these people by providing education and employment. Since the area they live has chances of flooding almost every year, they must be provided permanent shelters