Sunday, August 3, 2003		Books

Stepping out into the other India
Aruti Nayar

Stepping Out: Life and Sexuality in Rural India
by Mrinal Pande. Penguin Books.
Pages 221. Rs 295.

THE apathy that our healthcare system is plagued by, all visible signs of progress notwithstanding, is brought out in Stepping Out. The well researched and feelingly written book is indeed a telling comment on the priority accorded to women’s health. The Maternal Mortality Rate (MMR) in 1992-93 was 424 deaths per 100,000 live births but by 1998-99, it had risen to 540. One in 11 abortions is conducted by an untrained person, while myths, superstition and biases continue to cloud the issue of healthcare of women. While armchair feminists continue to talk of women’s empowerment in airconditioned comfort, Mrinal Pande has travelled through the length and breadth of the country to compile women’s voices. With a passion that is laced with sincerity, she gives us a peep into the "other India", which we are either oblivious of or nudge out of our consciousness.

Diametrically opposed to the India of swanky shopping malls overflowing with goods and nursing homes comparable to five-star hotels is the superstition-ridden, filthy and feral world where the bare minimum basic healthcare is still what is was centuries ago. The author visited Gujarat, Maharashtra, Rajasthan, West Bengal and Tamil Nadu to gain an insight into the structure and functioning of their healthcare systems, which are very different from each other. She writes about her observations, backing them with requisite statistics. However, the narrative is not a mere documentation, bereft of involvement. It is "A journey into lives of women...a patchwork quilt of narratives" that demonstrates how women are captive to not only social constraints but also oppression that has the sanction of tradition and customs.

While listing facts and figures culled from her travels and interaction with women, healthworkers and functionaries of NGOs, Pande successfully weaves into her account a felt intensity and empathy for women.

Her anguish at the shame and superstition-ridden customs that deny rural women basic dignity and the way in which a woman’s body is abused and maltreated, rings true. Here is no armchair feminist waxing eloquent about women’s rights because it is fashionable to do so. Whether it is her perspective of isolationist childhood rituals that affected her own growing up years or the bonding between sisters and women or the interpolation of folk proverbs and maxims or snatches of conversation that she uses to put forth her point of view, there is no doubt that Pande’s work is seminal. Exuding a pulsating vitality, the reader is given a compelling account that does not allow statistics to overshadow the human cost that is exacted by an unfeeling healthcare system. Pande laments the abdication of the government’s obligation, especially in the face of globalisation and market economics, to provide basic healthcare facilities.

While Indian traditions extol motherhood, the government’s population policies focus on curbing fertility. Women’s health issues cannot be studied in isolation from their status and work. Often, the violence inflicted on her mars her health in the long run. Add to this fear and shame. Pregnancy is the only time a woman can discuss her physiology without a sense of shame, feels the writer. For the population policies to succeed, women have to be able to exercise control over their productive and reproductive lives.

Population policies should focus on creating a network even underprivileged women can access. This seems a tall order indeed, especially given the abysmal rural poverty, condition of urban slums and the negligible role of the state in putting a system in place. Nothing typifies the government’s casual approach more than the description of nurses (supposed to serve rural areas) who diligently maintain registers, visiting the households only when women they are supposed to treat have already left for work in the fields. Since Pande uses direct quotes of the women to drive her point, it adds to the impact.

Even in an urban set-up the nutritional needs of the women take a backseat to their caregiving roles. However, in the rural areas it is compounded many times over due to constraints of custom, money, time and lack of support. Any illness, be it an infection or pelvic inflammatory disease, goes unreported because fear and silence govern the lives of a majority of women. Infections, even when they become life-threatening, go unreported and, as a consequence, untreated. Women continue to drag themselves, performing chores and fulfilling roles and duties, be it tending to children or farm work or ferrying fuelwood and water over long distances. Women and girls eat last of all and that too only leftovers, snatched in-between chores. Money to buy medicines is scarce as is the access to a healthworker, leave alone a doctor.

Pande reposes immense faith in the devoted NGOs who are contributing to rural healthcare and women’s health in a significant manner. Given limited resources, infrastructure and funds, the reach of these NGOs is bound to be limited. In addition, NGOs are known to fudge figures and accounts. If the government healthcare system is bogged down by inefficiency and bureaucratic delays, NGOs too can be used by vested interests to siphon off funds and grants.

One cannot help wondering who is Mrinal Pande’s target audience? The women, whose problems and lives she has so graphically captured are not likely to read the book, neither are the lackaidasical health functionaries who govern population policies and programmes. But even if it succeeds in shocking the readers into an awareness of the pathetic healthcare system, it has served its purpose. The conscience does get a jolt but after reading about "lanes filled with sewage overflowing in the open drain" or in halls filled with women and children who have not washed properly..." we go back to leading our cushioned and sanitised lives.