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Title

Empowering Communities: Integrating women’s traditional
health practices for sustainable health delivery systems in a
globalizing environment.

Abstract

In a country where non medical primary research on developmental health care (and
especially research grounded in alternative socio-cultural paradigms) is a rarity, there is
a need to integrate voices of women who are the repositories of traditional knowledge
for sustainability of health care interventions. Studies such as this provide the space for
rethinking health education and promotive health care strategies that respect culture and
traditions and focus on women's health while promoting self-reliance.

County Credited

India

Author Details

AUTHOR
Title of author / Dr.
Surname / Capila
First Name / Anjali
Name of Institution / International Planned Parenthood Federation-South Asia Regional Office
Address of Institution / 66, Sunder Nagar, New Delhi-110001, India
E-mail address of author /
Author biography
Anjali Capila has a PhD. in Development Communication from the University of Delhi. She has taught at the post-graduate department of Community Resource Management and Extension at the Lady Irwin College New Delhi for over two decades. She is the author of two books and has shared her work extensively both at national and International conferences. She is a Salzburg fellow and is currently working as the Programme Officer Adolescents with an International NGO( IPPF)

Category

Sustainable Development

Theme

Gender Equality
Health Promotion

Type of Contribution

Case Study

Empowering Communities: lntegrating women’straditional health practices for sustainable health delivery systems in a globalizing environment.

Anjali Capila

In a country where non medical primary research on developmental health care (and especially research grounded in alternative socio-cultural paradigms) is a rarity, there is a need to integrate voices of women who are the repositories of traditional knowledge for sustainability of health care interventions. Studies such as this provide the space for rethinking health education and promotive health care strategy that respects culture and traditions and focuses on women's health while promoting self-reliance.

This paper is based on a research carried out by me and documents the traditional health practices of women in the Kumaon hills in India. I gratefully acknowledge:

All the Kumaoni Women

The Community Health workers, and

The Dais, whose wisdom enriched this journey,

The rugged faced yet gently smiling women that you see in the photo are the ones whose health beliefs and knowledge I have documented. These traditional health practices are decreasing in importance in the face of what Illich terms increasing "medicalization and commercialization of life" (Illich, 1976). My approach towards advocating for the integration of holistic health

practices involves not merely documenting the practices, but also pointing out those that are beneficial to women, harmonious with nature and the life cycle, and others that are unscientific and obsolete.

In order to understand these issues, one must take a quick glimpse at the locale where the research was situated. Kumaon (in the newly formed state of Uttaranchal) is located at the foothills of the majestic Himalayas (the highest mountain range in the world); the entire area is considered dev bhoomi -the abode of the gods.

This paper is based on a year of participatory research with a nongovernmental organization (NGO) called Central Himalayan Rural Action Group (CHIRAG). I conducted my study in six villages in the Kumaon hills with a group of 60 women between the ages of 18 and 45 years. Of the six villages included in the study, two received no health inputs while the other four benefited from the CHIRAG (NGO) assisted outreach programs.

I chose to work with health workers as entry points for my research because they had rapport with the community and knowledge of health-related issues. The research documents not only health practices but also the dynamics of reaching far-flung areas through education and training .The methodology (listening to women talking about health practices) brings alive the skill of listening to the "hum" behind the words as women articulate the lived experience of knowledge constructs.

I would like to highlight the wisdom articulated by a health worker (named Kishni Devi) who said, "Life and health are one," and good health depends on a healthy environment, in the village, family, and society in general—which she saw as interlinked. Her ideas in a way reflect the World Health Organization (WHO) definition of health.

The theoretical framework for the analysis is derived from Ivan Illich's (1976) research on "cultural iatrogenesis," which can be described as the inability of individuals to deal with irremediable pain and impairment, decline and death. That culture and health coincide marks the central theme of the analysis.

Looking at the health delivery systems in a developing world like south Asia becomes significant also from another premise—the vulnerability of Indian women to a whole gamut of health risks literally from "cradle to grave." Women's health is linked to their environment; therefore, shortages of fuel, water, and fodder increase Kumaoni women's workload. Yet, implementation of India's population programs has been slow to address this issue or link women's health, in general, to their lower status in society (Karkal, 1995).

Poverty; lack of access to potable water, schools, and hospitals; and the bleak living conditions in the mountains subject women to a constant cycle of drudgery and deprivation. Added to these are the burdens related to early marriage, multiple and unsafe pregnancies, and high infant mortality rates ((IMRs) CHIRAG, 2000). Against this background, it was important to establish an innovative way of looking at health as an integral part of environment, culture, social knowledge, and practices that constitute the totality of health and development. The health scenario in Uttaranchal mirrors that of some rural areas in Indiawhere there is poverty, social deprivation, poor household hygiene practices, water scarcity, and housing problems. Land and forest degradation in rural areas and overexploitation of groundwater is seriously threatening sustainability of livelihoods in the country.

The district-level health facilities begin at the primary health center (PHC) level, which is staffed by two medical officers who do three days fieldwork, followed by three days in the Out Patient Department (OPD) and monitoring of sub centers. Health supervisors (male and female) and auxiliary nurse midwives (ANMs) also are based at the PHC although they visit surrounding villages. The ANMs are responsible for complete antenatal care. Although the ANMs are capable of handling cases and the government infrastructure is a strong one, my research found that the ANMs relied excessively on the services of the NGO, CHIRAG clearly indicating that an NGO should not replace a government program but should strengthen and support it wherever required.

After looking at the health scenario of Uttaranchal, I moved on to document the unheard voices of Kumaoni women with special reference to their reproductive and child health management practices. At this point, the research became an interesting blend of narration of "mother wisdom" woven into lived experiences. Modern practices have intervened in some instances (immunization and breast-feeding practices, for example), while other customs (like child birth/delivery) have not changed much over time.

Some of the myths related to menstruation stem from tradition. Since girls get married when they are prepubertal, they could be living with their in-laws when they menstruate for the first time. In this context, women from the village talked of a ceremony where a married adolescent who has menstruated for the first time sits with a coconut on her lap, signifying her potential to become a mother. The research also brought to light a practice that modern societies find inexplicable—the segregation of a menstruating woman. Conventionally, hill communities consider menstrual blood to be impure; they feel that the body is gettingrid of impurities through menstrual blood. Whereas earlier a woman would be kept in a cowshed with a piece of sacking to absorb the menstrual fluids, she now may be isolated in a room in the house in the more forward-looking families. She is not allowed, however, to cook or to go to the temple in either case. While women gain the positive benefit of rest from household work for that period, they still have to go to the fields and forests to cultivate and forage. This custom was true for 28.3% (of the 60) women who participated in the study. Women cited custom, tradition, and the belief that Kumaon is dev bhoomi as reasons for the continued isolation during their menstrual cycle.

Women use old (thus, disposable) cloths and worn-out clothes while they are menstruating, and they lack not only knowledge but also enough water or clean sanitary pads to maintain proper hygiene. Moreover, elderly women believe that reproductive tract infections are difficult to cure because they are impure in the first place and unworthy of attention from the gods. A woman who is menstruating is not given milk to drink and milk products to eat; the reason given by many women was that this is "outside the realm of our decision-making process" as it is believed that the cow (which is considered sacred) will stop giving milk. These practices give rise to emotional tension—women feel that they are "lesser human beings—the whole, episode is a nightmare". These snapshots of women's "voices and experiences show the linkages of the... canvas and their health practices creating the total picture like the warp and weft of a piece of fabric.

Childbearing constitutes another very critical episode in women's lives. In the Kumaon hills, the mother herself cuts the umbilical cord when the baby is born; if she is too weak to do so, the mother-in-law or the birth attendant (called Dai in the local language) performs that task. Although the dais are trained to sterilize the blade and use rubber cloths, practices like allowing the flow of residual blood from the cut cord toward the infant remain controversial. Medical doctors feel that such a practice may affect the infant's heart after the delivery. Powerful symbolism is reflected in the practice of burying the placenta under a fruit-bearing tree, which represents the potential of the woman to continue bearing children (just as a fruit-tree bear’s fruit); however, burying the placenta under a fruit-bearing tree and covering it with a stone symbolizes an end to child bearing. This symbolism carries a tradition-based family planning message.

LEARNING AND CREATING……

While all this unfolding was happening in terms of understanding the practices related to important milestones in a woman’s reproductive life, I began to see the importance of listening to women's roles as keepers of health and health care practices, as repositories of knowledge of local health practices. This was a valuable observation withregard to women's knowledge of traditional health care. Although women bear the brunt of care giving and possess conventional knowledge and skills, their wisdom does not find a place in the modern health care scenario. Even indigenous health practitioners (called vaids) who are largely the guardians of the curative aspect of this ancient wisdom do not value women's expertise. This devaluation has resulted in the erosion of the wealth of knowledge and has made an impact on the faith of the people in traditional knowledge. .

Overall, my research on which this paper is based advocates for an analytical and conscious adoption of beneficial practices that fit with the life of the hill communities—not a blind and ritualistic faith in traditional practices. The entire study calls for a holistic approach to health, a judicious blend of traditional health care practices and modern medical systems. Culture is a determinant of addressing the health needs of any community. Practices like the mother cutting the umbilical cord of her own child show the ownership shehas over her health and that of her family.

This journey was unique because I explored women's health practices not from merely transmission of knowledge but from a community-centric perspective. It is also valuable because it completes the "research-action" loop. Based on the findings of this research I was instrumental in setting up an AdolescentTrainingCenter in the villages that were served by CHIRAG, with essential health information in their language and idiom along with skills. Recently I have been back to the mountains to thank the traditional birth attendants and health workers for their participation in this magical journey.

References

  • Central Himalayan Rural Action Group (CHIRAG). (2002a). Fact Sheet, Uttaranchal, Retrieved September 7, 2004, from
  • Central Himalayan Rural Action Group (CHIRAG). (2002b) Sargarkhet clinic report. Sargakhet, Kumaon: Author.
  • Government of India, Planning Commission. (2003). Approach paper to the tenth five yearplan (2002-2007). Retrieved September 6, 2004, from
  • Illich, I. (1976). Medical nemesis: The expropriation of health. New York: Pantheon Books.
  • International Institute for Population Services (UPS) and ORC Macro. (2000). Nationalfamily health survey, 1998-1999. (NFHS-2). Mumbai, India.
  • Karkal, M. M. (1995). Our health: How does it count? An overview. In K. Malini (Ed.), Ourlives, our health. New Delhi:
  • Coordination Unit for the Beijing Conference. Office of theRegistrar General, India, (n.d.). Census of India. Retrieved September 6, 2004, from
  • Sethi, N. K. (2001). Health constraints of Uttaranchal on population stabilization and relateddevelopmental issues. Paper presented at the Conference on Health Development andPopulation Stabilization Issues. Uttaranchal, India.
  • World Health Organization. (1946). Constitution of the World Health Organization. RetrievedSeptember 9, 2004, from
  • World Health Organization. Western Pacific Region. (2000). A Report of the ConsultationMeeting on Traditional and Modern Medicine: Harmonizing the two approaches. Geneva:

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