Reproductive Trauma Narratives from Rural India

Manali Karmakar draws on the illness narratives of three women from rural India to showcase how caste, gender, and sociocultural and geographical location strongly shape reproductive health and well-being.

“Logicoscientific knowledge attempts to illuminate the universally true by transcending the particular; narrative knowledge attempts to illuminate the universally true by revealing the particular” (Charon 2001).

India is acknowledged as one of the few nations that has enforced the most progressive reproductive laws for promoting the holistic well-being of women. Way back in 1971, the Medical Termination of Pregnancy (MTP) Act was enacted to enable women to access safe and affordable abortion services. Recently, in 2021, the MTP Act was amended in order to respond to the growing crisis pertaining to women’s health issues and to reduce the stigma and prejudices surrounding the notion of abortion.

However, it is unfortunate to witness that in spite of the best attempts made by political, legal, and medical organisations, reproductive laws have failed to make an impact in every corner of the country. The limitations related to the MTP (Amendment) Act 2021 are being underlined by journalists such as Mansi Vijay (2021) and Seerat Chabba (2021). Chabba foregrounds the continuation of the discrimination and stigmatisation of unmarried women seeking abortion care. Susheela Singh’s (2018) study reveals that half of the pregnancies in India are unintended and only 22% of abortions are done through public or private health facilities. Vijay reports on how the LGBTQIA community continues to struggle to access “safe abortion, and other sexual and reproductive healthcare services”. Buckshee (2021) draws our attention to how the global pandemic has adversely affected Indian women, whose physical and mental health conditions were worsened due to the limited accessibility of reproductive health services, foregrounding the inadequacy of the medical infrastructure to respond to the multiple facets of ‘pandemic violence’.

Senior Advocate Jayna Kothari (2019) argues that reproductive law in India has failed to garner its objectives because women’s health and reproductive rights are studied through narrow perspectives. Normatively reproductive health crises such as “maternal death, child marriage, female foeticide, sex selection, and menstrual health and hygiene” are studied as discrete phenomena to be addressed by medical and legal bodies.

This article contests this approach and emphasises studying the problems by taking into consideration the complex web of socio-cultural factors that contribute to the failure to accomplish the objectives visioned by the Indian legislation. Amidst the evidence-based data-driven research, narrative research related to subjective experientialities of women stands as a living testimony to the sociocultural, political, and economic inequality and injustice that has been insidiously consuming the lives of people living in rural areas of India. Women’s individual narratives also enable us to take into account reproductive health traumas that are not given adequate attention in the premise of reproductive rights. These life narratives draw our attention to a range of health issues like amenorrhea (absence of period), inexplicable abdominal pain, urinal infection, vaginal discharge, cramps, muscle weaknesses, and nerve-related issues borne by women working as daily wage labourers. Drawing on the illness narratives of Manjula, Gayathri, and Tanuja from rural India showcases how caste, gender, sociocultural, and geographical location strongly shape the reproductive health and well-being of an individual*. This post, which references illness narratives archived on the PARI website, draws on a critical perspective from the concept of the social determinants of health (SDH) in order to highlight how generational poverty creates a vicious cycle of reproductive trauma for women. McGibbon and McPherson (2011) define SDH as a perspective that analyses the “structural causes-of-the-causes of social and material deprivation that leads to ill health” (59). It studies how intersectional causes such as poverty, lack of education, and accessibility of good healthcare services may have a compounding effect on the well-being of a nation.

A view from high up of three small dwellings with corrugated roofs
A view of the Madigara keri, colony of the Madiga (Dalit) community, in Asundi, where Gayathri and Manjula reside. Photo: S. Senthalir / PARI / http://bit.ly/3kUmyWe

Gayathri, Manjula and Tanuja’s stories

Twenty-eight-year-old Gayathri is an agricultural labourer who experiences ‘stomach cramps and back pain’ in spite of the fact that her menstrual periods stopped a year back. Gayathri states that “she feels like she is going to labour again… it’s hard to even stand up”. She does not know why her period stopped at an early age and what could be the possible reason for the recurrent abdominal pain. She wonders if is it because of “falling from the chair, kidney stone, or menstrual problem”. Similarly, 25-year-old Manjula “is also in pain and in all the times. She suffers from severe stomach cramps during her period, and abdominal pain and vaginal discharge afterwards”. The illness narratives of Gayathri and Manjula corroborate the health crisis of Tanuja who works as an informal labourer in a beedi factory (a factory that manufactures mini-cigars filled with tobacco flakes). She has been suffering from pain and stiffness in her lower back and reports that the majority of the women workers suffer from “nerve pain as well as pulmonary issues and even tuberculosis”. Gayathri, Manjula, and Tanuja represent women from the peripheries of society who have also been victims of illiteracy, early marriage, multiple pregnancies and accidental or self-induced abortions, along with poor sanitation and nutrition. Gayatri and Manjula reside in spatially-segregated Dalit colonies. They do not get adequate infrastructure to fulfil the basic requirements of their lives and hence women compromise on fundamental requirements, for example Gayathri who tries “reducing her water intake as a solution”. The saved water is used for bathing and cleaning utensils. Gayathri reports that now when she goes for urination, “it takes me at least half an hour to pass urine. It becomes too painful.”

In 2018, a couple’s baby girl (parents top row) developed a fever and passed away before they could take her to the hospital located close to the Kaimur Wildlife Sanctuary. But even this centre is decrepit and its broken-down ambulance has not been used for years (bottom row). Photos: Anubha Bhonsle and Vishnu Narayan / PARI / http://bit.ly/40hq1ht

The women state that they are reluctant to use existing government facilities because “while visiting a state-run hospital is cheaper, it involves waiting in long queues for follow-up tests and scans. The subsequent loss in daily wages is crippling”. Private medical care is not affordable as the expenditure outpaces their monthly income. Gayathri’s story states: “At the private clinic, the doctor advised her to get a blood test and an ultrasound scan of the abdomen. A year later, Gayathri has not undergone the diagnostic tests. At a minimum of Rs. 2,000, the expenditure seemed steep. “I couldn’t do it. If I went back to the doctor without these reports, they would scold me. So, I never went back,” she says. Due to a lack of financial resources, women from rural areas primarily rely on unregistered doctors and pharmacists who give painkillers, “a cheap and quick solution”, thus enabling them to resume their work at the earliest opportunity.

These stories demonstrate how the intersectionality of caste, gender, and religious discrimination along with the ever-prevalence of poverty creates a vicious order of illiteracy, ignorance, and negligence that has a saddening impact on present and future generations of rural India. The socio-cultural upliftment of rural India is an ever-growing challenge because of stagnated sociocultural practices and prejudices aligned with inadequate and inaccessible infrastructure such as primary healthcare facilities, educational institutes, and transportation.

 

*Despande explains, “the Indian Caste System is historically one of the main dimensions where people in India are socially differentiated through class, religion, region, tribe, gender, and language…The caste system is a classification of people into four hierarchically ranked castes called varnas. They are classified according to occupation and determine access to wealth, power, and privilege. The Brahmans, usually priests and scholars, are at the top…At the very bottom are those considered the untouchables (Dalits)” (Despande 2010, 2).

 

About the author

Manali Karmakar is Assistant Professor in English at the Vellore Institute of Technology, Chennai Campus. She earned her PhD from IIT Guwahati and specialized in the area of Medical Humanities (Literary Studies, Medicine, and Biotechnology). She is the principal investigator of the SPORIC SEED GRANT project titled Labour, Birth, and Agentic Crises in Maternity Ward in the Urban Setting: Pluralistic Qualitative Mixed Method Research. She is on Google Scholar.

 

References

Buckshee, Devina. 2021. “Dispatches from India: Pandemic Impacts Women’s Health.” Yale School of Public Health. Yale School of Medicine. https://ysph.yale.edu/news-article/dispatches-from-india-pandemic-impacts-womens-health/. Accessed 31/1/23.

Bhonsle, Anubha, and Vishnu Singh. 2022. “Decrepit Health Centres and ‘Bina-Degree’ Doctors.” Population Foundation of India. https://populationfoundation.in/decrepit-health-centres-bina-degree-doctors/. Accessed 1/12/22.

Charon, Rita. 2001. “Narrative Medicine.” JAMA 286 (15): 1897. doi:10.1001/jama.286.15.1897

Chabba, Seerat. 2021. “Just How Progressive Is India’s New Abortion Law? – DW – 11/18/2021.” Dw.com. Deutsche Welle. https://www.dw.com/en/abortion-in-india-bridging-the-gap-between-progressive-legislation-and-implementation/a-59853929. Accessed 18/11/22.

Despande, Manali S. 2010. History of the Indian Caste System and its Impact on India Today (Senior Project). California: California Polytechnic State University. https://digitalcommons.calpoly.edu/socssp/44

Jayna Kothari, Maya Unnithan & Siri Gloppen. 2021. “A Half-Written Promise.” Return to Frontpage. https://www.thehindu.com/opinion/op-ed/a-half-written-promise/article62109912.ece. Accessed 5/12/22

Khator, Smita. 2022. “Women Beedi Workers’ Health: Up in Smoke.” People’s Archive of Rural India. https://ruralindiaonline.org/en/articles/women-beedi-workers-health-up-in-smoke/. Accessed 31/10/22

McGibbon, E. & McPherson, C. 2011. “Applying Intersectionality & Complexity Theory to address the social determinants of women’s health.” Women’s Health and Urban Life, Vol 10, no. 1 (Special Issue), 59-86.

Senthalir, S. 2022. “The Private Torment of ASUNDI’s Dalit Women.” People’s Archive of Rural India. https://ruralindiaonline.org/en/articles/the-private-torment-of-asundis-dalit-women/. Accessed 18/8/22.

Singh, S., Shekhar, C., Acharya, R., Moore, A. M., Stillman, M., Pradhan, M. R., Frost, J. J., Sahoo, H., Alagarajan, M., Hussain, R., Sundaram, A., Vlassoff, M., Kalyanwala, S., & Browne, A. 2018. “The incidence of abortion and unintended pregnancy in India, 2015”. The Lancet Global Health, Vol 6, no 1, 111–120. https://doi.org/10.1016/s2214-109x(17)30453-9

Vijay, Mansi. 2022. “India’s ‘Progressive’ Abortion Law Is Failing LGBTQIA+ Indians.” Indiaspend. https://www.indiaspend.com/health/indias-progressive-abortion-law-is-failing-lgbtqia-indians-836771#:~:text=While%20India’s%20Medical%20Termination%20of,their%20reproductive%20choices%2C%20experts%20said. Accessed 28/9/22.

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