Anju, a visibly undernourished woman, surrounded by three scrawny children and a toddler perched carelessly on her hip, looks out of a small room she calls home from a grimy back lane in the heart of Patna. Her husband is a rickshaw puller. When asked about her age, Anju timidly replies – twenty. One of her neighbours, living in a similarly cramped room, who has just delivered a baby girl, is nineteen. Travelling through just one locality, say, Kadam Kuan in Salimpora Ahra in Patna, Bihar, one merely gets a glimpse of the grim reality faced by women in this country. As one heads towards Dargah Road in Sultanganj region, one sees most families comprise numerous children and pale mothers.

A resident of the slum region of Dargah Road, Najma Tabassum, in her early thirties, is a mother of five. Soon after appearing for her high school examinations, she was married in 1996. Today, despite her education, she plays no role in decision making in the family– not even for things regarding her own life.

“The responsibility of taking care of children, cooking food and maintaining the household lies on my shoulders but decisions regarding how many children, to educate them or not, what to cook, what to buy and what to wear– these lie with my husband, who sells shoes in the local market,” says Najma. Bringing up five children, Najma’s health has taken a beating. At thirty, she already appears as tired as a fifty year old woman.

Najma sees her neighbours sending their children to Anganwadi Kendras in the locality and benefitting from them, but she cannot go against her husband’s wishes.

Marriage before the age of eighteen and reproducing children without a gap of two years, more often than not, imparts the poor health of the mother to her children. According to the National Family Health Survey, about 10 million girls worldwide are married each year before the age of 18, and one-third of these live in India. While most states in the country have registered a decline in the percentage of underage brides, Bihar heads the list of number of child marriages in the country. According to a recent survey, 69.9 per cent of women aged 20-24 are married or are in union before 18 years in Bihar, and almost one in five are married or in union before 15 years. Of these, about 56 per cent are in rural areas. Nearly 76 per cent of the girls have no education.

These statistics represent lives of several voiceless Najmas and Anjus whose health is compromised often pay the price with shorter lives. At about 300 maternal deaths per one lakh births, Bihar has the fourth-highest Maternal Mortality Rate (MMR) in India and one of the highest MMRs in the world.

Worldwide, educating women is considered to be one of the most important factors towards bringing a change in the current scenario. Empowering them to take decisions regarding their own marriage, family planning, health and life at large, can be facilitated through education. “One cannot, however, turn a blind eye to the facts and cultural mores that require no surveys or statistics to focus on the role men play in a woman’s life in a patriarchal society. It has always been “the man” who decides whether it will be a condom, oral pill, a DMPA injection or nothing at all. This has not been addressed by any of the government schemes thus far,” point out health activists.

Last year, the Bihar government launched a programme through an agreement with Jhpiego, a US body in the field of health care services and developing human capacity worldwide. Under the agreement, Jhpiego provided technical assistance to the Bihar government in the area of post-partum family planning and pre-service education for nursing and midwifery cadre in the State.

Recently, Union health minister Ghulam Nabi Azad rolled out the ‘door-to-door contraceptive’ programme across all districts of the country where oral pills and condoms would be made available to all families at their doorsteps in rural India. The pilot scheme launched in 233 districts of 17 states was declared a success. Despite such initiatives by the government, there is still a lack of awareness on issues which directly or indirectly affect women’s health. (Charkha Features)

Undernourished young mothers pose a serious health problem both towards themselves and the children they rear. Of the 10 million girls worldwide married each year before the age of 18,

one-third live in India.