In West Medinipur, accredited social health activists (ASHAs) have brought down maternal and infant deaths, but are an unhappy lot
Only 18, Bijol Mahato is expecting her first child. Shelistens keenly as Chhobi Mahato, an accredited social health activist (ASHA)with Dakhinsole sub-centre, explains that though counselling about earlypregnancy has helped in some cases, there is still pressure from in-laws todeliver the first child quickly in villages. Like the young would-be mother,Nilima Mahato also listens quietly as Chhobi patiently explains the techniquesof breastfeeding.
Like Bijol and Nilima, Chhobi, who recently completed a yearworking as an ASHA, takes her health-related help to nearly 170 householdsacross three villages. On a balmy January afternoon, Chhobi comes visitingexpecting mothers in her village, Nandaria. Cutting across a maze of mess andmisconception prevalent among residents, it’s hardly an easy job.
“Once the first child is born, a mother-in-law usuallyrelaxes,” Chhobi says, referring to her advises to young Bijol. “The secondchild usually is born after three to five years but they (locals; morespecifically, in-laws) don’t seem to understand that it affects a woman’shealth.”
Corroborating, Bijol’s sister-in-law Mallika says sheexperienced complexities when she delivered her first child at 18. “Doctorstold us that either the mother or the child can stay healthy,” she says. Herfirst child is now five years old, and Mallika suffers from high blood pressure— a result of the complications encountered at the time of delivery.
It is very important, for instance, for an expecting motherto take regular doses of iron pills to ensure development of the unborn child.Reluctance to use contraception is another challenge health activists like herface in the villages, Chhobi says. And her observation is validated by thelikes of Shefali Mahato, who just had her second child. “I have never used anykind of contraception. My husband had said that we will take care,” Shefalisays. The deep-seated misconception about contraception is evident from peoplelike Seema Mahato, who says that both she and her husband are afraid of usingcontraceptives. “What if we die?” she asks, alarmed.
Chhobi says she has been trying to convince people to wearintrauterine device (IUD), telling them that it is safe and hassle-free. “Pillsdry up breast milk, while condoms are unreliable,” she says. All a woman needsto do is go to the health sub-centre and ask for an IUD — the ANM, she says,will do the needful.
Besides addressing the ground-level challenges, Chhobi saysASHAs also have to deal with irregular, in fact a paltry, pay, among otherissues. “We do not have a fixed income. We earn only when a woman getspregnant, or a child is born,” she says. “Our work is hectic but we will workwith more enthusiasm if we get our payments regularly.”
Frustrated, many ASHAs had recently stormed the districtmagistrate’s office to voice their grievances, Papia Adhikari, district secretaryof the ASHA workers’ union, affiliated to the All India United Trade UnionCentre (AIUTUC), says. She claims that ASHAs were initially paid `800 permonth. But the earlier format was scrapped and a new one implemented in October2011, through which ASHAs receive remuneration based on their work. ButAdhikari says that’s not enough: “We want a fixed salary, gratuity, andpension. Our payments are delayed by eight months. We have to nearly revoltevery time to get our money.
