ASHA workers are the prime movers in population control in Assam

TERESA REHMAN

Momataz Begum, 34 has completed a decade as a ASHA worker. She is the dedicated ASHA of Tukrapara village with total 1440 population and 293 households. She works under the Tukrapara Sub-Centre under Chaygaon PHC in Kamrup (Rural) district.

She had studied till class 9. In July 2007, she did training at Chaygaon PHC. She became an ASHA worker after having two children. “When the local ANM nurse came to invite me, I did not know what I was getting into. Then I went for a seven-day training at Chaygaon PHC. Then I realised the importance of an ASHA in a woman’s life. I wish there was a ASHA worker to guide me when I was expecting my baby. There were so many things that I did not know,” she said.

She is a busy person today. She goes door-to-door enquiring about expecting mothers and vaccination etc. Till ­­date, she has managed to get 50 tubectomies done. She agrees, “Men don’t want to take responsibility. We bring role models to talk to them. But it is difficult to convince them.” She said that once Dr Illias Ali came for a meeting and told everyone that family planning is in our religion.

momataz
Momotaz Begum, ASHA worker

A medical doctor Dr Illias Ali has been waging a silent revolution in minority areas and creating awareness for adopting a small family. In fact, he has been able to convince many Muslim men to go for vasectomy. In fact, the cites the Holy Quran in convincing people. He explains, “Islam in fact, talks about family limitation methods. There is a mention of “azol’ in the Holy Book, which means coitus interruptus (ejaculation outside vagina). During the time of Prophet, some of his companions tried to reduce the chances of conception and pregnancy by practising azol.”

Dr Ali informed that in a in a random study conducted in 2456 participants in a male sterilization procedure in 2009-10 in Assam, 1390 (55.37%) were Hindus, while 1066 (43.40%) were Muslims. “And it bears reiteration that of Assam’s population, Muslims constitute 30.92%( as per census report 2001). Another study of 2383 people who underwent permanent sterilization procedure in Barpeta district of Assam in the year 2011-12 of which 996 were Hindus (41.2%), while 1387 (58.8%) people of the group were Muslims. As a Muslim family planning activist, I strongly believe that there is a change in the attitude towards family planning within the community as they have realised that a small family is imperative to socio-economic growth.”

And on the ground, it is ASHA workers like Momataz Begum who are the changemakers. Now people approach Momataz for all their worries. When it is a complicated ceaserean case, it is referred to a bigger hospital. “Since, I am a mother, I can’t see another mother in trouble,” she says. She gets Rs 600 for all hospital deliveries. She proudly claims, “There has not been a single maternal mortality since I took over as a ASHA worker. I feel like I am rendering a service to society. If I was not there, so many mothers would have died.”

This lady is wise. She says, “After many years of independence, it was only in 2006 that ASHA workers have revolutionised the entire health system. I would like to thank the health minister Himanta Biswa Sarma. But she feels that the government should give more incentives to us. We are the true soldiers of the society.”

Since, she took over, the number of childbirths per family has come down. When I had first joined, I had delivered 50 babies on an average. But now the number has come down to 20-25. “Our men think that only the mothers suffer when they undergo childbirth. Therefore, it is their responsibility to think of family planning methods,” said Momataz.

Though she can ride the cycle since her school days, she prefers to walk around the village. She uses the bicycle only in times of emergency. And her supportive husband often drops her in his motorcycle. “Sometimes, a family does not have a single penny and I pay them from my own pocket. Sometimes, I don’t eat or drink for the whole day. And the guardians assume that we are mere government officials and are simply doing our duty,” she says. Her phone number is with every expectant mother. My phone is on 24×7. “Our responsibility ends after we take them to the hospital. Then the doctors take over. But the attendants insist that I have to be there till the delivery is done. Sometimes, I feel it’s a thankless job,” she rues.

As she walks to every eligible candidate’s house in the village, Momataz says, “Most of the women are illiterate. Sometimes we have to explain the same thing 3-4 times. Their family elders advise them not to have iron folic tablets as they think it will harm them. Then I try to explain to the mother-in-law. They try to tell us that our mothers never did that. Nothing ever happened to them,” she says.

Momataz adds, “Women usually go for tubectomy. Men fear that they will lose their virility. They are selfish. I advise them not to have many children. In fact, I tell them that land size will not increase. Where will the family stay?”

She feels that doctors sit in the hospital and they are mostly unaware of what’s happening in the society. “They never come to see what’s happening on the ground,” she rues. She feels that ASHAs like her are ushering in a silent revolution in the health department. “A man can never do my job. He has a lot of anger and ego. Women have a lot of sympathy and love. If I get news about a labour pain, I leave my food and rush. Sometimes, the delivery takes place on the way. I can do a normal delivery. I have learnt from experience,” she narrates.

Momataz feels that now she is now truly connected to her society. “Had I not been an ASHA, I would have been a mere housewife. I would have confined myself to my house and family. Now, the entire village is my family. Even doctors and nurses know us. Everyone respects us. Except the government who is yet to accord us our due honour,” she says.

Busy as a bee, Momataz is also part of the village health and sanitation committee. “If we can have public meetings. I am trying to convince people about vasectomy. It still remains a challenge for us. I am trying to change their attitude. Now they had faith in us. Earlier they thought that we are trying to earn money by giving advice,” she says.

The role of ASHA workers like Momataz Begum are even more important now as the Assam government has drafted a Population policy and has proposed a strict two-child norm. Families with more than two children will not be eligible for various benefits under different government schemes including applying for government jobs and becoming members of panchayats and civic bodies. 

Terming the policy as a socio-economic intervention, Health Minister Himanta Biswa Sarma claimed that Assam’s population has registered a one-crore increase between 2001 and 2017 which can also be attributed to early marriage in the char (riverine), tea gardens and tribal areas. Assam population according to 2011 census is 3.12 Crore. There was increase of about one Crore population in last decade. The policy stated that 17.07 increase rate of population is unsustainable for the state. The government, meanwhile, has sought public suggestions on the draft population policy, which would be put up in the public domain, before it is finally placed in the state assembly in August.

This proposed population policy has been hailed by Halima Khatun, an ASHA worker in Jawkata village under Sontoli PHC in Kamrup (Rural) district in Assam. She has started citing this in her door-to-door interactions with people in her village comprising of a total population of 1075 population. As a ASHA worker for the past 10 years, she says, “Some people are adamant and foolish. They even refuse to go for institutional delivery. It’s a challenge to convince them.”

She can see a sea-change in the attitude of the people now. Most families have two children these days. There are only around 10 families with 4-5 children. “I tell them that they will be happy only if they have a small family. But people are still reluctant to adopt permanent methods of family control like tubectomy or vasectomy. They say that if they do this, they will rot in hell. Still I try to convince them,” she says. They adopt other methods like contraceptive pills, condoms and Copper T.

Halima has a tough time convincing men to go for vasectomy as they will they will lose their virility if they do so. “I tell them that on the contrary your virility will increase as you will have a happy life as you will be able to provide for your children.”

Halima, who studied upto class nine feels a sense of pride as she wears her uniform and walks around in her village. “People say that I look like a nurse. I feel happy as I am able to make my villagers happy. I feel I have a fulfilling life. I want my village to be happy like a flower garden,” she says.

But it’s these foot soldiers of the state’s health department – the ASHA workers who are the real changemakers on the ground when it comes to population control.

(Photos: Author)

Teresa Rehman

Teresa Rehman

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