It’s a busy morning at Dr Rani Bang’s modest clinic in Shodhgram, Gadchiroli. There are a good number of young and elderly women waiting outside as she walks into the hospital run by SEARCH in this backward district of Maharashtra.

The women have travelled across several villages to keep their appointment with Amma, as they call her. They prefer the welcoming atmosphere here to the unfriendly air at the government-run primary health centres. With its thatched roofs, mud-brick walls, and a temple dedicated to the local deity Danteshwari, this hospital is designed to make the tribal and rural people feel at home. It is here that Bang has spent most of the last three decades trying to understand and deal with health problems faced by the tribal and rural women of Gadchiroli. As co-founders of SEARCH, she and her husband, Dr Abhay Bang, have earned global recognition for their pioneering work in the region, including an incredibly successful model of dramatically reducing newborn mortality rates.

“The missing linkages in our healthcare policies, programmes and implementation are still a cause for concern. While the National Rural Health Mission has had some success at making basic primary healthcare services available to the rural areas, the absence of affordable, good quality secondary and tertiary care undermines our ability to meet emerging health challenges,” she says, taking a quick break between seeing her patients.

The growing incidence of cancers among Indian women, for example, is something that the health system is ill-equipped to tackle effectively. Research shows that mortality-to-incidence ratio in breast cancer among rural Indian women is as high as 66 compared to 8 in urban women.“There is an urgent need for awareness and mass screening for early detection of uterine and breast cancers,” says Bang. “While such services may be available in the urban areas, rural women don’t have access to these facilities.”

Bang also points to systemic flaws in the public health system, especially when it comes to women. Gynaecological problems constitute 92 per cent of the unmet needs of rural women. “They account for nine out of every 10 medical cases. Our studies in Gadchiroli show that barely 8 per cent of women seek professional help for these problems.”

The maternal health component of the reproductive and child health programme has also had only limited success because it fails to offer the total gamut of reproductive healthcare, skewed as it is towards target-driven family planning. “The lack of trained staff at our PHCs results in the absence of maternal care during and after the delivery. Maternal care needs to encompass issues such as post-natal depression, which is very common but rarely discussed. Our health institutions also need to support women affected by infertility,” says Bang.

Further, obesity, hypothyroidism, hypertension, diabetes and stroke are some of the non-communicable diseases that rural women and men are now having to live with. All these need treatment and management over the longer term, leading to debilitating effects not just on health but also on their finances.

With rapid urbanisation of rural life, people are also at higher risk of diseases related to environmental pollution and increasing presence of chemicals in the food chain — trends little understood in terms of actual impact on the health of current and future generations. Rising alcohol and tobacco consumption too bring its own set of challenges. “We have to broad-base our interventions, stepping beyond the realm of doctors, health clinics and medical technology to look at nutrition and preventive care.”

She warns of the indiscriminate use of the morning-after emergency contraceptive pill. “Many young girls buy these pills over the pharmacy counter and consume them without professional medical advice. This has serious repercussions, including incomplete abortion, following which these girls often turn to quacks to undergo criminal abortions,” says Bang, adding this trend has been a big contributor to the rise in unsafe abortion rates in the rural areas.

Sexual health awareness a must

One way to counter this would be to increase awareness related to sexual health and contraception among adolescents — an effort she is involved in through her State-wide workshops with young boys and girls. However, there are challenges here, too. “Our social outlook towards premarital sex and pregnancy has not changed at all. There is still a lot of stigma attached to both. There is also unwillingness, even in government programmes, to talk about contraception to unmarried girls and boys,” she says, signalling gently that it is time for her to go back to the women patiently waiting outside her clinic.

The writer is co-founder of India Development Review

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