Written by Sarah Simpson

This past January, I made my first trip to India, together with 20 other students from around the world. For three weeks, we worked with the Tata Institute of Social Sciences (TISS) in Mumbai researching urban public health issues in the slum communities of Mumbai.

My project group sped around town in rickshaws and trudged through sludge and dust to study urban health in Shivaji Nagar, located in the M-Ward which is home to some of the largest slums in India. These 600,000 residents live near the Deonar dumping ground – a man-made mountain of debris and trash.

During our first day, we toured Shivaji Nagar, attracting lots of attention from the community, especially the kids who followed us everywhere. While walking through the slums areas, we were introduced to the “Mahila Mandals,” or traditional local women’s groups, that act to address public health issues caused by the breakdown of government services. They are community-based women’s organizations that seek to improve sanitation and health in the slums. Through broken English, translators and gestures, we learned firsthand how the health of these communities is complicated by many issues ranging from waterborne illnesses to infectious and communicable diseases, and is compounded by inadequate nutrition and overcrowded and poorly constructed living conditions. Historically, Mahila Mandals came together during times of celebration, sorrow or crisis; however their roles in their communities have evolved with the times. Our group decided to focus our research on finding out more about this evolution.

Instead of using a needs-based or problems-focused approach we decided to highlight the community’s assets by writing a case study. We did this by using a SWOT Analysis (Strengths, Weakness, Opportunities and Threats) to help investigate how to best utilize these important community assets. Over the course of two weeks, we traveled to different slum areas and interviewed six Mahila Mandal groups, including both registered and unregistered groups of varying size and membership. We found that not only do Mahila Mandals work to solve issues with sanitation, but that they also promote immunization of children, maternal and child health education, small business funding schemes and resolve domestic violence issues.

To help solve their community sanitation problems, the women frequently collect money for the cleaning of sewers and public toilets. Keeping these facilities clean decreases the exposure to the disease causing vectors and organisms that cause malaria, diarrhea and other maladies. Other community roles include the set-up of Anganwadis or child development centers, which provide childcare services. Children are fed and educated here, ensuring proper childhood nutrition, while alleviating some of the burden of care from their parents. Many of the women involved in these groups are also community health workers with ties them to the local urban health center. As part of their duties, they ensure the vaccination of children, which is especially instrumental in keeping infections, such as polio from re-emerging. Tuberculosis also continues to be a huge public health issue in India, and these women ensure through directly observed treatment programs the prevention of non-adherence to treatment and development of resistant tuberculosis strains. In addition, they also provide training to women on the importance of pre- and post-natal nutrition, family planning options and support for domestic violence incidents.

Their impact is limited mostly due to funding and support from the local community and government. Unregistered groups in particular, are only able to generate funds through community fundraising, which only enables them to solve immediate problems. During our case study interviews we were constantly asked for donations, and we regretfully had to explain over and over, we were students just there to study these groups. And many times, they would say,

“Then what is point of all this? What can you do for us?”

This presented some important ethical questions to consider, as TISS invited us to research these problems and recommend solutions, however, how will these recommendations be implemented after we leave? As this internship program continues, bringing more and more foreign students to trudge through these communities, will they finally have had enough of this “intrusion” and no longer welcome them? However, they still welcomed us into their homes, fed us despite our protests what little food they had to share, and truly made our experience in India unforgettable. Despite not having funds to give, as a thank you for taking the time to speak with us, I created a photo-journal, which we presented to each group we interviewed as a token of our time with them. Since leaving India, I felt compelled to share my experiences, however due to our research not being “approved” by a research board and consent limitations, it’s been frustrating to find ways to properly do this.

At the end of our study, we contended that if more government funding could be mobilized for community-based participatory research programs, communities would more able to identify, support, and mobilize existing resources to create shared visions of change and encourage greater creativity in solving community issues. Along with funding, there is a need for an infrastructure for delivery of care. Apart from services provided by the Mahila Mandals, NGOs, and private clinics and pharmacies, health services are practically nonexistent. Services such as provision of specialized information, physical exams, diagnostic services, hospitalization, medications, follow-up care, prevention, and surveillance need a proper infrastructure that includes specialized and trained personnel. None of these social services can be provided or created by the slum residents themselves. Other services such as access to water and electricity are also desperately needed in these communities.

Support from the local community is also important for the conducting of Mahila Mandal activities. We found that many of these groups consisted of mostly “grandmothers”. This seemed to be due to established gender roles, with younger women discouraged from participation, staying in their roles as “house-wives”. We learned that this is just the tip of the economic, religious as well as cultural hindrances that prevent women from actively participating in these groups.

Most importantly, these groups present a great opportunity to organize women around common issues, challenging and overcoming caste and class hierarchies. They not only provide opportunities for dialogue and discussion, but they also contribute to the capacity of members to understand and find solutions to their community issues and challenges. These groups are prime vehicles for enhancing the position of women in Indian society, as their participation in these groups provides an opportunity for women to take an active part in public affairs.

Overall, community organizations, like the Mahila Mandals, are important for sustainable improvement not only to public health, but for social change as well. While poverty reduction, self-empowerment, and elimination of disparity are important and worthy goals for improving health care in these communities, the speed of development and size of urban slums render achievement of these goals enormously challenging.

Our internship presentation can be found at: http://prezi.com/i0lbgveimbyc/copy-of-indian-urban-slums/

Experiences, Learning, Platform, Projects

Mahila Mandals: A community health study

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