By Patricia Mukhim
The decadal growth rate in Meghalaya according to the 2011 census shows an upward spiral. But this should not surprise anyone. According to the National Family Health Survey (NFHS)-3 for 2005-6, Meghalaya tops the graph among all 28 states for the highest fertility rate and the lowest contraceptive use (unmet needs for family planning) among women in the age group of 15-49 years. A survey made in four villages by the faculty of Martin Luther Christian University under the guidance of researchers from the Royal Tropical Institute, Amsterdam led by Pauline Oosterhof have revealed that women in the child bearing years have very little awareness about contraception. One of the villages is in Ri Bhoi district while three other are in East Khasi Hills. Individual interviews of women in the child bearing years and focussed group discussions among female only groups and male groups provides interesting perspectives about the hesitance to adopt contraceptive methods for family planning. While a casual questioning might reveal that they have no desire to reduce the family size, a deeper probe speaks otherwise. Most rural women are in a dilemma about whether it is “sinful” to use contraceptives. Much of this understanding of ‘sin’ comes from received wisdom. When asked how many children they wanted, their standard reply is, “Whatever God gives” (katba ai ei u Kynrad). Being a small community which often had to bring women from the plains of Sylhet or Assam for their men to marry (ring kongor) that argument held good at the time. Today a large family has economic costs. The health of the mother and children become unintended casualties.
Amongst the educated, middle class it is the man and woman as a couple either by marriage (church ordained or legally registered) or cohabitation (Ka jingiapoikha) who have the right to decide how many children they desire to have. But in the rural settings these decisions are influenced by religious affiliations, by the woman’s parents or in-laws, by social pressures (we are a small community and must beat the numbers game). Then there is also the question of the clan. Some belong to large clans, others to smaller ones. Since the Khasis practise matriliny, clan matriarchs would sometimes say that women should give birth to more children, preferably girls, to perpetuate the clan. While educated, urban women who straddle the pressures of work and family could shoot back and say they cannot appease their parents or in-laws because it is they who carry the burden, rural women often are diffident about talking back. At age 25, many already have three or four children with another one on the way. Their faces depict a listlessness and despondency, almost as if they are prisoners of their fates.
When these women were asked individually if they would want to space their children and when they were shown the choice of contraceptives, they would ask what are the ones most in use. They seemed to have an aversion for pills because of their likely impact on their health. They also seemed to harbour some doubts about Copper-T (an intra-uterine device). These aversions and doubts seem to arise out of conversations among peers and after listening to opinionated elders. But they cannot cite a single case study of any woman who had a health problem after taking contraceptive pills (Mala-D) or a monthly anti-pregnancy injection. When asked if their husbands were open to using condoms, most women were reticent. A few said, yes their husbands did use condoms. Others said they had heard of condoms but never really saw or touched them. Hence there is a lot of mystery surrounding the use of contraceptives in Meghalaya.
To test the availability of condoms, a group of young male and female researchers (who were getting ready to launch into a qualitative research on reproductive health needs and fertility desires among women in the reproductive age of 15-35 in rural Meghalaya) went to the local pharmacies to purchase condoms. They had varied experiences. Some reported that the pharmacists, mostly male, seemed embarrassed to sell condoms to young women. Others simply said they sold no condoms. Still others were diffident about showing the young women the different types of condoms available including their flavours. The pharmacists apparently did not display the condom boxes on the counter for the women to choose from and carefully see each type and variety. They took them out gingerly from inside the shelf, quickly gave them the condoms and just as quickly and furtively took them away and put them back in the boxes, unless the women asked to buy them. Even the male researchers had a similar experience. It was almost as they were being judged for buying condoms! So much for family planning awareness in Meghalaya!
At the villages, the researchers had mixed experiences. The ASHA workers on whom a lot of responsibility is devolved by the system (Government, Dorbar etc.),to capacitate women on their sexual and reproductive health, were, themselves, largely ignorant about the other more intricate details of reproduction. Their knowledge was at best half-baked. It is not clear whether they loved their work and therefore volunteered to do it, or they were there for the commissions they got from every delivery they reported to the health centres and the immunisations they got done. In some focussed group discussions (FGDs) the ASHA workers dominated the proceedings and did not allow women to speak for themselves. Much of the information volunteered was of course, assumptive.
When asked if the churches or any faith-based groups gave any awareness workshops or camps on contraceptive needs and benefits, the villagers said churches only preached on spiritual matters. Evidently the church does not want to venture into the sensitive domain of sexual and reproductive health. But the standard argument of all women with large families of 6 or 8 or 10 children, excluding those who had also died in between is “We take as many children as God gives.” When asked if they were able to provide for the needs of every child, including proper schooling etc, they did not have clear answers. From the interviews it transpires that education is not a priority. Women with 6-7 children and were still in their early thirties, shifted the burden of looking after the smaller kids to their sons and daughters who were themselves hardly 7 or 8 year olds. The children were skimpily dressed and did not seem as if they had their baths regularly and I am not being judgemental here but only speaking from the hygiene and health point of view.
An earlier research done by some faculty of MLCU found that Vitamin A deficiency is highly prevalent in rural Meghalaya. Some kids who have enrolled in institutions for the blind are found to have lost their eye-sight due to severe Vitamin A deficiency. Vitamin A is a fat-soluble vitamin that is naturally present in many foods. Vitamin A is important for normal vision, the immune system, and reproduction. Vitamin A also helps the heart, lungs, kidneys, and other organs work properly. There are two different types of vitamin A. The first type, preformed vitamin A, is found in meat, poultry, fish, and dairy products. The second type, pro-vitamin A, is found in fruits, vegetables, and other plant-based products. The most common type of pro-vitamin A in foods and dietary supplements is beta-carotene. Obviously diet is an important source of Vitamin A. But with vegetables, meat and fruits being unaffordable for most families, Vitamin A deficiency among children in large Khasi families is inevitable.
Childbirth entails responsible child rearing as well. It involves giving the child the best care possible which would include nutritious food, health care, education amongst others. It is perhaps more ‘sinful’ to bring children into the world and leave them to roam around dirty and unkempt. The ‘God’ argument therefore cuts no ice and it is incumbent upon the church to teach these basic lessons to their adherents. Religion is also about a good life on this earth and not an abstract aspiration for a “heaven” we have not seen. Above all, too many children in too little time is a burden on the mother and takes a toll on her health. These are issues that faith-based institutions might need to pay greater attention to. And maybe there are lessons for the health department to in these findings!