Visiting the Communities, Part 3: ASHA Home Visits – Blog Posts #6

Continuing to post all my blogs đŸ™‚

Sunday, June 26th 

Continuing on about my first week in Purnea and the communities:

Saturday – ASHA Home Visit: What I really liked about Saturday was actually being able to get my first true glimpse into who ASHAs are and the positives and negatives of their incorporation into India’s health system. The ASHA that helped us around the community that day was really sweet, but she did not seem like she was fully committed to her responsibilities as an ASHA. For example, she was not wearing her ASHA uniform and she was not able to properly conduct the home visit, so Prabha had to show her. The first house we went to belonged to a 20-year-old, her husband (who was currently out of town for work), and her two children (8 yo and 2 1/2 yo).  It was really difficult to get her to open up, mainly because her husband was not there. While Prabha was asking her questions and going over the ASHAs booklet with her to explain permanent and temporary contraceptive methods, other women started to gather (which probably made her more uncomfortable, but this was a common occurrence; often, the women would even answer for her). Even her brother-in-law came, and surprisingly, he was more interested in the information that Prabha was giving out – he actually pulled Prabha aside and asked about information on the pill for his wife. However, while Prabha was asking her questions and giving the girl the information, she seemed very distracted because she was trying to take care of her children. Prabha commented that if she had waited a little longer to have her second child, her first child would have received a lot of attention and a lot of love, and would be more mature by now, but that was not the case. Prabha asked her when she was married, whether she was studying at the time, whether her parents were why she stopped studying, whether her in-laws wanted to her to have another child, whether she was familiar with SRH/HTSP information, and if she wanted to have a child later rather than now. With some effort, she responded saying that she was married at 15 yo and wasn’t studying at the time because her parents said no. She said that her in-laws did want another grandchild, and she agreed that she wanted a child later. But when presented with the information, she said she would not like/choose any of the methods until her husband was here. I was also able to ask her questions, but I felt that by then, she just wanted to be done. I was able to ask her a few questions, but she gave short responses. She said that she already knew about some of the contraceptive methods, but that she would only accept them if her husband said to. She also said that she believes girls should be married later, but that her home community and parents believe in early marriage. It was interesting to see that the woman I met at the next house had a very different outlook on early marriage. When I asked the woman there about her thoughts on Sashakt and beliefs regarding early marriage, she said that she really likes the work of the ASHAs and what Sashakt was doing. She also said that boys and girls should get married at the legal age established by the government, and that she herself tells people not to have their children/daughters married off early. In fact, she said that even her family was against early marriage. She also told me that her and her husband were metric pass (12th grade pass, which is pretty impressive, esp. in rural parts of India) and that after having her last child, her and husband agreed that sterilization was best (different from other women I had met, who said their husbands didn’t agree to getting an operation). There were many women surrounding her who joined in on the conversation and some more that we met when we shifted to their “chabootra” (common gathering place). I was able to ask the women what the common reasons were for practicing early marriage, and they gave me the following responses:

  • As a girl develops and people see her (e.g. working in the field, earing 200-300 rupees), then they feel that she should get married. People later start thinking that the girl’s parents are just keeping her at home, getting her fat. The community pressures girls to get married early (societal pressure).
  • Girls look prettier when they are younger, not after 17-18 years of age. (I believe I even heard that after 19-20 years of age, girls are considered old.)
  • The younger the girl, the lower the “dahej” or dowry money. The older she is, the more dahej.

I was later able to also interview the ASHA and BCM, or Block Community Mobilizer. I had never heard of a BCM before, but I learned that he is the head of the ASHAs. Any health-related information given to him by the government, he passes on to the ASHAs, who then pass it on to the community members. I also learned that there are guidelines set by the government for the ASHA selection process, and that the local government (“Panchayat”) head, Medical Officer in Charge (head of the primary health center), and the BCM have to say yes. The ASHAs are then given 7 days of training (and have been given additional training by Pathfinder). He said that it has been 6 years since the ASHAs have been implemented into the health system, and overtime, there training, knowledge, and approach have improved. Nonetheless, they do not earn a salary and taking a woman to the PHC, which is far from the community, is quite difficult. Even though ambulances are available in communities, in this community, only 1 is decently functioning out of 2. Some ASHAs are also illiterate.

I definitely learned a lot yesterday, and I am especially more interested in learning about the ASHAs, given that they are a vital component of Sashakt, but are also known to be ineffective in some ways (but I can’t blame them, given that they don’t get a salary, and being an ASHA seems to be like a full-time job). I am also interested in talking to a greater sample of community women to get a better idea of what they believe regarding early marriage and Sashakt. I will try to communicate to Prabha and Ravi what I want to do.