Jigyasa Mishra

Illustration

P. Sainath

Editor

Sharmila Joshi

Series Editor

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Poonam parts Rani’s hair into two sections, then
oils and braids it tightly. But before she can tie in a rubber band, the child runs
outside to play with her siblings and friends. “Dost
sab ke abitai, e sab saanjh hoite ghaur sa bhaig jai chai khela lel [As
soon as their friends turn up, they all run out to play in the evening],” says
Poonam Devi about her children, as she prepares 
dinner. Rani is her eight-year-old, second daughter.

Poonam has three daughters and a son. But it’s
only for her son – the youngest of her four children – that she has a birth
certificate. “Humra lag me ette paai rahitay ta
banwaiye letiye sabke [(If I’d had the money, I would have got it
for the other three as well],” she says.

Her kachha
house is fenced by bamboo sticks like many dwellings in rural Bihar. Married to Manoj, 38, a daily wage
labourer, she lives in Ektara village of Benipatti block of Bihar’s Madhubani
district. Manoj makes around Rs. 6,000 a month. 

“I am now 25 years and a few months old,” says
Poonam (all names in the story have been changed). “My Aadhaar card is
with my husband and he is not home right now. I don&#39;t remember exactly how old
I was when I got married.” If she is 25 now, she was probably around 14 at the
time of her marriage. 

All of Poonam’s children
were delivered at home. “The dai [traditional birth attendant] helped every time. We consider going to hospitals
only if the situation seems critical,” says Saanti Devi, 57, Manoj’s aunt. She
lives close to their house in the same mohalla
and considers Poonam to be her own daughter-in-law.

“Like most of us, Poonam did not know the
procedure to obtain a birth certificate,” says Saanti Devi. “To get it made,
one has to go to the district hospital and pay a certain amount of money. I do
not know how much.” 

Payment for a birth
certificate?

“Takkhan ki
[Of course]! They don’t give it [the certificate] for free here. Do they
elsewhere?” With ‘they’ Poonam refers to the ASHAs (Accredited Social Health
Activist) and hospital staff. “Paai lai chhai,
ohi duaare nai banbai chhiyai [They
all ask for money, that’s why we couldn’t get the certificates for our girls],”
Saanti adds.

Both Poonam and Saanti Devi – and indeed everyone
in this mohalla – speak in Maithili. The language has over 1.3
million speakers in the country, mainly concentrated in Madhubani, Darbhanga
and Saharsa districts of Bihar. It is also the second-most spoken language in
neighbouring Nepal.

Interestingly, the Prathmik
Swasthya Kendra (primary health centre) in Ektara is located barely 100 metres
from Poonam’s house. The PHC, say locals, mostly remains closed, except for the
rare days when the compounder shows up. “The last time he was here was three
days ago. He usually opens the hospital twice a week, but the doctor also
rarely turns up and we haven’t seen him too in months,” says Poonam’s neighbour
Rajlaxmi Mahto, who is in her 50s. “Dular Chandra’s wife is the dai we all call for deliveries. She lives in a
nearby hamlet. She is a trustworthy woman.”

<a href="https://www.researchgate.net/publication/342170461_Health_Infrastructure_in_India_Need_for_Reallocation_and_Regulation">A 2019
report</a> published in the Research
Review International Journal points
out : “According to the Niti Aayog, India has a scarcity of 6 lakh doctors, 20
lakh nurses and 2 lakh dental surgeons. Though the World Health Organisation
(WHO) recommends a doctor to patient ratio of 1:1,000, in rural India it is
1:11,082 and in some states like Bihar it is as low as 1:28,391 and in UP it is
1:19,962.”

The  report also
notes that “around 80% of India&#39;s 1.14 million registered [allopathic] doctors
work in cities which are home to just 31% of the country’s population.” It’s
the same story with physical infrastructure, like PHCs, district health centres
and hospitals. That makes the proximity of the PHC to Poonam’s house even more
ironic. 

We’re talking while standing in Poonam’s dalaan – the semi-open area between the
verandah and the rooms of a house. In Bihar, the dalaan is often used by men or elders as a living space.
After a while, a few more women from the neighbourhood join us. They seem to
prefer that we go inside a room, but we continue the conversation in the dalaan. 

“When my daughter had to deliver, we rushed to the
Benipatti aspataal [hospital]. The
delivery was planned at home earlier, but at the last moment we got to know
that the dai
had gone out of station. So my son and I took her to the hospital in an
autorickshaw. Upon delivery, the on-duty nurse demanded 500 rupees from us. I
told her we could not give that amount and as a result, she made us struggle to
get the birth certificate,” says Rajlaxmi. 

And that experience, at the lowest end of the
health chain, captures the story of the torment, the irony and dilemmas
confronting poor women here.

With the lack of infrastructure, doctors who don’t
show up, private medical services that are either unaffordable or dangerously
incompetent – poor women depend a great deal on the assistance of the ASHAs. If
anyone has been at the frontline of the battle against Covid at the village
level, it has been the ASHA worker. 

Walking door to door while everyone else was
quarantining for safety, ASHAs have been out, risking their lives for
vaccinations, medicine distribution, pre and post-natal care, besides various
other tasks assigned to them. 

So when petty corruption raises its head at the level
of the local auxiliary nurse midwife (ANM), the ASHA, and the anganwadi worker,
women like Poonam and Rajlaxmi are helpless. The amounts demanded may appear
small but for poor women here, these are more than they can afford.

The ASHAs too, including the few resorting to such
practices, are under immense pressure. There are over a million ASHAs across
the country who essentially connect the rural population to the public health
system. They perform an incredible array of tasks at great risk to themselves.
In many parts of the country, they were required since April last year to visit
25 households every day, each of those at least four times a month, surveying
them for the coronavirus. And that, with <a href="https://ruralindiaonline.org/en/articles/ashas-fighting-a-pandemic-with-no-protection/">very
little protection</a>. 

Long before the pandemic, in 2018, ASHAs in Bihar
– at 93,687 the second largest contingent of such workers in India – had
mounted a huge strike demanding better pay. The strike was called off after
various promises were made by the state and central governments. But nothing
happened.

05-COVER-ILLUSTRATION-JM-In_Madhubani_girls_are_born_but_not_certified.jpg

In March this year, led by the ASHA Sanyukt
Sangharsh Manch, they again struck work, with the slogan: “Ek hazar mein dum nahi, ikees hazar masik manday se kum
nahi [1,000 rupees increment
is not enough, don&#39;t settle for less than 21,000 rupees monthly honorarium).” 
They also demanded government employee status for ASHA workers. Presently,  ASHAs in Bihar average at best Rs. 3,000 in a
month – even that income accruing from unsteady ‘honorariums’ for their
multiple tasks.

Governments seem to make them promises each time
they go into strike action – then renege on their commitments. They are no
closer today to government salaries, pensions, or other job benefits. It is
incredibly hard to live and work as an ASHA, or for that matter as an anganwadi worker.

Meena Devi, an ASHA from Darbhanga, says: “You
know how underpaid we are. How will we survive if we do not take the money they
[families with newborn babies] give us happily? We never force anyone or demand
a specific amount. Whatever they give with happiness is good for us, be that on
childbirth or for the making of birth certificates.&quot;  

And that might be true of her and some others –
there are lakhs of ASHAs across the country who indulge in no such practices at
all. But that is not the experience of very poor women here in Madhubani and
some other parts of Bihar who speak of demands amounting to extortion.

Manoj’s parents used to live with him and Poonam,
and the couple’s first three children -- Anjali, 10, Rani, 8 and Sonakshi, 5.
But his parents are no longer alive. 
Their fourth child and only boy, Raja – now two and a half years old –
was born after their passing. “My mother-in-law had cancer. I don’t know which
type, though. She died some 4-5 years ago. Then after my father-in-law’s demise
three years ago, it&#39;s been just the six of us. He always craved for a grandson,
I wish he could have seen Raja,” says Poonam.

“See, earlier I did not know about this janam patri [birth
certificate] thing,” says Poonam who went to school only up to Class 6. Her
husband Manoj has passed Class 10. “Only after my third delivery, when the ASHA
asked me for money, did I get to know that such a thing called birth
certificate exists. As I recall, it was some 300 rupees she asked for. I
thought it was the normal fee. But then my husband told me that we don’t need
to pay anyone for the certificate. Getting it free from the hospital is our
right.” 

“Kahalkai adhaai
sau rupya diyau tauhan janam patri banwa deb [She said I will get the birth certificate
made if you give me 250 rupees].” We got it done for our son as she had reduced
her demand by 50 rupees. But we could not afford the further sum of 750 rupees
which she demanded for getting the certificates done for our daughters as
well,” Poonam tells me.

“If we try getting it directly made ourselves, we
would have to go to Benipatti [block headquarters] hospital. There, we’d have
to pay something to the safaiwali [sweeper]. So money has to be spent either way –
whether we pay the ASHA here, or travel all the way to Benipatti,” points out
Poonam. “We decided to let it be. We’ll see if those [certificates] will be
needed anytime in the future. My husband makes barely 200 rupees a day. How can
we spend what would be his four days’ earnings – just like that?” Poonam
asks. 

Saanti adds, “I even had an argument with an ASHA
once. I told her clearly that if we have to pay, we would rather not get the
certificates made.”

By then most of Poonam’s neighbours are already
leaving for the weekly haat (rural market) in the village, aiming to reach
there before it gets dark. “I am waiting for Sonakshi’s father [as Poonam
formally refers to her husband],” she says, “so that we can also go and buy
some vegetables or fish. I have been cooking dal
and rice for three days now, continuously. Sonakshi loves rohu [fish].” 

It does seem there are matters more immediate and
pressing than birth certificates for daughters.

PARI and CounterMedia
Trust&#39;s nationwide reporting project on adolescent girls and young women in
rural India is part of a Population Foundation of
India-supported initiative to explore the situation of these vital
yet marginalised groups, through the voices and lived experience of ordinary
people. Want to republish this
article? Please write to zahra@ruralindiaonline.org with
a cc to namita@ruralindiaonline.org . Jigyasa Mishra reports
on public health and civil liberties through an independent
journalism grant from the Thakur Family Foundation. The Thakur Family
Foundation has not exercised any editorial control over the contents of this
reportage.

In Madhubani, girls are born but not certified

મધુબની: જ્યાં દીકરીઓ જન્મે તો છે પણ એમની નોંધણી નથી થતી

‘कागज’ से बेदखल मधुबनी के बेटी लोग

मधुबनी: जिहां नोनी मन के जनम प्रमाण पत्र नई बनय

मधुबनी: जिथे मुलींचे जन्‍म दाखलेच बनत नाहीत

మ‌ధుబ‌నిలో పుట్టిన ఆడ‌పిల్ల‌లకు స‌ర్టిఫికెట్లుండ‌వు

مدھوبنی: جہاں بیٹیوں کے برتھ سرٹیفکیٹ نہیں بنتے

മധുബനിയിൽ പെണ്‍കുട്ടികൾ ജനിക്കുന്നു, പക്ഷേ രേഖകളില്ല

মধুবনীতে মেয়েদের জন্ম নথিভুক্তিকরণ: ফেলো কড়ি মাখো তেল

ಮಧುಬನಿ: ಇಲ್ಲಿ ಹೆಣ್ಣು ಮಕ್ಕಳಿಗೆ ಜನನ ಪ್ರಮಾಣ ಪತ್ರ ಮಾಡಿಸಲಾಗುವುದಿಲ್ಲ

মধুবনীত ছোৱালীৰ জন্ম হ’লে প্ৰমাণপত্ৰ নাথাকে

ਮਧੂਬਨੀ ਅੰਦਰ ਕੁੜੀਆਂ ਦਾ ਜਨਮ ਬਗ਼ੈਰ ਜਨਮ ਸਰਟੀਫ਼ਿਕੇਟ ਦੇ ਹੁੰਦਾ ਹੈ

ମଧୁବନୀରେ, ଝିଅମାନେ ଜନ୍ମ ହୁଅନ୍ତି ମାତ୍ର ଜନ୍ମ ପ୍ରମାଣପତ୍ର ବିନା

मधुबनी: जहां बेटियों के जन्म प्रमाणपत्र नहीं बनते

மதுபானியில் பெண் குழந்தைகளுக்கு சான்றிதழ்கள் இல்லை

Madhubani

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Want to republish this article? Please write to <a href="mailto:zahra@ruralindiaonline.org" target="_blank" rel="noopener noreferrer">zahra@ruralindiaonline.org</a> with a cc to <a href="mailto:namita@ruralindiaonline.org" target="_blank" rel="noopener noreferrer">namita@ruralindiaonline.org</a>

In Madhubani, girls are born but not certified

Women from poor families in Bihar’s Madhubani district face hurdles when accessing health services at the best of times. So when petty corruption surfaces in the few systems that serve them at all, they’re helpless

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