‘I walked off alone, to get my tubes tied’

The only thing she can read or write is her name. She writes it proudly, in Devanagari, with careful strokes: Go-Puh-Lee. And then she laughs, peals of infectious laughter.

Gopli Gameti, 38, and a mother of four, says women can do anything they set their minds on.

In this cluster of barely 30 homes on the outskirts of Karda village in Udaipur district’s Gogunda block, Gopli delivered each of her four children at home, assisted only by other women from the community. The first time she ever went to a hospital was a few months after giving birth to her fourth child, her third daughter, to undergo a tubal ligation procedure.

“It was time to accept that our family was complete,” she says. A visiting health worker from the Gogunda community health centre (CHC) told her about the “operation” that would prevent further pregnancies. It was free of cost. All she had to do was make it to the CHC, a government-run rural hospital catering to villages served by four primary health centres (PHCs), located 30 kilometres away.

Several times, she broached the subject at home, but her husband took no note. She steeled herself over months, wondering while she breast-fed her youngest child whether she had it in her to see her decision through.

“One day, I just walked off saying I’m going to the dawakhana [clinic] to get my tubes tied,” she says, smiling at the memory, speaking in broken Hindi and Bhili. “My husband and mother-in-law came running behind me.” There was only a brief argument on the road, for it was clear that Gopli was determined. Then, together, they boarded a bus to the Gogunda CHC where Gopli had the surgery.

There were other women getting a tubal ligation on the same day at the CHC, she says, but she doesn’t know if it was a sterilisation camp, nor does she remember how many other women were at the CHC that day. Sterilisation camps in small towns, where rural women from nearby villages can get the procedure done, are meant to overcome problems associated with poorly staffed village health centres. But poor sanitary conditions at these camps and the target-driven approach to sterilisations have been a subject of intense debate for decades.

Tubal ligation is a permanent birth control method in which a woman’s fallopian tubes are blocked, a 30-minute surgical procedure also called ‘tubal sterilisation’ or just ‘female sterilisation’. A 2015 report by the United Nations found female sterilisation to be the most popular contraceptive method worldwide, with 19 per cent of married or in-union women opting for it.

In India, 37.9 per cent of married women aged 15 to 49 years opt for a tubal ligation, according to the National Family Health Survey-5 (2019-21).

For Gopli, whose flaming orange ghoonghat is pulled low over her head so that it partially covers her eyes, this was a rebellious turn. She was exhausted after the fourth baby but in good health. Her decision was largely a financial one.

Her husband, Sohanram, is a migrant worker in Surat, and away for most of the year, returning for a month each during the Holi and Diwali festivities. When he came home a few months after their fourth child was born, Gopli was determined not to get pregnant again.

“The men are never around for any assistance with child rearing,” Gopli says, seated on the cool floor of her brick home with a thatched roof. A small batch of corn kernels is spread on the floor to dry. Sohanram was absent through most of her pregnancies, while she worked, heavily pregnant, on their half bigha (about 0.3 acres) farmland, and other people’s land, and looked after the home. “There is often not enough money to feed the children we have, so what sense is there in having more children?”

Asked if they tried any other contraception, she smiles shyly. She doesn’t want to speak about her own husband, but says the women in the community find in general that getting the men to commit to any form of contraception is futile.

Karda village, part of the Royda panchayat , is located on the foothills of the Aravallis, only about 35 kilometres from the touristy Kumbhalgarh fort in neighbouring Rajsamand district. The Gametis of Karda are a large group of 15-20 families belonging to a single clan of the Bhil Gameti community, a Scheduled Tribe. Settled on the outskirts of the village, each family owns less than one bigha of land. Almost none of the women in this cluster completed school, the men faring only marginally better.

Barring the monsoon months of late June through September when they till their land to grow wheat, the menfolk rarely live at home for more than a month at a time. Particularly after the difficult months of the Covid-19 lockdowns, most men have been away in Surat, employed at saree-cutting units – where long reams of fabric are manually cut into six-metre lengths, the edges then beaded or tasselled. It is completely unskilled labour, earning them Rs. 350-400 per day.

Gopli’s husband, Sohanram, and the other Gameti men are among the lakhs of male workers from southern Rajasthan who have migrated for decades to work in Surat, Ahmedabad, Mumbai, Jaipur and New Delhi, leaving behind villages populated mostly by women.

In their absence, completely illiterate and semi-literate women have, in recent years, learnt to make complex health care choices and decisions themselves.

Pushpa Gameti, in her early 30s, and mother to three, including a teenage boy who was brought back from Surat by anti-child-labour activists just before the pandemic, says the women had to adapt.

Earlier, if a medical emergency arose, the women panicked. She narrates past experiences of women freezing in fear when a child’s fever would not subside for weeks, or when gashes sustained during farm work wouldn’t stop bleeding. “Without any men among us, we didn’t have cash for medical expenses, and didn’t know how to take public transport to visit a clinic,” says Pushpa. “Slowly, we have learnt everything.”

Pushpa’s eldest son, Kishan, is once again working, this time in a neighbouring village as an assistant to a driver of an earth excavator machine. For her younger children, Manju and Manohar, now 5 and 6, Pushpa learnt to visit the anganwadi in Royda village, 5 kilometres away.

“For our older children, we got nothing from the anganwadi ,” she says. But in recent years, the young mothers of Karda began to walk carefully uphill along the winding highway to Royda, where the anganwadi served hot meals to nursing mothers and young children. She would carry Manju on her hip. Occasionally, they would get a lift.

“That was before Corona [Covid-19],” Pushpa says. Post-lockdowns, until May 2021, the women had not received information on whether anganwadi centres were functional again.

When Kishan dropped out of school after Class 5 and suddenly left with a friend to work in Surat, Pushpa felt she had no control over the family’s collective decision on how to tackle the teenager. “But I’m trying to keep decisions about the younger ones in my control,” she says.

Her husband, Naturam, is the only male of working age in Karda currently. Unnerved by the summer of 2020 when restive migrant workers under lockdown clashed with the Surat police, he is trying to find work around Karda, without much luck.

Gopli has told Pushpa of the benefits of tubal ligation. The women have not heard of medical problems arising from lack of post-operative care (including wound sepsis or infections, intestinal obstruction or other damage to the intestine and damage to the bladder) or about the possibility of contraceptive failure in this method. Nor does Gopli understand that sterilisation surgeries are a target-driven population control strategy. “It’s the end of worrying,” she says.

Pushpa had all three children at home too; a sister-in-law or elder woman from the community had cut the cord and tied the end with ‘lachha dhaaga’, the thick yarn thread commonly worn on the wrist by Hindus.

The younger Gameti women will not undergo risky home deliveries, says Gopli. Her only daughter-in-law is pregnant. “We won’t take a risk with her health or our grandchild’s health.”

The mother-to-be, who is 18, is currently at her maternal home, in a village high in the Aravallis from where a quick evacuation in an emergency is difficult. “We will bring her here when it’s time for the delivery, and two or three women will take her to the dawakhana in a tempo.” By tempo, Gopli means the large three-wheeler used as a form of local public transport.

“Anyway today’s girls cannot take the pain,” Gopli laughs, prompting the other women, all of them her neighbours and relatives who have gathered around, to nod and laugh along.

The nearest PHC is in Nandeshma village, about 10 kilometres away. The younger women of Karda are registered at the PHC when they confirm a pregnancy. They go there for check-ups, and accept the calcium and iron supplements distributed by health workers visiting the village.

“The women from Karda go in groups, sometimes as far as Gogunda CHC,” says Bamribai Kalusingh, who belongs to the Rajput caste and lives in the village. The need for independent decision making about their health has changed the lives of the Gameti women, who earlier rarely left the village unless accompanied by a man, she says.

Kalpana Joshi, a community organiser with the Udaipur unit of Ajeevika Bureau, which works with migrant workers including the Gameti men, says self-reliance in decision making has emerged slowly among the ‘left-behind’ women in villages with large outbound migration. “They now know how to call for an ambulance themselves. Many go to hospitals on their own, and they speak candidly to health workers and NGO representatives,” she says. “Things were very different even about a decade back.” Earlier, all medical needs would be put off until the men returned from Surat, she says.

Two or three other women in this cluster of homes also underwent a tubal ligation, but the women are too shy to discuss it. No other form of modern contraception is used commonly, “but maybe the younger women are smarter,” according to Gopli. Her daughter-in-law was married nearly a year before getting pregnant.

In a village less than 15 kilometres from Karda, Parvati Meghwal (name changed) says being the wife of a migrant worker was always stressful. Her husband worked in a cumin packaging unit in Mehsana, Gujarat. For a brief period, she tried to live with him in Mehsana, running a tea stall, but she had to return to Udaipur for their three children’s education.

In 2018, while her husband was away, she met with a road accident. A nail pierced her forehead as she fell. Discharged from hospital after her injuries healed, she then suffered from an undiagnosed mental illness for more than two years, she says.

“I always worried, about my husband, about the kids, about money, and then the accident happened,” she says. She had catatonic episodes and periods of deep sadness. “Everyone was scared of my screaming and the things I did; nobody would approach me in the entire village. I tore all my medical papers, I tore currency notes, I tore my clothes...” She knows now that she did those things, and carries some shame about her mental illness.

“Then the lockdown happened, and everything went black again,” she says. “I nearly had another mental breakdown.” Her husband had to walk home from Mehsana, more than 275 kilometres away. The anxiety sent Parvati almost over the edge. Her youngest son was also away in Udaipur, where he worked at a restaurant, making rotis .

The Meghwal are a Dalit community, and Parvati says women left behind by migrant workers of Scheduled Castes face an inordinate struggle in earning a livelihood in the village. “For a Dalit woman with a mental illness or a history of mental illness, can you imagine how it was?”

Parvati had worked as an anganwadi worker and as a helper in a government office. After the accident and her poor mental health, keeping a job proved difficult.

Around Diwali in the year 2020, as the lockdowns lifted, she told her husband she would never allow him to migrate for work again. With loans from family and from a cooperative, Parvati set up a small grocery store in her village. Her husband tries to find daily wage work in and around the village. “ Pravaasi majdoor ki biwi nahin rehna hai [I don’t want to remain the left-behind wife of a migrant labourer],” she says. “It is too much mental trauma.”

Back in Karda, the women agree that finding livelihood on their own, without the menfolk around, has proven almost impossible. The only work available to the Gameti women has been under the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), and the women in the cluster outside Karda had all completed 100 days of work for 2021 by the time the monsoon rolled around.

“We need 200 days of work every year,” says Gopli. For now, the women are trying to grow vegetables that they can sell at the nearest market, she says, another decision they took without consulting the men. “Anyway, we need something nutritious to eat, right?”

PARI and CounterMedia Trust'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.

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