Several women in the Sikanderpur Ghosi slum of Gurugram have a common complaint, when asked about their health during the lockdown to contain the novel coronavirus. “I have a headache almost every day since the lockdown began,” they tell me. These women live in one-room houses, with several children and their husbands who no longer go for work.
According to Dr. Sahil Singh, doctor and co-founder of V-Medica, a multi-specialty clinic in Gurugram, there are multiple reasons for frequent headaches in women in urban slums. “Headaches arise from gastric problems, infrequent urination, lack of menstrual hygiene, iron deficiency and stool retention. Women also suffer from nutrient deficiency as they only eat pulses and rice. More than 10 people use one toilet in a slum, and the conditions of the washrooms are deplorable. This is why women choose to hold onto urinating as long as possible. This ultimately leads to urinary tract infection (UTI) and headaches.”
Priyanka Kumari, a 19-year-old migrant woman from Bihar, told me that she has frequent bouts of anxiety since the lockdown began. She complained about gastric issues, so I took her to a local NGO called, Smile Foundation, which distributes free medicines to people in slum areas. The doctor correlated her problem with erratic eating times and requested her to eat on time. Priyanka further told me that she has lost her appetite to eat since the lockdown began. “I feel very anxious and scared for my year-old son. I also try and save food for my family as we are low on ration and can’t afford to buy more food right now.“
Lack of Information and Political Will
Priyanka admitted to laxing on her one-year old son’s tika (vaccination) after moving to Gurugram. She told me that the local government hospital has stopped vaccination for children since the lockdown began. Children between 12-23 months of age have to receive vaccines against diseases such as diphtheria, measles, polio and Hepatitis A. Priyanka is also uninformed of the symptoms of the coronavirus, and wears a mask ‘because others do’. She also relies mainly on her husband for information, as she doesn’t have a smartphone and can’t read English.
I also spoke to an ASHA worker in the slum to understand the barriers women are facing because of the lockdown. “I take a walk every day around the slum to inform people about coronavirus. I also have a list of women who live in the slum. In fact, after the lockdown began, more women reported their pregnancy to me,” she said. On being probed about women in the slum who aren’t aware of her existence, she interjected, “I work with full integrity. If a woman has recently moved here, I will know.“
Furthermore, the anganwadi centre (primary healthcare centre) in the slum is empty. Its gate was locked, every time I visited the slum. I asked a local shopkeeper about the timings of the centre. “Koi kabhi bhi aata hai, kabhi bhi jaata hai” (People come and go according to their convenience). The ASHA worker informed me that she redirects women who can’t access the anganwadi to a local government hospital. However, she sends them to a hospital only for the delivery of the child. She is frustrated with the media’s focus on frontline healthcare workers like doctors. She feels that there is a power play with a focus on the challenges of doctors, while ignoring ASHA workers.
“There are two ASHA workers in the slum. We work with patients every day and we don’t even get a mask or gloves. We even collect samples of COVID-19 patients without gloves,” she said.
“The doctors and nurses walk into the clinic/hospital in their PPE kits, while I stand by hiding my face with my dupatta (stoll). Is this parity? Is my life of no value?,” she added angrily.
The View On The Field
A private hospital lies at the curb of the anganwadi centre in the slum. It is empty in the afternoon, except for one doctor and one staff member. The doctor, a gynaecologist, said that she charges about Rs. 6,000-7,000 ($80-$92) for delivery. She currently serves about 6-7 patients. She does most of her consultation over the phone, to avoid meeting people. Women who come to her clinic for ante-natal care are treated while maintaining social distancing. When asked about vaccination for children during the lockdown, she referred me to the anganwadi.
“Vaccination facilities and free medicine are available there, but the service has stopped. I give vaccination to those who come to the hospital.” She added that the anganwadi is ‘temporarily closed’ because of some ‘instructions from higher authorities'”. She refused to divulge more details.
The local community centre, which is responsible for distributing cooked food, has been closed since April. Local women complained of malnutrition and hunger, as the police have refused to register them for ration. Women have become the sole breadwinners during the lockdown, as men refuse to beg to police or well-off people for food. I approached a local police officer, who told me that some of the women are lying to me as their husbands have already started work. “If they really have a problem, then why aren’t their husbands coming forward to ask for ration?,” he remarked.
Several women in the slum were domestic workers at local bungalows. They are no longer being paid their salary and are out of job. I called up the helpline of the Haryana government to register Rita Devi, a migrant worker from Odisha. The government official offered Rita a job to clean the road. Rita outrightly refused as she considers the work below her pay grade. She told me she would rather die of hunger than clean the road. On being prodded, she said, “What will I tell my village folks? That I came here to work at a bungalow or company, but ended up doing the work done by a lower caste?“
Healthcare Institutions Have Failed Women
The coronavirus pandemic has forced India’s healthcare to choose between serving COVID-19 patients and non-COVID-19 patients. With poor people to hospital bed ratio, the pandemic has forced hospitals to devote most of their staff and hospital beds to COVID-19 patients. Anganwadis have shut down as the healthcare workers want to avoid contracting the coronavirus. This has put women in the lurch, as their health problems have taken a backseat. Migrant women in slums have simply decided to bear the pain, as they are left with little options.
“There are cases where a woman who has turned up at the hospital complaining about heavy bleeding during menstruation was simply given painkillers for symptomatic relief. Further follow up on her will be difficult as my hospital has become a dedicated hospital for coronavirus patients,” said Saurabh (name changed), a doctor at a government hospital in Bhagalpur, Bihar.
Dr. Jyoti Dabas, a gynaecologist at a government hospital in the Nuh district of Haryana, concurs with this view. “After the lockdown, women stopped coming to the hospital for fear of contracting the coronavirus. There are cases where women have died because bleeding couldn’t be stopped during their delivery. Indian women are typically deficient in iron and it is necessary to conduct tests to determine iron levels before delivery. Home deliveries were common before, but after the lockdown, they have increased.“
According to Dr. Sahil Singh, medical termination of pregnancies (MTP) is now going unmonitored as abortion facilities have been stopped in government hospitals. “During the lockdown, women seeking an abortion are going to pharmacies which openly sell medicines for MTP. Several women who have opted for this route in their six or seventh month of pregnancy have died and these numbers are going unreported as there is focus on the coronavirus.” Dr. Singh added that stress and anxiety owing to the lockdown has also led to an increase in premature births.
The Added Fear of Domestic Violence
Women in slums were used to bearing the burden of housework and childcare before the lockdown. Not much has changed for them, except the fact that their husbands now stay at home. This has increased a widespread problem women find difficult to get rid of – domestic violence. Jayanti Devi, a resident of the Sikanderpur slum, was nervous as she spoke to me. Her husband, who was a manual labor, has lost his job and increased his consumption of alcohol. He verbally abuses her and beats their children. “I want this lockdown to end soon. I am worried for my husband and the future of my children,” she asserted.
“Domestic violence is a vicious cycle. The men release their frustration by beating their wives and the wives in turn manifest the frustration through stress,” said Dr. Sahil Singh.
As I probed around, I discovered several reasons for the spike in domestic abuse. “With the lockdown, alcohol wasn’t available in many states, so several men may have experienced withdrawal symptoms, and lack of employment may have exacerbated existing uncertainty and frustration, leading to increased instances of violence. We are speculating here, and studies will have to establish these“, said Oommen C Kurian, Senior Fellow at the Health Initiative of the Observer Research Foundation (ORF).
According to Monika Tiwary, a counsellor at Shakti Shalini (an NGO that supports survivors of domestic violence), women in slums are suffering from increased mental stress and even displaying suicidal tendencies because of an increase in domestic violence. Following the lockdown, Shakti Shalini‘s helpline number reported a surge in calls – about 5-6 a day. Eventually, the NGO attended 360 calls in between March 21 to June 14. In all cases, women reported extreme levels of emotional and verbal abuse.
“Our helpline was active 24 hours a day, but even our helpers were overwhelmed by the surge of calls. Severe cases of wife battering were reported to us. In some cases, some women were thrown out of the house and we had to rescue them,” said Monika.
Babita Devi, a migrant worker from Bihar facing domestic violence from her husband, requested me to buy her a medicine for headache. I went to a local doctor, who told me that he only treats patients reporting ‘preliminary’ symptoms of diseases, without specifying more details. I visited another clinic-cum-pharmacy in the slum – Biswas healthcare clinic. It was empty, except for a man in the corner, who was sleeping in the waiting area. He woke up to inform me that the doctor left for his hometown as soon as the government restarted the train service. “You should bother about other things, the doctors here aren’t that great anyway,” he added and went back to sleep.
Ankita Mukhopadhyay is a journalist based in Gurugram, India. Ankita has over five years of experience in broadcast and digital media. Her articles have been published in Deutsche Welle (DW), The Economist Intelligence Unit (EIU), The Jakarta Post, Indian Express, Dainik Bhaskar and Youth Ki Awaaz. In 2020, Ankita received a grant from the National Geographic Society to cover a story on the COVID-19 pandemic. Ankita’s key interest areas are gender, business, politics and its intersection. She holds a Master’s degree from the London School of Economics and Political Science (LSE) and a Bachelor’s degree in History from Lady Shri Ram College for Women (LSR). You can find her on Twitter, Facebook and LinkedIn.
This work was supported by the National Geographic Society’s Emergency Fund for Journalists.
All pictures have been provided by the author herself.
Featured Image Source: Business Standard