Undoing Gender

Taking a Stance: Homosexual acts in Uganda are punishable by death. On August 4th 2012, Ugandans held their first gay pride parade, which was broken up by the police.

I have spent most of my first six weeks at Dimagi India in the field in Manjanpur, Eastern Uttar Pradesh. Uttar Pradesh, or UP, is the most populated Indian state and sends the most members to the Indian Parliament. It ranks lowest amongst the 28 Indian States in terms of human and social development indicators with a Human Development Index of 0.388.

Manjanpur itself is a predominantly agricultural setting, and the rice paddies that gleamed with water six weeks ago are now lush and green.  Dimagi India is working with CRS to deploy CommCare to 111 rural ASHAs, community health workers appointed by the government to deliver maternal and child health services at the community level.

One of the first things to strike me, other than the heat, was the strict gender roles and relations that seems permeate all walks of life here in Manjanpur (and possibly the rest of India). Women are never seen in the 2 restaurants here in Manjanpur. The literacy rate for women (59%) is 20% less than that for men (79%). Women’s activities and choices are limited to traditional spheres such as housework, childrearing, agriculture, and some professions like teaching or nursing. They lack the opportunities and exposure afforded to men boxing in their potential and contributions to self and society.

A local woman experiencing severe pain in her abdominal area after having an operation approached me in the district hospital lobby during a CommCare training day asking if I know where the lady doctor sits. She was prepared to forego care, or spend significantly more time and resources to travel to Allahabad, 60 kms away, to receive treatment; that is until I coaxed her to visit the male doctor in the district hospital. Hopefully, the doctor examined her case, as during my own visit to the health center due to a weird skin infection on my back (next to the shoulder).  I was prescribed anti-allergy medication, antibiotics, and a third medicine, without the doctor having a look at the infection because he was too shy. Another doctor in Mumbai finally diagnosed that a lizard or beetle had peed on me.

Needless to say, the ASHAs, their supervisors, the Auxilary Midwife Nurse (ANM), and the staff nurses in the facilities are an all-woman brigade. Any work that the ASHAs are currently doing also targets women, specifically mothers, while the fathers are left out of the picture. Enter Commcare, where our application also plays a role in doing gender [1]. Training analogies frequently veer into gendered examples, we invite ASHAs husbands along to CommCare trainings so that the lower literate ASHAs can register cases in CommCare with their help, and one of the ways to identify a pregnant woman in our application is through her husband’s name. Father Anyone?

During vaccination day, we hunted down a newborn at his home in order to vaccinate him, where the mother was working hard alongside the father, replacing the cow dung floor with the baby in tow, 8 days after delivery. At the same site, Shuklan Kapurwa, we also saw a father who came with his 2 children to get them vaccinated, no mother in sight.

Father brings along his two children on vaccination day.

How effective would CommCare be if the ASHAs delivered counseling with a man’s voice reverberating from the audio, enticing fathers also to listen in and learn about safe pregnancy, parenting, adequate nutrition, and looking after the well-being of their children? One of the ASHAs mentioned that during one of her first hospital deliveries, the mother passed away during childbirth due to heavy bleeding, while the baby died 8 days later, probably due to inadequate nutrition and lack of care. Could the infant’s death have been avoided if his father had also been counseled on these relevant topics and encouraged to participate in child rearing activities?  Can CommCare better this situation if we are more aware and daring with our innovations and applications?

Vaccinating a new born 8 days after delivery in his home.

Sangya Kaphle is a Dimagi Field Manager based in Manjanpur, India.  She helps support the CRS CommCare project in Manjanpur, which includes over 100 ASHAs.