Renu Khanna (above photo) talks to Andréia Azevedo Soares about implementing feminist-inspired health interventions and encouraging women to make themselves heard on matters of health policy
WHO Bulletin, 2021;1 July; 99(7):484-85 (Excerpts)
… I [first] found a job with the Voluntary Health Association of India where I worked with people who were committed to addressing the health issues faced by the rural poor and to alleviating poverty.
The real “light bulb” moment came in 1984 when I was invited by a women’s cooperative in Jabalpur in central India. The women, who were very poor and, for the most part, illiterate, produced and sold spices. I spent the first day working with them on their business and in the evening visited the home of their leader. I will never forget it. It was this dilapidated hut in the middle of a slum. The woman’s husband had tuberculosis and was lying on a charpoy (a kind of bed) outside the hut, and the woman, who was the breadwinner for the family, was going about her business, in the most matter of fact way – with the utmost dignity, and without a shred of self-pity. I was so moved by her courage and resilience. My commitment to women’s rights was born from that experience. Around the same time, we co-founded SAHAJ and our very first project was with women waste pickers in the city.
SAHAJ (Society for Health Alternatives) is a non-profit committed to supporting and promoting the health and education of children, adolescents and women. We work with stakeholders to ensure access to quality health care and other public services. We also concentrate on policy advocacy, maintaining an intersectoral perspective to reflect the way in which women’s health interconnects with other aspects of their lives, including their work.
… In the mid-1980s, we were invited by an organization working in a tribal area in western India. The focus was on watershed management and improved agricultural techniques…. The more we talked [to the women workers], the more it became apparent that they were living with all kinds of health issues, ranging from backache and depression, to menstrual problems, urinary and genital infections, and pregnancy-related issues. Inevitably, the subject of health services, or the lack of health services came up and we started thinking about what we could do to help. A young feminist doctor from the UK, who was volunteering in India at that time, helped us design a feminist-inspired maternal health programme that could be implemented in a setting essentially without services. That was when we started training local women to deliver maternal health care.
… We started with a group of traditional midwives and local leaders and ran training sessions using the self-examination methodology set out in Our Bodies, Ourselves, the Boston Women’s Health Book Collective’s book that was published in the early 1970s. The participants were encouraged to examine themselves, including their genitalia, using a speculum, a mirror and a flashlight. Every month we would meet with the women for two days so that we could share challenges encountered and solutions found. The women we trained in that way became agents of change, spreading the word to other women. We called them the “barefoot gynaecologists”.
One day the district health officer came and said that what these women were doing was irresponsible. We said if government doctors and nurses were present, the women would not have to do what they were doing. We invited him to talk with the health workers we had trained and see if what they were doing was safe and within the limits and boundaries of what they could do. He grilled them with all kinds of technical questions, and they were able to answer him with utmost confidence and accuracy. He went away extremely impressed, but also with a better idea of what the community’s health needs were.
In the late 70s. I remember one of my colleagues at the Voluntary Health Association of India raving about a Rural Women’s Social Education Centre (RUWSEC) in South India that was translating and adapting the book. I went straight to the library and found a copy. I was absolutely fascinated, not just by the idea of women coming together to share their thoughts and feelings about their lives and their bodies, but also being able to use that process to produce this medically sound book. One of the first publishing projects that a group of us undertook in the 1980s was to translate a book produced by rural women called Sharir Ki Jankari (knowledge about our bodies) into Gujarati. And later, in the early 90s, our nationwide feminist health research collective, Shodhini, produced a book based on the barefoot gynaecologists’ initiative, called Touch me, touch-me-not: women, plants and healing.
… I remember the Sharir Ki Jankari book had little flaps over some of the drawings to avoid giving offence. People could lift them if they were curious about the male and female genitalia. But I think it is important to emphasize that the material was about connecting women with themselves as much as with their bodies; it was about supporting them in establishing their identities and encouraging them to find their own voice and place in society.
…Women’s voices are also absent from policy discussions. Who gets access to the government of India or the state health departments? International NGOs and global universities’ researchers. Not rural or tribal women’s collectives and community-based organizations. So, we make sure these groups are heard, then amplify ground-level voices and ensure that they reach policy-making arenas by leveraging state, national and global coalitions. We also document our work, sharing lessons learnt and insights, often using social media. Finally, we seek to strengthen women’s voices, training them to generate data, and produce reports and to use that evidence in their conversations with health system stakeholders. [continues…]