Abstract: This paper explores and analyses, why and how, the women from slum and their contributions to the household are devalued and what effect this has on their lives and their health. Poverty is a very significant part of the rationale for choices made by the women that in the long run are detrimental to their health. For the women of the slum, the physical and social environment, poverty and under-nutrition, as well as their devalued low social status compounded by overwork, and the burden of reproduction are all responsible for their poor health. The paper argues the circumstances in which these women seek health care are not only rooted in material and social conditions but also in the subjective cultural norms born out of the patriarchal nature of family and social institutions.

Keywords: women’s health, poverty and ill health, social devaluation, patriarchy, biomedical perspectives, social pressure

“… And now I appeal

I appeal for love lost, for dreams broken

For the right to live as a whole human being.

I appeal to all peace loving people to protect to support, and give a hand to innocent little girls who do no harm. Obedient to their parents and elders, all they know is smiles Initiate them to the world of love

Not to the world of feminine sorrow…” Dahabo Ali Muse (Feminine Pain)

Women are the lynch pins holding families together, through their diverse roles as mothers, wives and daughters-in-law. They are not only responsible for keeping their households running; they are the care-takers too with the additional responsibility of increasing the income of the family. They tend to put the needs of their family foremost, and in a situation of poverty, take especial pains to see that their family is cushioned as far as possible from the problems of subsistence attendant on pauperisation. In fact, in a manner of speaking, the women’s social existence is a part of the mode of survival mechanism of an impoverished family. Women living in the patriarchal societies are conditioned into accepting this social valuation of themselves as undistorted and authentic. They therefore live out their lives reaffirming their secondary social status. In a situation of poverty therefore, where survival is at stake, these women who believe that their only value is in sustaining their families, willingly forego their own needs.

This paper is an abridged version of chapter VI of the PhD Thesis titled the social basis of outcomes of pregnancy in the Goutam Nagar slum of Delhi (1999) based on en empirical study between 1991-95. The sources of the poor health of women are traced by integrating quantitative and qualitative data on women’s health and general illnesses from about 3,000 households- a fifty percent simple random sample of the slum. Two hundred pregnancies at different point of time of the study period and a socio- economic survey of the sampled households with detailed medical and sociological data on the pregnant women were collected through observation, obstetrics history sheets, informal semi structured interviews, open- ended questionnaires, in-depth interviews and case studies. In addition, data from a health clinic run twice a week by the researcher was also analysed.

This paper explores and analyses, why and how, they and their contributions to the household are devalued and what effect this has on their lives and their health. The first section analyses the impact of work and social status on health and of the pregnant women with a specific emphasis on nutrition. Second section captures the responses to women’s ill health both from the society and from the medical fraternity. Final section is a discussion on morbidity profile of women form the study area.

Subordinate Status of Women as Injustice

It is important to realise that women do not voluntarily carve out such lives for themselves. Social pressures assist in moulding their lives. There is a creation of a poor self-image, with socialisation into duties and responsibilities. Girls grow up believing that being selfless, and being caretakers for their families is one of the most important facets of their lives. Not only do they share the responsibility for managing the housework with their mothers, social norms and the environment dictate an early marriage. Bimla N. and Shakuntala K. are both working mothers with teenage daughters. They both felt “It’s not good to have an unmarried young girl at home. It is too risky, especially in these days when one does not know what boys and girls are upto. Better to marry her off as early as possible.” In fact Shakuntala V.’s daughter did run off with a neighbour, and they had to marry her off to him at the age of sixteen. Girls are therefore married off at an early age and sent to their in-laws house (the ‘kanyadan’ for which they were born). Here at their in-law’s house, where their mothers-in-law have waited all their lives for someone to command, girls learn to take responsibility for the whole household at the comparatively tender age of about eighteen or even earlier. As Lakshmi

A. said, “When I was married I was not even eighteen. At home I had helped my mother with the housework, but here they only sit and order me around, even my younger brothers-in-law. At home I had worked outside, here his mother refuses to let me go out.”

Not only must these girls become good housewives, they must also carry out their duty of producing and rearing children. Many have to continue having children until they have at least one son and those who do not bear sons are “taunted because I have no son”.

Most women realise that they are being given a subordinate status that is reflected in all aspects of their lives. Many of them accept it, for they have been told time and again, that their aim in life is to be good daughters, and later good wives and mothers and good housewives. Women therefore tend to feel worthless unless they prove themselves by fulfilling these aims. The fact that these women need to consider their own selves as important, or that they by themselves have any intrinsic value is negated, generating a feeling of hopelessness and worthlessness reflected in a statement by one of them – “What is there in a woman’s life..?”

Women are denied both, self respect in their relationships and their basic rights… “Whom can I go to when I have a need?” asks a daughter-in-law who has to go out to earn though she has delivered less than a month ago, and still complains of weakness. In fact most women are aware of only their duties and responsibilities, not of their rights. So they learn to ignore their own needs, choices – circumstances and others dictate their lives… “When I was young, my parents used to decide everything for me; they said, you are a girl, what do you know? And now my husband says, you are a woman, leave all this for me to worry about. But it is all right if I go out to earn! Then no one remembers that I am a woman and delicate ”

Of all those who are aware of this subordinate status as an injustice, almost none are able to fight and overcome this social circumstance. Their acceptance (no matter how unwilling), of their low status is expressed as, “No man gives his wife as much value as he gives even his stomach” or “If the man is alright, it is good for the woman, otherwise her life is of no use” and even “in-laws treat you well only if your husband cares for you.” In fact one woman went as far as to say “God should not create one as a woman. It is good if one has no daughter. At least she won’t suffer”.

Social pressures have over time, hammered in the realisation that women must learn to be submissive, and that accepting neglect and abuse without rebelling is part of being exemplary women. This is typified with the role models of Sita and Savitri being held up before them. Women thus learn to defer to their men folk in all decisions pertaining to the household, themselves or otherwise, as a mark of respectful submission. Social pressures have also conditioned women into accepting that a family is needed for them to fulfill their aim in life – all these pressures manage to annihilate their feelings of self and autonomy, converting them into passive quiescent models of ideal womanhood. Patriarchal societies stress, not only their need for these ‘womanly’ qualities, but also the women’s need to have sons- indeed, married women gain in stature if their first born is a son. Accordingly, women grow up with the knowledge that their function in life is to selflessly serve their families, to be passive humble and obedient, and to carry on the family name by bearing strong and healthy sons- by being a ‘mother machine’ (Corea G. 1985).

The Impact of Work on Women’s Health

Household activities for women include a wide variety of tasks that are essential for the family’s survival such as, maintaining hygiene of the house, tasks like food preparation, buying house hold provisions, caring for children, the elderly and the sick. It may stretch her work days considerably. Besides over burdening women, these tasks keep them from getting the rest required to recuperate their strength and energy, and demand a constant effort to juggle domestic and (if present),professional responsibilities. This situation has serious repercussions on women’s health.

For employed women, other than their workload, another factor affecting their health is the kind of jobs (mainly domestic or unskilled labor) available to them. Women know that there is a sexual as well as a social division of labor, and that their jobs are devalued, discriminatory and ruinous to their health. As Margshri said – “a job where the employer has no respect for us is not a job we do willingly—”, yet they cannot choose their health over the work that brings much needed money. As one of the domestic help said “Even though I get so tired, and I know the money I earn goes to my husband, still it’s money coming into our house.”

The impact of social status on women’s nutrition and health

In poorer families, especially in those with irregular incomes, almost all the members may not be getting an adequate diet. Undoubtedly the quality and quantity of food depends to quite an extent on ones income, and there from one’s budget for nutrition. a reasonable diet for a family of four to five members may cost Rs. 30-40 day which is equivalent to at least Rs. 900 to Rs. 1200 pm. Taking into consideration all other household expenses, this means a minimum salary of Rs. 1500 pm (and this does not include medical bills or other major financial needs which may arise from time to time). About 40% of the families in the slum have incomes upto Rs. 1000 pm which means that for them it is not at all possible to spend so much money on food every day. Another 35% earn less than Rs.1500 pm, hence they may manage a borderline nutrition, if there are no pending loans (and there often are). Therefore, while about 40% may not even make it to the required nutritional status, an additional 35% are often in a situation where they too may not be able to regulate the quality of their nutrition. Only about 25% earn more than Rs. 1500 pm, which means that only 25% of the populations of the slum probably have just enough to eat.

Manju L. has left her husband and is staying with her mother. One month after Manju’s delivery her mother was the only earning member of the house, and was earning about Rs. 600 pm. There were two adults and three children in this household. One afternoon, when the researcher was sitting and talking to Manju while she cooked lunch, there was enough flour for three chapatties. There were also two potatoes that were cooked for the vegetable. The researcher observed that Manju’s twelve years old brother, who had just returned from school, had two chapatties and some potato, and her three years old daughter had the remaining chappati and potato. For Manju and her mother there was some rice eaten with a handful of salt bought for one rupee. Manju was lactating and knew she needed more nutrition, but she was helpless, for the adults could not let the children go hungry.

Similarly in Girija and Rani’s families, where there is a lack of food due to poverty, it will be the mother who eats last or not at all. However, Rani said she was grateful that her family had not yet reached the state of having to eat chapatties with only red chili paste.

While Girija is a housewife whose husband is an unskilled laborer with an irregular income, Rani was working as domestic help until her daughter fell ill. Her husband had just lost his job. They had to take a loan for the girl’s treatment (incidentally they lost their daughter). Now Rani has lost her job, but luckily Babulal has found employment. They are subsisting on his salary of about Rs 1200 pm, as well as repaying the loan on monthly installments.

This decision to feed the family first at the cost of the women’s health is a socially accepted phenomenon. The logic is maternal love – the children must be of necessity fed. The women state “..no mother can see her child go hungry,” or “.. we are older people, we can handle our hunger”. Additionally, since it is a social belief that the husband is not only the bread winner, but also the central pillar of the family (even though women may contribute a good part of the income and actually hold the family together); it would obviously be the women who literally have no choice but to eat last, even if it may mean going hungry.. As Jalu, a housewife with two children who are less than five years old said, “If someone has to go hungry who can it be – the one who is earning cannot go hungry, for then who will earn? And I cannot let the children go hungry. Who else is left but me?” In the socio-economic fabric in that the entire family exists, this is the only rational solution for survival. Ramkali’s expression of this dilemma was “I sit and cry didi, as to how to feed them. If we don’t feed the children how can we parents eat?”

Poverty has not been necessarily dealt with as a separate issue, it is nevertheless a very significant part of the rationale for choices made by the women that in the long run are detrimental to their health. This shows how even poverty is differentially experienced due to woman’s social status. There are studies (Zurbrigg S. 1984; GOI 1979),that demonstrate that not only are poor nutrition and overwork correlated with poor health, factors like poor sanitation, impure water, overcrowded and poor housing also have a contribution to make. The relationship of poverty and malnutrition, to decreased immunity and increased susceptibility to infections, as well as to increased severity of infections and increased morbidity and mortality is well known (Rudman D., 1987: 395).

Social response to women’s ill health

The term ‘health’ describes an individual’s relation to a concept of normality. These norms of expectation that define what is expected are laid down by those in authority in given social groups (for women these are fathers, husbands, mothers in law, sons etc.). These concepts of normality ask for something much less than the ideal state of positive health presented by the WHO (1978) – perhaps no more than that a woman should be physically capable of carrying out bet daily role (Sagar A.D., 1994:367).

Sushila complained regularly of backache, but she continued taking care of her family, and also continued working as a domestic help. Everyone (her husband and neighbours) therefore felt she was complaining to get attention, ultimately she was found to have a third degree uterine prolapse and she finally needed a surgical repair.

Similarly, Rafikan had complained for months of heavy periods that were not improving with conservative management. She needed to go to the hospital· for investigation. However, her husband, neighbours and even one of the private doctors she visited told her that this was expected at her age (forties), and she would soon be fine. However ·it was only when she fainted one day that her husband got worried and let her go to hospital. She was found to have a large uterine fibroid and needed to have a hysterectomy done. While women thus remained neglected unless they are very ill, children and men were immediately attended.

In the present social milieu, where economic and social inequality is rife, the concept of normality is varied due to differing social forces within differing social groups. Among these social groups, women seem to have a special problem. One has already seen their subordinate status reflected in their ill health. The women also understand this relationship between their health and social status. Most women know that a large number of their health problems arise from their being overworked, underfed and poor. They state clearly “You need three things to be healthy

– good food, as well as a good mental state, and you should not have to do too much work”. However, they also know there are no medicines to treat a problem of ill health that arises from their social circumstances “When the world is like this, what can we do”.

This fact that the accepted ‘sick role1’ in any group and between groups is defined by the figures of authority and not the person who is ill, accounts for the lack of correspondence between the ‘sick role’ and the actual existence of disease. Though women may perceive their own health differently, they are powerless to change the definitions being practiced. Change is possible only if the perceptions of the figures and groups in authority change.

Only when their functioning in their daily work is affected do they seek medical care, and when they seek care they do so with the knowledge (imparted by their figures of authority) that they are delicate women. As many mothers-in-law state ‘’Today’s girls are always complaining and this, when they don’t have to do even half the work we did.”

One of the problems where women seem to have mainly subjective complaints is anemia where unluckily the symptoms are such, that the complaints can be converted by figures of authority into manifestation of “feminity” or “psychosomatic” problems. The very nature of the problem is therefore used as a tool to negate its presence. The experiential health of the women is therefore ignored and the burden of disease is never quantified. The signs and symptoms of anemia, which are weakness, lethargy, giddiness or fainting, are utilised to further the representation of women as ‘delicate’.

Women’s ill health (especially where the symptoms are subjective) will not be experienced by the authorities- their fathers, husbands, sons, or mothers-in law and their social groups and is therefore never legitimised by the values of the larger social structures. They also govern women’s participation in treatment (Susser M. 1969) and women themselves keep denying their needs.

When Hirawati was diagnosed as suffering from tuberculosis during her pregnancy, her mother -in-law felt there was not much point wasting’ money on Hirawati’s treatment. However, after she bore a son, her mother-in-law’s attitude towards her softened somewhat.

Therefore, if women often do not seek care immediately for their ill health it is not because they are foolish, ignorant or stupid, but because in their frame of reference where there is poverty, as well as their lack of social value in the household, as well as social negation of their ill- health, it is the only rational method of behaviour.

Table 1. Systemic classification of illnesses amongst the non-pregnant women of the slum

Total problems of ill health – 592

Medical response to women’s ill health

The attitude of the dispensers of health care – the doctors is no less a problem. When women seek medical care, they reach an authority that has the power to define what is normal, and what is abnormal (Ilich, I. 1976). Often many people go to hospital to find their complaints are not listened to or dismissed summarily.

Shyama had lower abdomen she was sent back from the OPD with a diagnosis of hyperacidity, and was given Digene. Later, the same day the researcher met her and on examining her made a presumptive diagnosis of acute appendicitis and sent her back (with a letter) to the emergency ward. She was admitted and operated upon the same night with a final diagnosis of acute appendicitis.

When Ramdevi started complaining of loss of sensation in two of her fingers, she was told by the family that it was probably nothing important. Her husband felt she was wasting her time and refused to give money. She used her own savings to pay for her visits to the doctors who found no abnormality, gave her vitamins and told her she would improve with time. The sent her to a neurologist in AIIMS, who suspected Hanson’s disease (leprosy), and referred her to a dermatologist who confirmed the diagnosis and started treatment.

Shanti R. paid a few visits to hospital complaining of low back ache and discharge, which she felt was due to her copper T. The doctors gave her some painkillers, and said “bibi, all this is only in your mind”, and refused to remove the copper T. It was later removed by the researcher, and Shanti’s menorrhagia and backache decreased over the next few months. (Incidentally after a course of haemantinics and antibiotics, when she felt more fit, Shanti returned voluntarily to have a new copper T inserted, since she knew it would be removed if her problems recurred).

Thus while the patients feel the distress, it is the health care system that defines their need(Evans R. G. and Stoddart G. L. 1990: 1347-1360), and often declares them hysterical or neurotic and their health problems are often termed psychosomatic. A healer (traditional or modem) therefore has the power to label a woman as ill, or to refuse social recognition of her pain and disability.

Modern curative medicine due to its professed “scientific” base is considered value free and neutral. By delinking issues of health from social structures, or by talking of individual biology or the physical environment in isolation from the social environment, it fails to understand the intricacies of health status. This lack of complete understanding leads to an incomplete diagnosis that has far reaching implications for the women. Yet the doctor has the authority to label her!

Rajkumari was diagnosed as having pulmonary tuberculosis, and had received incomplete treatment for two years. The TB Hospital at Mehrauli, investigated and diagnosed an active recurrent lesion. Treatment was begun but stopped two months later as her husband had stopped taking her to the hospital. He was chronically unemployed, and claimed he had no money. An NGO began to pay for her medication yet the husband did not take her to Mehrauli regularly. He also stopped coming to the office for her supplementary nutrition. Neighbours did not help, partly because he had the reputation of becoming violent. Rajkurnari was in no shape to move and the doctors at Mehrauli refused to give medicines by proxy to the husband, for they could not guarantee that the medicines reached her. There were no beds available to admit her either. For a month the health worker helped by bringing her drugs, and her suppliments but once Rajkumari improved slightly, the NGO stated that the husband needed to take over responsibility. He did not and her treatment was discontinued for the second time. In medical jargon however, she is a ‘defaulter’ and the doctors will probably blame her for stopping the treatment!

A doctor is socialised through medical education into acquiring a certain way of thinking, a set of attitudes, and a scale of values and preferences that are quite different from the lower ranks of society (Cockburn 465-474). This is especially so, since the doctor comes from a class quite different from that of the slum dwellers.

Amongst doctors, the General Practioners (GPs), who stand close to the community and are subject to many pressures from it, tend to be somewhat more sensitive to the personal aspects of care. Their hours of availability are also established with their patient’s daily routines in mind. The RMPs among the practitioners are very popular in the slum. So, when one of the four MBBS doctors used his connections to have their practice in this area forbidden, because they were ‘quacks’, this has not appreciated by the slum dwellers who stated quite clearly that Ajit had these doctors removed, since they were good and charged less than the allopaths, and therefore, he was making less money. However, by 1998 there were ten RMPs practicing in the slum once again.

In this slum, many people prefer to go to a Private Practitioner who were cheap, effective, timing were convenient so wages were not lost, and interaction was polite. For an illness that persists they go to the hospital. Of the one hundred and eighty three pregnant women (with two hundred pregnancies, 80.5% preferred a Private Practitioner for minor ailments, 83% said they would go to the hospital only if referred, if they needed investigations, or if the Private Practitioner was unable to treat them. Hospitals were not necessarily helpful,

Gyanti’s baby was sent back from Safdatjang Hospital (SJH) casualty with nasal drops when she was actually suffering from acute Broncho Pneumonia with Septicemia. She was admitted to the casualty in AIIMS (taken by the researcher) and hospitalised for three weeks! Other than this kind of mismanagement which occurs on a dangerously regular basis, there is also the problem of the burden of ill health being carried by these women being considered as exaggerated, and therefore not quantified and thus neutralised.

For a doctor the woman is a ‘medical case’. Their multiple roles in society are ignored and the social determinant of sickness or any socially defined need for medical care (e.g. poverty) is always treated as if it were a disease (Susser M. 1974, pp.539-548), and therefore amenable to drugs. This we saw in back aches due to anaemia, weight lifting and heavy load of work which prevents the women from being able to rest. The medical profession rarely takes these factors into account. These women often receive medication like Gestanin, as well as perfunctory advice for bed rest that is socially impossible for the greater number.

Similarly anemia due to lack of food can hardly be eliminated merely by prescribing haemantinics for a few weeks. Anguri came to the clinic with the complaint of tiredness. Her husband is a kabari-wallah (waste picker), but was earning very poorly because he had developed severe weakness of the left upper limb. The reason for this weakness had not been diagnosed, therefore he was not receiving any treatment. Due to this problem he was notable to cycle well, or pick up heavy loads. He was therefore was earning less. Anguri was forced to work as a domestic help.

A large part of their earnings went towards doctor’s fees and medicines. They had four children, and they also needed to save some money since their eldest daughter’s marriage was impending. As a result there was not much money for food. Over a few months, Anguri became severely anaemic. The drugs and nutrition prescribed for her anemia were beyond her financial capacity. Only after her son found work and she borrowed to set up a shop to earn some money, she was able to marginally improve her diet and reduce her anaemia.

Doctors are not the only hurdle, the general problems of Government Hospitals – of overcrowding, poor sanitation, long queues repeated visits, cultural chasm between the providers and the poor patients- tends to make even the bravest hearts quail.

Table 2. Patterns of disease distribution amongst the non-pregnant women of the slum

A morbidity profile of women in the slum

The data from the clinic (where medicines were subsidised or given free if required and where the timings were elastic so as to suit working women as well as housewives, and where patients complaints were not summarily dismissed), though probably the tip of iceberg, gives some indication of the size and the kind illnesses women carry. It gives lie to the fact that women are ignorant of their health problems and need to be given health education to be able to learn to seek care for themselves.

Over 1992 November to October 1993 a total of 2049 patient-visits in the clinic were recorded., 1255 (61.3%), were of women between fifteen and forty five years of age. Amongst these 1255 women-patient-visits, 496 (39.5%) were for general illnesses while 759 (60.5%) were specifically for pregnancy related disorders. Such a large proportion coming for antenatal care reflected an expressed need, which will be discussed later.

Significantly, amongst the 759 pregnant women, 79 (10.4%) had amenorrhea, and had come to find out if they were pregnant. Among women with general illnesses – in 496 visits 592 diseases were recorded (19.4% with more than one illness at a visit). This demonstrates that for many women one illness exacerbates the occurrence of the other that 19.4% of women apparently needed this additional disease burden before they could legitimately” call themselves ill and in need of medical care. Of these 96 women, about 28% were diagnosed to have anaemia and an additional illness, and 32% had respiratory infection with another illness. About 20% were pregnant and suffering from an infectious disease and 13% had a combination of malnutrition, or skin or gastrointestinal problems etc.

Amongst the pregnant women seen in the field, of the 95% who complained of obstetric related ill health, 68% had sought medical care while of the 26% with infective illness only 13% had sought medical care. This data very clearly demonstrates that all come for health care only when the load of illness cannot be missed by others. Disease pattern showed that about 47% women had infectious diseases, 16% were from anemia, and 37% suffered from other non-infectious illnesses. Systemically, the morbidity among women is reflected in Table-I.

Anemia was the single commonest problem for women affecting 16% of the women with general health problems. Its signs and symptoms were- exhaustion, tiredness, lethargy, giddiness, which are subjective as physical manifestations like pedal oedema, extreme pallor or signs of heart failure are seen only in extremely florid anemia. The data again reinforces the social misinterpretation of anemia as ‘malingering’ ‘lazy’ or portraying them as weak, neurotic or hysterical as mentioned earlier.

Amongst combined diagnoses of different systems, it is observed that infections of the respiratory tract (17.6%) are the commonest. These include infections of the upper respiratory tract (URI) including ear, nose and throat, pulmonary infections like pneumonias, and tuberculosis (TB). Thereafter, are non-infectious gynaecological problems (13.2%), which include women with infertility, bad obstetric history (BOH), uterine prolapse, and problems with periods. Genitourinary infections (12.3%), which include pelvic inflammatory disease (PID), and urinary tract infections (UTI), are the next common problem. Subsequent are infections of the alimentary tract (10.6%), which includes gastroenteritis (GE), caries and other infections of the alimentary tract like colitis, appendicitis, hepatitis, etc. Gastritis is the next common problem (4.9%), followed by infections of the skin (3.4%), and fevers (3.2%), mainly malaria. The problems of the skeletal system are mainly of the joints and muscles (2.5%), or injuries (1%). The remaining are miscellaneous problems of other systems, Table- II

For the women of the slum, the physical and social environment, poverty and under-nutrition, as well as their devalued low social status compounded by overwork, and the burden of reproduction are all responsible for their poor health . While this thesis deals with the problems of poor women, it needs to be kept in mind that these problems are true in a wider way for all the weaker social and economic groups and this includes males as well though they are not devalued within their families.

Our data shows that even when women recognise their ill health, their decision on action depends upon various considerations including resource constraints, other family needs (which act as social pressures), capacity to continue working, the attitudes of their social figures of authority; the efficiency of health care system and its cost. The circumstances in which these women seek health care are thus not only rooted in their material and social conditions but also in the subjective cultural norms born out of the patriarchal nature of family and social institutions. It is ironical that, the very same patriarchal social structures, culture and kinship patterns that form an integral part of the survival mechanism of the poor communities, sucks the very lives from the bodies of their women.

NOTE

1 The concept of the ‘sick role’ was first outlined by L. J. Henderson (1935), and later elaborated by T. Parsons (1951). This concept has been criticised on a number of grounds. For some critics, Parson’s model of the ‘sick role’ is itself a legitimation of the power of doctors over patients. However, here, in the slum it is seen that this model is the legitimation of the power of all figures of authority for the pregnant women.

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Contributor:

ALPANA SAGAR. She completed her MBBS from Vellore Medical College and then chose to work in the state of Himachal with a non-governmental organisation that served the villages. After some years of practice, her questioning mind brought her back to academics as her work threw too many questions regarding her practice and the reality of her patients’ lives. She wanted to understand the root causes of illness and see if she could work at another level of practice. She got her Ph.D. from the Centre of Social Medicine and Community Health, Jawaharlal Nehru University in the year 1999 and then joined the Centre as an assistant professor. Over the short period of her work, she enriched the academic life of the Centre. She worked for her post doctoral research with an interdisciplinary perspective in areas such as declining sex-ratio in India, maternity care, nutrition, women’s health and history of public health and research methodology. She published her work in journals and books.

In her death, we lost a very active, bright and perceptive public health scholar committed to her students, colleagues and the collective vision of an alternate public health for India.