EndMMNow Monitoring the Delivery of Maternal Health Services in Assam, India
a project by
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Project Summary Female tea garden workers in Assam suffer from the highest rate of maternal mortality in India.
Today, modern-day slavery persists across Assam’s tea gardens (North-East India) where workers, the majority of whom belong to the Adivasi community, lack access to healthcare, housing, and nutrition despite domestic and international laws protecting these basic rights. Women in these Tea Garden communities have insufficient access to essential healthcare services and minimal exposure to legal resources that would inform them of their rights. Due to the devastatingly poor availability of health infrastructure and low awareness of their rights, female tea garden workers in Assam suffer from the highest rate of maternal mortality in India. To address these gaps Nazdeek, PAJHRA, and ICAAD, have developed a project combining technology with community awareness and participation to increase access and accountability in the delivery of reproductive health services, thereby, reducing the number of preventable maternal deaths and increasing access to life-saving medical treatment.
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Context Despite 51% of India’s tea production hailing from Assam, tea garden workers face egregious violations of their human rights.
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Context Tea garden workers in Assam earn the lowest wage in the organized sector in India. Additionally, tea garden workers have insuďŹƒcient access to health facilities and essential services. Existing facilities are severely underequipped and understaed, and many villages are located in underserved
Assam has the highest maternal mortality rate in India
and remote areas. As a result, Assam has the highest maternal mortality rate in India and families have minimal access to legal resources to seek redress. According to the Government of Assam, the State’s Maternal Mortality Rate is 381 and the Infant Mortality Rate is 55 which is far above the national MMR of 178 and IMR of 42.
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The Supreme Court of India has recognized the right to
Maternal mortality is a human rights violation
health as a fundamental right, and various High Courts have held that maternal mortality is a human rights violation. The Central Government and the State of Assam have enacted a series of policies to curb maternal and infant mortality rates and guarantee universal health care, however, extremely limited awareness of government policies among communities combined with a lack of monitoring and weak community engagement has resulted in gross failures to implement policies that ensure access to basic health entitlements for tea garden women. The existing monitoring system is ineďŹƒcient and unaccountable, and community members are unaware of their entitlements.
A 2009 study by the Guwahati University investigating Primary Health Centers in the Sonitpur District found that,
only 17%
have inpatient service
only 21%
offer 24 hour delivery service
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only 39%
have a labor room
Program Mission Issues of discrimination, poverty, and distance often exacerbate barriers to accessing healthcare resources. We seek to close the gaps so that women from marginalized communities in Assam have access to life-saving medical treatment in accordance with basic human rights law. By strengthening the enforcement and awareness of laws, policies, and programs we will increase accountability in the delivery of reproductive health services for women in Assam’s tea gardens, thereby, reducing the rate of preventable maternal and infant deaths in Adivasis communities.
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Opportunities for Intervention Lack of a Mechanism to Report Health Rights Violations
While most maternal deaths are preventable if health care is timely, women are often rejected on the basis of their status or inability to pay. Currently, female tea garden workers do not have the means to report violations of their health rights due to the lack of transparent reporting mechanisms that hold public and private entities accountable for their failures. At a technical level, basic tools to communicate, inform, seek help, and document are virtually non-existent, which perpetuates systemic discrimination.
Lack of Data for the Advancement of Rights of Tea Garden Workers
Without an effective means to document and report real-time incidents the eďŹƒcacy of any NGO to represent individual or communities is severely impaired. Governments often insist on advocates providing data before any discussion on policy change or monitoring enforcement of existing laws can occur. More importantly, legal claims before courts are strengthened when advocates can provide comprehensive factual evidence demonstrating a pattern and practice of abuse or failure to protect its citizenry. Without hard data, NGOs and activists simply do not have the capabilities to properly serve the marginalized tea garden workers in Assam.
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Lack of System Ensuring Accountability of Data
For NGOs to strengthen their advocacy and ensure credibility, they must internally reect the accountability and transparency they often seek from the governments they challenge. An online mapping platform enables NGOs to take individual incident reporting and openly share, collaborate, and visually represent their data in a way that ampliďŹ es their concerns. This ensures internal accountability/ transparency, bolsters credibility, and strengthens advocacy eorts while helping to disseminate information and raise awareness of rights violations at the international level.
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Our Solution Nazdeek, PAJHRA, and ICAAD are conducting a pilot project that enables communities to monitor and report gaps in the delivery of health services in Assam, India
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During the one-year pilot program, we are relying on existing mapping and SMS based technology tools such
The aim is to work with community members and grassroots groups to document the delivery of maternal health services
as those offered by FrontlineSMS and Ushahidi. The aim is to work with community members and grassroots groups to document the delivery of maternal health services by developing SMS mobile application and a website that maps gaps and areas for improvement.
The data collected enables health rights advocates, like Nazdeek and PAJHRA, to provide the Government key data on the gaps in the delivery of maternal health services, increasing community awareness and monitoring of existing facilities and services, and ensuring access to remedies for victims of health rights violations.
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Project Activities Establishing a Mobile Application
By assigning project volunteers mobile phones with SMS technology, communities are provided with the tools to promptly report previously unobtainable data to activists and lawyers.
Advocacy Training and Education
To pilot mobile reporting or mapping platforms in an effective manner, volunteers are trained on basic maternal and infant health rights under Government schemes, as well as on the use of the technology to report violations. Training materials have been developed and translated in Assamese.
Incident Mapping
By developing a mapping platform which tracks incidents of maternal health violations, we aim to increase the community and public awareness of gaps in service delivery, resulting in a more accountable reproductive health system with heightened transparency.
Advocacy
The data collected through the project is analysed and submitted to authorities at District and State level which can utilize it to plan allocation of resources more effectively. Additionally, the data can also be used for litigation, namely to develop public interest cases which guarantee concrete reliefs for women, strengthen health infrastructure, and redress structural discrimination while avoiding overburden of the judicial system.
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Our Team Nazdeek is a transnational alliance of lawyers, researchers, and activists who seek to bring access to social and economic justice closer to marginalized communities in South Asia. Through intensive community-based work, Nazdeek has developed strategies for applying constitutional and human rights frameworks in national courts to improve the lives of the poor and marginalized. The International Center for Advocates Against Discrimination, ICAAD, is a nonprofit organization that combats structural discrimination by challenging legislation, case law, government policy, and cultural norms that negatively impact vulnerable communities. ICAAD builds the legal capacity of local NGOs; conducts rule of law trainings for judges, law enforcement, and faith leaders; uses technology to harness data for litigation; and recruits artists to amplify local issues globally. By leveraging private-public partnerships with law firms, universities, NGOs, artists, and technology companies, ICAAD aims for large scale systems change. Promotion and Advancement of Justice, Harmony, and Right, of Adivasis, PAJHRA , is a grassroots membershiporganization led by Adivasi. Their goal is to empower, promote, and protect the rights of the Adivasi community through advocacy, capacity building, and community organization with a focus on the protection and promotion of the Adivasis’ indigenous identity.
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Our Impact Mapping failures in the healthcare system will provide the data needed for advocates to close the gap in access to healthcare. Tracking pregnancies will help local NGOs and health workers ensure that female tea garden workers have access to adequate reproductive healthcare. By engaging in targeted trainings with lawyers, journalists, activists, and students we will build a local legal network to advance rights for Adivasis peoples, strengthen the community capacity to engage in rightsbased advocacy, increase knowledge of rights and entitlements among community members, raise awareness and action on behalf of tea garden workers in regional and international networks, and ultimately reduce preventable maternal mortality in Assam.
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