Social mobilisation for change

In Tamil Nadu's backward Dharmapuri district, a public health campaign employs the medium of street theatre to address social issues such as female infanticide and evolves into an effective campaign for women's empowerment.

VENKATESH ATHREYA

THE mass literacy campaigns of the 1990s in India, even as they differed widely in the degree of success attained in respect of final literacy achievements, were in most instances successful in mobilising and motivating the community around the agenda of literacy (Frontline, September 6, 1996). An important reason for this success was the specific strategic instrument that was utilised for the process of social mobilisation: the use of travelling theatre troupes.

Drawing on this aspect of the experience of mass literacy campaigns, the Tamil Nadu Government launched an initiative in Dharmapuri district as part of the Tamil Nadu Area Health Care Project (TNAHCP) funded by the Danish International Development Authority (DANIDA). While Tamil Nadu is generally considered a relatively advanced State in terms of social indicators such as the rate of literacy, the infant mortality rate (IMR), various demographic parameters such as birth and death rates and so on, Dharmapuri district performs very poorly with respect to most of these indicators. The general status of women in Dharmapuri is particularly appalling. Its rural female literacy rate, as per the 1991 Census, was 31.3 per cent, well below the State average of 41.8 per cent. Less than half the births in the district took place in medical institutions as against the State average of 70 per cent. Its rural sex ratio in 1991 was 941 females per 1,000 males for the general population and 905 for the population in the 0-6 years age group. The corresponding figures for Tamil Nadu are 981 and 948. Its rural female IMR of 130.8 in 1995 was more than twice the State average of 57.3, and almost twice the district's rural male IMR of 69.

Behind the phenomenally high female IMR of rural Dharmapuri lies the horrendous social practice of female infanticide. From 1994 to 1997, more than 1,000 female infants were killed annually. These accounted for more than half the female infant deaths in the district. The practice cuts across all castes.

Clearly, the abysmal state of health and gender empowerment in Dharmapuri district warranted urgent government intervention. An opportunity arose when Dharmapuri was selected as the project district for the third phase of the TNAHCP. While the TNAHCP mandate in the project district was to improve primary health care, Project Director Sheela Rani Chunkath, who is also Commissioner, Maternal and Child Health and Welfare, Government of Tamil Nadu, believed that it would not suffice to act only on the "supply" side by providing more and better primary health care facilities, even though this would be an important aspect of the project. In her view, it was equally or perhaps even more important, given the extreme backwardness of the district and the particularly disempowered status of women, to create an environment in which people, especially women, would want to and be able to access the public health care services. In practice, this meant:

R. SRIDHAR
The campaign in Dharmapuri district incorporated street theatre to get across messages on health and gender issues.

* creating awareness about the availability of primary health care services, and the people's right to demand and avail themselves of these services.

* putting health in general, and women's health in particular, on the agenda of the community.

* sensitising the community as well as the health service providers to the issues of infant and maternal mortality and morbidity, and the particularly vulnerable position of women in the prevailing patriarchal social order with respect to health issues.

Sheela Rani Chunkath, who led a highly successful mass literacy campaign in the State's Pudukkottai district in 1991-92, decided that a key step in the process of improving the health status of the people of Dharmapuri district would be to motivate and mobilise the community in general and women in particular to put their own health on the agenda of the community and to demand and access primary health care facilities. Since such an extreme and repugnant form of discrimination and violence against women as female infanticide was an important dimension of the district's poor health status, any effort to mobilise the community around health issues would have to address the issue of women's empowerment directly rather than focussing primarily on spreading health information.

Sheela Rani Chunkath said that the Government of Tamil Nadu has explicitly acknowledged the problem of female infanticide, documented it and is serious about tackling it, unlike some other parts of India where the problem exists but policymakers there have not acknowledged or dealt with it. The Health Minister of Tamil Nadu has stated that stringent action would be taken against those committing infanticide, including the father of the victim. The Government is also contemplating special legislation to tackle the problem.

The most important thing, however, is to motivate and mobilise the community against this heinous practice. Sheela Rani Chunkath believed that legislation should recognise the pressures brought to bear upon the woman by her husband and in-laws to commit infanticide. The onus to prove his innocence must be on the father of the victim of infanticide.

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A scene from a skit with a message against dowry, "Neengalae Sollungal" (You be the Judge).

The TNAHCP incorporated the strategy of itinerant street theatre (kalaipayanam in Tamil) as part of its campaign on health and gender issues in Dharmapuri. With the focus on women's empowerment and community participation in health, a number of skits and songs were developed at workshops under the guidance of a professional street theatre playwright and director, Pralayan. A team of street theatre activists working full time with the Dharmapuri district mass literacy campaign helped shape the language and idiom of the plays, imparting an authenticity that is crucial to making a performance effective. These activists later served as master trainers.

The active involvement in the project of key officials was a significant feature of the effort. The Project Director and key programme managers spent several days with the playwright and the troupes going over the finer points of the issues involved and ensuring that the messages to be communicated would reflect these nuances as accurately as possible.

The skits and songs touched upon such themes as violence against women in the form of so-called 'eve-teasing'; early marriage and frequent childbirths, which violate not only the right to reproductive choice but the right to education and employment; dowry; the preference for sons and the wider context of patriarchy, which provides a basis for the practice of female infanticide; the need to access antenatal care and go in for institutional delivery to minimise the risk of maternal death; the need for male participation in reproductive and sexual health; the exploitative character of commercialised private health care; and the right of people to access public primary health care.

In order to saturate Dharmapuri district with the messages, around which the skits and songs were woven, at least 3,000 street theatre performances, one in every hamlet, had to be arranged. The project leadership developed one street theatre troupe for each of Dharmapuri's 18 blocks. Each block troupe would travel around the block for 40 days and present 140 to 150 performances, lasting 60 to 90 minutes. This required a major mobilisation effort, since each troupe had 15 persons, of whom around a third would be women.

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A scene from "Valliyin Vazhakku" (Valli's Case) depicting eve-teasing as a form of violence against women.

Dharmapuri's ongoing mass literacy campaign had brought forward committed social activists. The synergy between the literacy campaign coordinators, drawn mostly from the Tamil Nadu Science Forum, and the TNAHCP leadership, helped in developing 18 block-level kalaipayanam teams. The task of putting together 18 troupes, a total of around 280 persons, was remarkable in itself. It meant that in backward, patriarchal rural Dharmapuri, there were young women willing to travel with young men and perform street plays before different kinds of audiences for 40 days continuously. This was a testimony to the progressive impact of the district mass literacy campaign.

After a fortnight-long training, the troupes hit the road. A colourful rally to inaugurate the Nam Nalam Ariya Kalaipayanam (a Tamil expression that translates broadly as 'campaign to know our health') was flagged off by Minister for Health and Electricity Arcot N. Veerasami in the presence of Minister for Information and Publicity Thiru Mullaivendan, people's representatives, State- and district-level officials and other eminent persons. While this served to provide official recognition to the campaign, the presence of a large number of people, including social activists from the literacy campaign and other mass movements, who had come from all parts of the district, testified to the potential of the campaign as a people's movement.

Meanwhile, efforts were under way to ensure maximal community participation in the campaign. A team of health service providers and literacy activists was formed in every PHC. (A PHC normally serves a population of around 30,000, typically spread over eight to 12 panchayats.) The team members approached the leaders of elected local bodies and locally influential persons and explained the purpose and the details of the campaign. In most instances, the community leaders were more than willing to host the troupe, arrange for the performance and mobilise the community to attend it. This testified to the generosity of the rural communities - and especially the poor among them - that one had so often encountered in the mass literacy campaigns earlier.

THE kalaipayanam campaign was, by and large, very successful. While the project funds helped meet the expenses of transport, equipment, uniforms, training and other core expenses, local hospitality, publicity and stage arrangements were taken care of by the local community. The involvement of the community was also reflected in the quality of the discussions that were provoked by the skits and songs.

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Sheela Rani Chunkath (centre), Commissioner, Maternal and Child Health and Welfare, with members of the local community taking an oath against female infanticide.

In a play called "Valliyin Vazhakku" (Valli's Case), a village girl Valli brings together the women of the village and forces a reluctant all-male panchayat to render justice to her by punishing a young man who molested her. The man is forced to fall at her feet and seek forgiveness. Predictably, some men in the audience thought this was going too far, while all the women heartily approved of the act of apology. But more interestingly, after a little reflection, many men agreed with the women. The reactions thus reflected both the pervasive reality of male dominance and the positive impact of the play.

"Kolli Vai" (Light the Funeral Pyre), a play in which the funeral pyre of the father is lit by his daughter defying the custom that only a son can perform this ritual, drew an emotional and enthusiastic response. The play attacked the preference for sons and female infanticide subtly, but with great effect. Many in the audience identified themselves with the father who is driven out of his own house by his son and is then taken care of by his daughter and son-in-law.

Plays such as "Kalyani" (about ante-natal and natal care and reproductive choice for women) and "Kolli Vai" often moved individual members of the audience to action. In many villages, the people assembled took an oath to put an end to the practice of female infanticide and to take good care of infants and pregnant mothers. Sometimes, young women and men came on to the stage after the performance and resolved to put an end to the practice of dowry. In about a third of the villages where the troupes performed, village-level health committees were formed under the leadership of the elected panchayat leaders, many of whom were also women.

Other indicators also point to the positive impact of the campaign. Attendance at outpatient clinics in PHCs has shown a dramatic increase after the campaign. Discussions with village health nurses and male health workers of PHCs and health sub-centres show that they have become better attuned to the gender-specific dimensions of health issues at the grassroots. Most of them also say that they now feel confident of openly raising the issue of female infanticide and speaking strongly against it, because the campaign has sensitised local youth and heightened awareness, thus providing them a supportive environment. A visit to a few villages distributed over several blocks and field-level discussions with residents suggested that practically everyone knew of the kalaipayanam, many had watched the performances, and quite a few had actively participated in its organisation and conduct. The impact of the campaign is also evident in the willingness of the community in many places to contribute to and participate in the building of health sub-centres.

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A happy mother and her female infant in a rural area of Dharmapuri district.

An aspect of the campaign that comes through during field visits is the degree of involvement of some health department officials and the literacy activists. Particular mention must be made of the following: Dr. Alphonse Selvaraj, Deputy Director of Health Services in Dharmapuri; Dr. S. Nalini, medical officer; Alphonse Mary, district public health nurse; Bhagvathi Venkat, Central Programme Coordinator in the district literacy campaign, and officials R. Srinivasan and P. Nagaraj.

In all these cases - as in the case, interestingly, of professional drivers who transported the troupes to numerous villages, often driving late into the night - there was a significant element of voluntarism. Although they all drew salaries or received wages, the amount of time they put into the campaign went far beyond the call of duty. This kind of voluntarism lent the campaign a lot of strength.

CLEARLY, the successful conduct of the kalaipayanam campaign is only a first step. Unlike literacy campiagns, which have a single-point agenda and well-defined norms of achievement, and are something on which consensus is relatively easy to obtain, health - especially when linked to women's empowerment - is rather more contentious territory. The campaign has served to sensitise health service providers in the government sector and heightened awareness of health and gender issues among a sizeable section of Dharmapuri's rural population. Here and there, local committees to pursue the agenda of the campaign have emerged. Local body leaders, a significant proportion of whom are women, participated in the campaign and, in that sense, own its agenda and objectives. But sustaining these gains is not easy, especially since the agenda ahead involves confronting both patriarchal structures and powerful vested interests of various hues, as well as successfully gearing up the 'supply side' of the public primary health care system. Systematic training on health and gender issues within the framework of the new panchayati raj institutions needs to be imparted to social activists and community leaders, at least half of whom must be women. This could be the most important next step.

Dr. Venkatesh Athreya is Professor of Economics at the Indian Institute of Technology, Chennai, and an executive committee member of the National Literacy Mission Authority.

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