Like clockwork, a terrible abdominal pain grips Gayathri Kachcharabi every month. The three days of pain are the sole reminder of her periods, which stopped more than a year ago.
“That is how I know it’s my period, but I don’t bleed,” says Gayathri. “Maybe giving birth to three children left me without enough blood to menstruate,” the 28-year-old says. The amenorrhea – absence of menstrual periods – did not dull the monthly stomach cramps and back pain, which are so painful that Gayathri says she feels like she is going into labour. “It is hard to even get up.”
Gayathri is tall and lean, with striking eyes and a staccato style of speaking. An agricultural labourer from the Madigara keri – colony of Madigas, a Dalit community – on the outskirts of Asundi village, in Haveri district’s Ranibennur taluk in Karnataka, she is also a skilled hand pollinator of crops.
It was when urinating became painful, about a year ago, that she sought medical attention. She went to a private clinic in Byadgi, nearly 10 kilometres from her village.
“They don’t give proper attention at government hospitals,” she says. “I don’t go there. I don’t have that card for free medical care.” She is referring to the Pradhan Mantri Jan Arogya Yojana , a health insurance programme under the Ayushman Bharat scheme, which provides medical cover of Rs. 5 lakhs per family each year for secondary and tertiary care hospitalisation.
At the private clinic, the doctor advised her to get a blood test and an ultrasound scan of the abdomen.
A year later, Gayathri has not undergone the diagnostic tests. At a minimum of Rs. 2,000, the expenditure seemed steep. “I couldn’t do it. If I went back to the doctor without these reports, they would scold me. So I never went back,” she says.
Instead, she approached medical stores for pain medication – a cheap and quick solution. “Entha gulige adavo gotilla [I don’t know what tablets],” she says. “If we simply say we have a stomach pain, the store gives us the medicines.”
The existing government medical services in Asundi are inadequate for the population of 3,808. None of the medical practitioners in the village has an MBBS degree, and there is no private hospital or nursing home.
The Mother and Child Hospital (MCH) in Ranibennur, a public facility nearly 10 kilometres from the village, has only one obstetrician-gynaecologist (OBG) specialist, though two posts are sanctioned. The other government hospital in the vicinity is in Hirekerur, nearly 30 kilometres from Asundi. This hospital has no OBG specialist though it has one sanctioned post. Only the district hospital in Haveri, nearly 25 kilometres away, has OBG specialists – six of them. Here, all 20 posts for general medical officers and six posts for nursing superintendents are vacant.
Till date, Gayathri does not know why her periods stopped or why she suffers from the recurring abdominal pain. “My body feels heavy,” she says. “I don’t know if the abdominal pain is because I fell from a chair recently or because of kidney stones or menstrual problems.”
Gayathri grew up in Chinnamulagund village in Hirekerur taluk , where she dropped out of school after Class V. She picked up the skill of hand pollination, which brings an assured payment and steady work for at least 15 or 20 days every six months. “It is 250 rupees for crossing [hand pollination],” she says.
Married at the age of 16, her work as an agricultural labourer has always been precarious. She finds work only when the land-owning communities, especially the Lingayat community, in nearby villages, need labourers to harvest corn, garlic or cotton. “Our coolie [wage] is 200 rupees for a day,” she says. Over a period of three months, she gets agricultural work for 30 or 36 days. “If the land owners call us, we have work. Otherwise, no.”
Working as an agricultural labourer and hand pollinator, she earns Rs. 2,400-3,750 a month, which is not enough for her medical care needs. The financial crunch is more acute in the summer, when regular work dries up.
Her husband, also an agricultural labourer, is addicted to alcohol and doesn’t add much to the household income. He is often unwell. Last year, he couldn’t work for more than six months because of typhoid, and fatigue. In the summer of 2022, he met with an accident and broke an arm. Gayathri stayed at home for three months to take care of him. His medical expense came to nearly Rs. 20,000.
Gayathri borrowed money from a private money lender at an interest rate of 10 per cent. Then she borrowed money to pay that interest. She has three other outstanding loans of about Rs. 1 lakh from three different microfinance companies. Every month, she ends up paying a Rs. 10,000 towards these loans..
“ Coolie maadidraage jeevna agolri mathe [We cannot run our lives on daily wages],” she emphasises. “We have to borrow money when we are unwell. We cannot miss repaying the loan. Even if we don’t have food, we don’t go to the weekly market. We have to pay the sangha [microfinance company] week after week. Only if there is money left do we buy vegetables.”
Gayathri’s meals are almost bereft of pulses or vegetables. When there is no money at all, she borrows tomatoes and chillies from neighbours and cooks up a curry.
It is “starvation diet”, Dr. Shaibya Saldanha, associate professor at Department of Obstetrics and Gynaecology, St. John’s Medical College, Bengaluru, says, “Most women agricultural labourers in north Karnataka live on starvation diets. They eat rice and thin dal saar [curry], which has more water and chilli powder. Chronic starvation causes chronic anaemia, which makes them exhausted,” adds Dr. Saldanha, who is a co-founder of Enfold India, an organisation that works to improve adolescent and child health. She was on the committee constituted by Karnataka State Commission for Women in 2015 to look into unwanted hysterectomies in the region.
Gayathri complains of bouts of dizziness, numbness in the arms and legs, back pain and exhaustion. These symptoms are indicative of chronic malnourishment and anaemia, Dr. Saldanha says.
According to the National Family Health Survey 2019-21 ( NFHS-5 ), in the last four years, in Karnataka, the percentage of women aged 15-49 years with anaemia increased from 46.2 in 2015-16 to 50.3 per cent in 2019-20. In Haveri district, over half the women in this age group were found to be anaemic.
Gayathri’s fragile health also affects her wages. “I am unwell. If I go to work one day, I don’t the next day,” she says with a sigh.
Manjula Mahadevappa Kachcharabi, 25, is also in pain, and all the time. She suffers from severe stomach cramps during her period, and abdominal pain and vaginal discharge afterwards.
“The five days when I am menstruating are extremely painful,” says Manjula, who works as an agricultural labourer for Rs. 200 a day. “I cannot get up for the first two to three days. I get stomach cramps and I can’t walk. I don’t go to work. I don’t even eat. I simply rest.”
Besides pain, Gayathri and Manjula share another problem in common: the lack of a safe and sanitary toilet.
After her marriage 12 years ago, Gayathri came to live in a 7.5 x 10 feet windowless house in the Dalit colony in Asundi. The home is just over a quarter of the area of a tennis court. Two walls partition it into kitchen, living and bathing areas. There is no space for a toilet.
Manjula lives with her husband and 18 other family members in a two-room house in the same colony. Mud walls and curtains fashioned from old saris divide the rooms into six sections. “ Enukku imbilri [There is no space for anything],” she says. “When all the family members are present for festivals, there isn’t space even to sit.” The menfolk are despatched to the community hall to sleep on such days.
The entrance of the small bathing area outside her house is covered by a sari. The women of Manjula’s household use this space to urinate, but not if there are a lot of people at home. Of late, a foul smell has begun to emanate from here. When the colony’s narrow lanes were dug up to lay pipelines, water stagnated here and fungus grew on the walls. It is here that Manjula changes her sanitary pads when she menstruates. “I get to change pads only twice – once in the morning before going to work, and in the evening after coming home.” There are no toilets she can use on the farms where she works.
Like all spatially segregated Dalit colonies, Asundi’s Madigara keri too is consigned to the village periphery. Nearly 600 people live in the 67 houses here, and half the houses accommodate more than three families each.
Spread over 1.5 acres of land allotted to Asundi’s Madiga community more than 60 years ago, the colony is growing in population. But several protests demanding more housing have led nowhere. To accommodate the younger generations and their growing families, people have divided the available space with walls or sari-curtains.
That was how Gayathri’s house went from one big room of 22.5 x 30 feet to three small homes. She, her husband, their two sons, and her husband’s parents, occupy one of them. Her husband’s extended family live in the other two. A narrow, dingy passage in front of the house is the only space available to do the chores the cramped house cannot accommodate – washing clothes, cleaning vessels and bathing her two sons, 7 and 10 years old. As their home is too small, Gayathri has sent her 6-year-old daughter to live with the child’s grandparents in Chinnamulagund village.
While 74.6 per cent of households in Karnataka use an ‘improved sanitation facility’ according to NFHS 2019-20 data, in Haveri district only 68.9 per cent households have one. An improved sanitation facility, according to NFHS, includes “flush or pour-flush to piped sewer system (septic tank or pit latrine), ventilated improved pit latrine, pit latrine with slab, or composting toilet.” No such facility is present in Asundi’s Madigara keri . “ Holdaga hogbekri [We have to relieve ourselves in the fields],” Gayathri says. “The farm owners fence their fields and hurl abuses at us,” she adds. So the colony’s residents go early, before dawn.
Gayathri reduced her water intake as a solution. And now, when she returns home without urinating because the landowners were around, she experiences excruciating abdominal pain. “If I go back after some time, it takes me at least half an hour to pass urine. It becomes too painful.”
Manjula, on the other hand, suffers from abdominal pain because of vaginal infection. When her period ends every month, vaginal discharge begins. “It continues till the next menstrual cycle. My stomach and back hurt till I get my periods. It is extremely painful. I don’t have strength in my arms and legs.”
She has visited 4-5 private clinics so far. Her scans came back normal. “I was told not to go for any more check-ups till I have a child [become pregnant]. That’s why I haven’t gone back to any hospital after that. There was no blood test done.”
Not satisfied with the doctors’ advice, she sought refuge in traditional herbal medicines and local temple priests. But the pain and discharge hasn’t stopped.
Malnutrition, calcium deficiency and prolonged hours of physical labour – along with unhygienic water and open defecation – could lead to vaginal discharge, with chronic backache, abdominal pain and pelvic inflammation, says Dr. Saldanha.
“It is not about Haveri or some pockets,” underlines Teena Xavier, an activist in north Karnataka who was a part of Karnataka Janarogya Chaluvali (KJS), the organisation that petitioned the Karnataka High Court on maternal deaths in the region in 2019. “Vulnerable women all become prey to the private health sector.”
The lack of doctors, nurses and paramedical staff in rural health facilities in Karnataka forces women like Gayathri and Manjula to look for private healthcare options. An audit in 2017 of reproductive and child health under National Rural Health Mission, which surveyed selected health care facilities in the country, pointed to a huge shortfall in doctors, nurses and paramedical staff in Karnataka.
Unaware of these structural problems, an anxious Gayathri hopes to have her problem diagnosed some day. Anxious on days when she is in pain, she says, “What will happen to me? I haven’t done any blood tests. If I had, maybe I would have known what the problem is. I have to somehow borrow money and get diagnosed. I have to at least know what is wrong with my health.”
PARI and CounterMedia Trust’s nationwide reporting project on adolescent girls and young women in rural India is part of a Population Foundation of India-supported initiative to explore the situation of these vital yet marginalised groups, through the voices and lived experience of ordinary people.