RESPONSE OF WOMEN ON HEALTH CARE SERVICES IN

HIMALAYAN HILLS: A STUDY FROM ALMORA DISTRICT OF

UTTARAKHAND, INDIA

Dr.Deepak Paliwal
Dr.Harish Chandra Joshi
Dr.Saroj Paliwal

Abstract

The mountain people, especially the rural women have been the subject of
colossal neglect for centuries. In a family, they have different status and
role to performed, i.e. mother, daughter, daughter-in-law etc. Their family
works are distributed among themselves, according to their position, but
the common concern is ‘Drudgery’and Health Status which is widely
spread in their life. Frequent pregnancies, coupled with poor diet, result in
anemia. Illiteracy among women has added to the problem as most of the
rural women are subjected to the various traditional beliefs and health
practices. Women share abundant responsibilities to perform a wide
spectrum of duties both in the home and outside, but their participation is
considered as normal by the society. This paper starts with the concept of
status of women , health facilities, and moves on to examine the
understanding of health seeking behaviorand social dogmas imposed on
women and women perception towards various health issues.

Keywords- Healthcare services, Women, Himalaya Hills, Health Status,

Drudgery

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
Dr. Deepak Paliwal & Dr. Harish Joshi & Dr. Saroj Paliwal/ Page 61-73
Introduction

Himalayan hills are characterised by tough geographic and climatic conditions that often
impaired with the growth and development of the region. At present, most of the
Himalayan hills have poor infrastructure and health facilities, and are characterized by a
society with some common malpractices such as caste based
misconduct/discrimination, superstitions and intake of excessive alcoholic beverages
etc. Even after passage of nearly twenty years since the creation of separate state i.e.,
State of Uttrakhand, the status of hill people is still not satisfactory in terms of
employment, agricultural productivity, health status particularly of women and
education. This is the reason, people are forced to migrate to nearby cities, big towns
and even to state or national capital regions in order to earn their livelihood and educate
their children. The human populace living in villages mostly comprise of those with
higher age classes where money-order based economy still in vogue. The per cent
forests are continuously on the rise which has, in turn, resulted into more and more
dangerous animals moving inside the human habitations. Therefore, man-wildlife
conflicts have also increased to great extent. The condition of women is still more
miserable. According to an study, it has been estimated that eighty nine and half (89.5)
per cent of females in India are engaged in agriculture and industries in rural India with
a diversity of roles such as labour works in agricultural fields, housewife, self-cultivators
and managers of their homesteads and thus, are invisible backbone of Indian
agriculture (Ahmed, 2004; Vineeta Nagarkoti, 2014). ‘Drudgery’ and ‘Health’ are still
the main concerns of hill women. Higher frequency of pregnancies, coupled with poor
diet has resulted in poor health of mothers and in long run its consequences appear in
form of malfunctioning of the body. Further, the situation has been worsened by poor
women literacy. The women usually remain overloaded with various responsibilities and
works inside as well as outside the home. Their household duties and agricultural
responsibilities are conceived of as if it is a part of their duties. In addition to this,
traditional beliefs and superstitions, poor health and education facilities have also
contributed in aggravating the situation. Accordingly with these observations, the
present study was planned with the following objectives:

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
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 to investigate the status of health facilities in the select study area

 to analyse the perception of rural women about traditional and modern health
care facilities and available latest technologies

 to assess the traditional health care practices adopted by women in the

mountains and to collect knowledge on these practices

 to study the role and impacts of socio-cultural barriers in effective delivery of

health services to women

Methodology
a) Study Area
The present study was conducted in Almora district of Uttarakhand in India. There are,
at present, eleven (11) development blocks (DBs) in the district namely Bhaisyachana,
Chokhutia, Dwarahat, Lamgarha, Takula, Bhikiyasaan, Salt, Dholadevi, Hawalbagh,
Syalde and Tarikhet. However, for the current study, we have selected Dhauladevi DB
for it being the only Educationally Backward Block (EBB) as per MHRD, Government
of India (source;http://ssamis.nic.in/blockdetail.do). Map of the study area is shown
as Map 1.

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
Dr. Deepak Paliwal & Dr. Harish Joshi & Dr. Saroj Paliwal/ Page 61-73
b) Sampling procedure
Three stage sampling method was followed for the selection of DB, Villages and
Respondents. The First stage was to select a DB among the available DBs through
purposive sampling, here we have used criteria of being most EBB among the total DBs
of the district. Second stage included selection of villages within the selected DB and it
was carried out through lottery method.Ten (10) per cent of the total villages in the DB
were selected for detailed study. The Third stage of sampling included the selection of
households in the select villages and criteria of selecting ten (10) per cent or a
maximum of two hundred (200) householdswas followed.

c) Data collection
Data has been collected from both primary as well secondary sources. Primary data is
collected through intensive field work in the select villages. Structured questionnaires
were developed for the purpose and personal as well as group interviews were
conducted for collecting data. In addition to this, data was also collected through verbal
and personal communications. The secondary data was collected from existing records,
manuscripts, survey reports and published literature.

d) Analysis of data

Results and discussion

i) Selection of Villages: Following the methodology
Table 1. List of select villages
as described above, Dhauladevi DB was selected for 1 Agar
the present study. Twenty (20) villages out of 200 2 Badiyar
3 BamanSwal
villages in the DB were selected through lottery 4 Barakuna
method. In each village ten (10) households/ 5 Basoli
6 Bayali
respondents were selected randomly on the basis of 7 Bhanoli
marital status, educational and economic status. This 8 Bhargala
9 Chageti
way a total of 200 respondents each representing to
10 Chariya
one household was selected and information and data 11 Chil
collected. The selectvillages are presented in table 1. 12 Dhurka
13 Dunar
14 Dungara
15 Gunaditya
16 Likoti
17 Pali
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18
19 Taiya
20 Tarkot
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ii) Family structure of households

Family is a basic unit of human society and it is the family where the necessary
conditions for the development of human personality are available. The family structures
of households studied are presented in Figure 1.
It is evident that majority of the households are
Figure 1 Family Structure
still in joint family systems. Although many of the
Nuclear,
20.5 households have separate houses due to
restrictions of space in original houses yet they
are in joint family system as they share the
Joint,
common properties, share joint responsibilities
79.5
and they do celebrate festivals as if they are one
family. Thus, the concept of joint family system is still alive in the hills. It is generally
considered as the foundation of the family and it inculcates among the family members
the feeling of joint responsibility for production and consumption. Further, it also affects
the life of young generation as their socialization beginsat home in contrary to nuclear
families.

iii) Literacy

According to the census of India (2011), the literacy of District Almora is 73.6 per cent
with 91.7 per cent in urban areas and 71.8 per cent in rural areas. The male literacy in
the district was higher (89.2 per cent) in comparison to female literacy (60.6 per
cent).Among the 11 DBs, the highest literacy is of Tarikhet(78 per cent) and lowest is of

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
Dr. Deepak Paliwal & Dr. Harish Joshi & Dr. Saroj Paliwal/ Page 61-73
Dhauladevi (61.6 per cent). The literacy in rural areas is 88.5 per cent for male and for
female 58.4 per cent. The lowest female literacy of was of Dhauladevi Development
Block (45.9 per cent). Literacy or status of education is an indicator of development of
any society or region or nation. It affects the attitude of humans as well as the way of
looking at and understanding any particular social phenomena. The eighth plan also has
focus on the universalisation of primary education, promotion of adult literacy and
establishment of secondary schools in unreachable areas and, also creation of teaching
and research facilities, but all these need adequate planning, policies and societal
support. Further, determination for social cause is needed on the part of administrators,
government, non-governmental organisations, social workers, and teachers and, above
all at household level to make education meaningful and purposeful. Having the lowest
female literacy in Dhauladevi DB is one of the important matters of concern as far as
health of women is concerned.

iv) Hill women and their workload

Women in all the villages are more or less engaged in a diversity of activities for
extended duration. The diversity of
3% Collection of Milk
activities she remains engaged upon, is 12% 6%
Feeding animals
evident from the pie diagram presented in 12% Collection of water
Figure 2. The maximum duration of her Cooking of food
Farming activities
engagement was observed in cooking 30%

and farm activities. In addition to these

37%
activities, she also does other activities
such as collection of water, feeding
Figure 2 Daily activities and duration
domestic animals, milk collection etc. Due to over engagement in these activities, she
has least time for taking good care of herself.

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
Dr. Deepak Paliwal & Dr. Harish Joshi & Dr. Saroj Paliwal/ Page 61-73
The daily work profile of
women in our study area
includes cooking, washing
homes, cattle rearing, leaning
their sheds and undertaking
all other household chores
including shopping of daily
use articles from the nearby
markets. All these activities
are additional to the
conventional farming
activities. The ceaseless Figure 3. Man- woman workload Share in percentage
work begins as early as 5 am and she only goes to bed around 10 pm. As far as water
in villages of Uttarakhand is concerned, a lot of scarcity has been observed. Out of total
16000 villages 8800 villages have been placed as water scarce villages. The districts
like Almora, Pauri, Tehri, PithoraGarh and Chamoli are facing drinking water crisis. 72%
women and 14% children have to bear the responsibility of carrying potable water
(UMPR 2010).We have also observed in our study area that water is a big problem and
women have to walks 1-2 kms daily in hilly terrain to fetch drinking water.

As far as the workload distribution between men and woman is concerned, it is very
unequal and women are mainly overloaded as she is the only person in a household
that remains involved in all chores from indoor to outdoor activities. According to a study
conducted in 2005, it has been shown that in many instances women’s contribution is
more than 90% for example fuel collection (91.73%), fodder collection (99.01%), paddy
transplantation (98.74%), sowing and cleaning field (98.92%), foodpreparation and
other works (98.20%) (UPUEA 2005). In majority of the cases, the contribution of men
was negligible.

v) Women and their health status in hills

Health is one of the indicators of development of any society. The existing studies done
on the women show that the health of women is comparatively poor than that of men.

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Almost one-third of women in Uttarakhand are undernourished as per the weight-for-
height index or the body mass index. Nutritional deficiency is more prevalent among
illiterate women and women belonging to the household with a low standard of living.
Pregnant women get no extra food, and continue doing strenuous work throughout their
pregnancies. In India, nearly 3/4 of all births take place at home and 2/3 of all births are
not attended by medical personnel. The result of ill health and unsanitary conditions in
motherhood meets sometimes death. In Uttarakhand, more than 82 % of deliveries
occur at home in rural areas and more than half of these get assistance from dais. Only
one of seven births that occur outside a medical facility receives a postpartum check-up
within two months of delivery. Facilities available for emergency obstetric care are
grossly inadequate in the rural hill area. They have more faith in dais instead of doctor
one of the important reason behind this is a low level of awareness and unwillingness of
doctor to visit the rural hill area.

Further, there are many social taboos among the women in the hills and many of which
are related with women health. One such taboo which directly or indirectly affects the
women health is taboos regarding women menstruations. During such periods, women
are regarded as untouchable and regarded as impure, and therefore, are not allowed to
participate in socio-cultural life, sometimes even kept separately in isolation. It results in
long lasting impacts on female’s mental and physical health. The menstrual is a
biological process which brings about many hormonal changes in female body and
many a time women suffer from extreme symptoms such as pain, heavy bleeding, etc.
During such times, women needs to be cared well enough so that her health remains in
good state, however, due to taboos, it rarely happens. It has been observed in the
present study that women themselves promote such taboos and she happily accepts
the restrictions imposed on them. Majority of the respondents (57 %) were happy with
the restriction whereas only forty three (43 %) per cent of respondent felt bad about the
restrictions imposed on them during periods. The causes of such happiness was getting
time to relaxation as during periods they are not allowed to perform either domestic or
other works. Regarding hygiene and care, majority of the respondents (67.5%) told that
they don’t feel any problems as it’s a natural process and there is no alternative but to
bear it whereas only thirty two (32.5 %) per cent had bad feelings for periods as they

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had to suffer from stress and other health issues during such time. Seventy one (71 %)
per cent of the respondents take a rest during menstrual cycle whereas only twenty nice
(29%) per cent had to take some or other medication in order to cope up with the pain of
the cycle. Although menstruation is a natural process, yet demands adequate care and
hygiene. Various pogramme and health campaign are being conducted in order to
aware the women about the healthy practices to be followed during the menstrual cycle.
In the hills, it is observed that women do not discuss about menstruation due to lack
education and awareness, and in the absence of resources the hygiene is also
compromised. The graph shows that the majority of the women (69.5%) used clean
clothes during menstruation and minimum number of the respondents (0.5 %) used pad,
etc. Thus, it confirms that women are now more aware of the personal hygiene as they
are using clean clothes for the cleanliness. It has also been observed that majority of
the respondents (72 %) per cent discuss their period related issues with their male
counterpartwhereas only twenty eight (28 %) per cent denied it possibly they had the
feeling that it is a part of life and they only have to bear the pain.

Menstruation is a natural and biological process, but in the rural areas the women are
generally considered as impure during the menstruation period. Rituals in the form of
restrictions prevent women to perform and involved in daily activities. The socio-cultural
beliefs behind this are based on the concept of ‘pollution’. Majority of the respondents
(97.5 %) per cent confess that they are not allowed to visit nearby temples to perform
worship, even at home whereas only one per cent of the respondents were of the view
that they are even not allowed to cook food and perform other daily activities. The
women are relived from such exclusion only after purification after the five days of
menstruation. If women unwillingly touch their own child or other, holy water or low cow
urine is sprinkled to make them pure. It’s clear from the above analysis that there is a
need to create awareness among the rural community regarding the misconception
which they have towards the menstrual cycle.

vi) Perceptions and Knowledge of the Women towards Health Care Services

Apart from hygiene and health during menstruation, we tried to understand women’s
perception and awareness on health care services available in their locality or

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elsewhere. Sixty four (64.5) per cent of the respondents accepted that they consult
doctor for normal illnesses like fever, headache, etc. whereas only six and half (6.5) per
cent accepted that they take homemade medicine for such treatments. Thus, women in
the hills have are more aware of their health rights and preferred to take medicine after
taking due consultation with trained professionals.

Another important belief regarding women in the rural areas particularly in the hills is
that they have least or no knowledge about the treatment and steps to be followed
during pregnancy. However, this was only misconception and surprisingly majority of
the respondents (i.e. 90.5 %) had the knowledge about dos and don’ts during
pregnancy. It is evident from the fact that majority of them (77 %) had timely vaccination
during pregnancy. Though the women have knowledge about the care to be taken
during pregnancy and the importance of balanced diet yet they could not follow the
same particularly having balanced dietas they are not economically self-sufficient to buy
dietary supplements and fruits for them. Thus, it is not awareness but the economically
backwardness which poses hindrance in maintaining due health conditions during
pregnancy.

Accredited Social Health Activist (ASHA) was created in each village within the
identified states to act as a bridge between the rural people and health outlets. Asha is
basically a village level female health workers as well as promoter of healthy practices.
In the rural areas, Asha as a name indicates a day of hope for the rural women who are
unable to visit the doctor frequently due to various reasons. The researcher tries to find
out the view of the respondents towards the role and service as provided to them by the
ASHA and health worker of their village. The results show that the majority of the
respondents (77.5 %) were fully satisfied with the work and services of the ASHA
workers. Further, we also tried to find out the knowledge of the women towards various
health facilities available at the village level. It was observed that the majority of the
women (69.5 %) had the least knowhow of the health facilities available at the
hospital/Community Health Centres (CHCs)/Primary Health Centres (PHCs). Majority of
the respondents (85%) preferred to take natural treatment for the primary health needs.

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Thus, it is clear that respondents are still dependent on the natural treatment process
for the primary health care with no side effect.

Although there are many PHCs and CHCs opened in hills yet they do not have
adequate facilities at times if serious illnesses. Further, tough topography and long
distances to reach to nearest Health Centre usually meet with failure to get timely
treatment to the patients. There are instances when pregnant women have given birth in
the car or bus while still on the way to hospital. It is observed that opening of health
centres is not sufficient but equipping the centre with facilities and adequate staff is still
a challenge for the government in Uttarakhand hills. Not only in Hills but in the whole
country is a challenge. According to WHO, there should be one doctor for every 1,000
citizens, but this is still far from the goal. As far as availability of staff and doctors in the
PHCs and CHCs was concerned, majority of the respondents (79.5 %) endorsed the
regular presence of staff in the health centre.

Thus, it may conclude that that respondents are aware of health care and basic hygiene
required during various illnesses particularly during pregnancy, yet the lack of health
facilities in the health care centres coupled with hill terrain and distances are still a
challenge particularly durig some serious or complex illnesses for which facilities are
either available in district headquarters or Haldwani or Bareilly which are far away from
the study area. Therefore, there is an urgent need to have adequate facilities as per
WHO guidelines in hills so that due service to women be rendered at times of necessity
with least wastage of time.

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Dr.Deepak Paliwal
Joint Director, Dr.R.S.Tolia Uttarakhand Academy of Administration,
Ardwell Camp,Mallital,Nainital, Uttarakhand

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 Towards Excellence: An Indexed, Refereed & Peer Reviewed Journal of Higher Education /
Dr. Deepak Paliwal & Dr. Harish Joshi & Dr. Saroj Paliwal/ Page 61-73
Email-dipaksociology@gmail.com
&
Dr.Harish Chandra Joshi
Assistant Professor (Forestry), School of earth & Environment
Science, Uttarakhand Open University, Haldwani
email-hcjoshi@uou.ac.in
&
Dr.Saroj Paliwal
Reserach Fellow (Sociology of Culture), Ministry of Culture,
Government of India
email- sarojpapnai83@gmail.com

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