The following is an edited transcript of a “fireside chat” of Madhuri Dixit and Dr. Ram Nene with Priya Singh of Stanford University Medical School at the AIF -Stanford Symposium on Maternal and Child Health, and remarks at a dinner with AIF leadership. We are deeply grateful for their partnership and especially their support of this event.
Priya Singh: Madhuri, you are a UNICEF goodwill ambassador for India, Padma Shri awardee and a mother of two. Please tell us how you got involved in the area of maternal and child health.
Madhuri: I started working with UNICEF around five years back and I am the child rights advocate. I have worked a lot for women and children in different capacities. We did Mamta Ka Anchal in [Madhya Pradesh], which works with mothers to be, during and after the pregnancies, worked with a program called Maa (campaign for breastfeeding) which encourages new mothers to breastfeed, which is not only an issue in urban areas but equally affects the mothers and children in rural India. Young mothers don’t want to breastfeed for various reasons: health reasons, being very young, and also they don’t know how to do it, they need to be educated and elderly people in the household don’t encourage them. We did campaigns like Boys Don’t Cry where we talked about spousal abuse and worked on Girl Rising where we talked about educating women, because if you educate a woman you educate the whole family. We also did Bety Bachao and Beti Padhao (Save the Girl Child; Educate the Girl Child), which was launched with the Prime Minister of India, Mr. Modi, that also talks about educating women and protecting her and empowering her.
Madhuri, you have spent time in India and in the United States. How would you describe the status of women’s empowerment in both countries?
Madhuri: Poverty here translates very differently in India. Poverty there is very abject poverty, people there have literally nothing; they live on the streets. For a woman it’s very difficult, and the problem of the woman begins when she is in the womb, to be born or not to be born; she comes out in the world with a big question mark, and that follows her through life. The life we see here and the life in India is very different especially in the rural areas. Education, going to school, all these are big issues for the girl child. And, even if she goes to school she leaves halfway, because the family thinks she needs to work to earn, to be able to educate the boy in the family, as she will get married anyway. They drop out of schools because of sanitation, as there are no bathrooms in the schools. There are very simple, little things, when women empowerment is concerned and if we can do something on a grassroots level, very basic level, like we see the Sahiyas (community health workers trained under AIF’s MANSI program) and Anganwadi workers in the villages, those who go on their feet and knock on each and every door and they explain what is to be done. Sometimes things are in place, provided by the government but people are not aware of the facilities. For example, going to hospitals for deliveries instead of having a midwife – the mothers are young – just basic things like distributing folic acid to make sure young mothers stay healthy and they have healthy babies as well.
Ram you have been a medical doctor and accomplished surgeon in the US and now living in India. What is your perspective on women’s empowerment in America and in India?
Ram: It’s a bit of paradox that we had a woman Prime Minister in India in the 70s and only now we are on the brink of having the first potential women president in US, and yet when you look at the gender roles here, its very different. In my opinion everyone should be treated equally regardless of their gender, their merit, irrespective of race and creed. The real issue is there are two Indias: there is metro India where people believe in certain value sets and there is rural India. When you are talking about a population of 1.25 billion people, you can imagine what the issues could be and in some parts of India the literacy and education rates are vastly different, and in particular the ones who takes the hit are often the girls, the girl child and as the girl becomes the mother and so fundamental to this equation, to defeat this cycle of poverty, education has to be critical but in the maternal fetal environment little changes can make huge differences. Some of the things like kangaroo kids to keep fetal temperature up. At the same time women are very anemic and having iron tablets and folic acid and prenatal, perinatal and antenatal care is critical in what they do. Subtle changes in education and awareness and execution through ground forces are critical. What Stanford Medicine and AIF are doing today, with this collaboration and partnership is very important and we applaud you on that.
“What Stanford Medicine and AIF are doing today, with this collaboration and partnership is very important and we applaud you on that.” – Dr. Ram Nene
What would you both say are the greatest barriers to overcome in providing quality care for mothers and infants in India?
Ram: Access is the word of the day, and the equation for the physicians is, there are 1.6 million doctors of which 800 thousand are Allopathic along the MBBS and MD track and the other 800 thousand are Ayurveda and alternative medicine, of that you imagine a population of 1.25 billion, of the allopathic track only 2% of the MBBS ever make it to rural areas, so you are dependent on physician care extenders which most of the times don’t exist. When you talk about basic access, 200 million people a day don’t get enough to eat or don’t get enough protein, a number of people don’t get clean water, 400,000 deaths in India occur due to diarrheal illnesses and 37 million people die of diarrheal illness every year in India. Simple things like hand washing don’t happen, as there is no sanitation or clean water. In my opinion access issues have to be solved in the most organic, granular level, and you cannot change everything. In US we pour money on solutions but there you cannot do because you don’t have that kind of money; only 4% of the GDP is spent on healthcare as compared to 17% in US, so the issue is how do you make it work, how do you go to last mile, only now last mile connectivity and payment gateways are coming online but these efforts have to be led by people on the ground. These efforts have to blended with technology solutions and masses on the ground, its campaign of awareness to defeat simple truth that have been there for ages.
Madhuri: We need a huge ground force, to reach out to every villager…There has to be human touch, like Anganwadi workers and Sahiyas (community health workers trained under AIF’s MANSI program), who are there for the young mothers in the villages, preparing them and the families for the difficult situations during and after the pregnancy. I think, I consider myself fortunate that I can add a voice and share my message and as people will listen to me, which can then encourage the workers who are working on the frontlines and saving the lives of countless mothers and newborns. I feel I have a gift and I can use it to accomplish good things for people and every one of us can do little things in our own way to make a difference.
“We need a huge ground force, to reach out to every villager…There has to be human touch, like Anganwadi workers and Sahiyas (community health workers trained under AIF’s MANSI program), who are there for the young mothers in the villages, preparing them and the families for the difficult situations during and after the pregnancy.” – Madhuri Dixit Nene
Is there a personal experience or anecdote each of you would like to share either in your work related to maternal and child health or as part of your move from US to India?
Ram: I think we in the West don’t understand what kind of challenges people face in India. I have a company there that does technology and the large share of the people come from slums, my assistant lives in 10X10 room with 6 people and it’s one of 14 rooms in this slum with one shared bathroom for 14 rooms. In Mumbai at least the cost of real-estate is ridiculous, yet when you talk to them and visit them, they are the most courteous hosts, they are not unhappy, this how they live, and do the best they can. There is a certain dignity in these people. The commitments we made that our people and staff go will beyond professionally and personally to help them, but the question is: how we can all collectively and individually break this circle of vicious poverty? How we can make simple things better for them? I think you don’t realize until you go to India how lucky we are here in United States. And in villages there is whole other level of magnitude, they are always working hard to achieve better but we can all join hands and give them the gift of giving.
Madhuri: I have met interesting girls, through UNICEF, while working on various programs in India. It’s easy when you are in a position, where you are empowered, educated and talking to like minded people but the stories of these young girls are so inspiring. There was a young 13 year old girl who stood up to the whole village, as there was no shower facility for the women and they had to go to a pump and take shower while all dressed up and it was embarrassing. She collected group of youth from her village and fought for it, and she stood against all the odds and constructed a small hut as a facility. There are such inspiring stories in the rural areas and glaring examples that encourage all of us to do something for a better world.
Do you have a message for the audience? What can people here, living in the United States in Silicon Valley, do to improve the lives of women and children in developing countries like India, other parts of South Asia, and Africa?
Ram: There are a couple of things. One thing is awareness: if a tree falls in the forest, doesn’t make a sound, no one knows it has happened, so the very fact that you are educating people as to what the problem is, is the first step. Now you go there and then you use your resources to educate the populace, and put relatively low cost technological solutions, but more importantly awareness in people to take care of yourself, now you have started along the road to healing. And it’s a difficult thing, and India is not alone, but even some of the effects of that and so the issue is, awareness of the problem in all of us is the first step then the second step is getting people to give of themselves and trying to get them to align with different entities that have integrity, that’s always the hard things in India. You never know what you are going to get, if you give a dollar somewhere. And I would say AIF has a very high integrity quotient and thankfully there are entities like that. And then the last part of the equation is going out and doing something. I would invite you to go to India if you haven’t and just see what kind of challenges people face, but more importantly the country has such beauty, you go 50 miles, north, south, east, west the whole culture changes. Everything about it, the beauty, religion, food, culture, language. If you appreciate that sort of things these are things we can fix and deserved to be fixed and how you bring out the beauty of the rest of the culture and enjoy it together.
“AIF has a very high integrity quotient” – Dr. Ram Nene
On behalf of the audience and AIF-Stanford Medicine we thank you and will keep you engaged in all the collaborative efforts moving forward.
AIF’s Maternal and Newborn Survival Initiative (MANSI) works to reduce maternal and child mortality in some of the remotest parts of rural India. The current program in Jharkhand has reduced neonatal mortality by 46% and the pregnant women check ups have gone up by 89.3% in the areas we work in. The program is currently expanding within Jharkhand and also expanding to three new states of India: Uttarakhand, Andhra Pradesh and Odisha.
MANSI utilizes a public-private partnership model to provide the resources and support required to empower local communities to care for their mothers and children while improving the local health system. MANSI provides preventative and curative care for both mothers and newborns all the way from the individual household to government health facilities to ensure new mothers and infants have the care they need to prepare for, survive, and thrive during and after pregnancy.
For more information