Women workers of Assam tea gardens grapple with critical health issues

Durga Karmakar is a 19-year old tea garden worker in Muttak Guttibari area of Dibrugarh district in upper Assam. Like any usual day, Durga was cleaning her thatched roof house when suddenly she felt stark pain in her stomach. Immediately, she went to the pharmacist and took a medicine for ringworm. The next day Durga went to the tea estate for her daily plucking task and in the afternoon, her friends at the garden found her lying unconscious on the ground. Soon after reaching hospital, doctors declared that she is three months pregnant and suffering from chronic anaemia, a critical health condition that posed maximum risk to her life.  

One of India's millennium Development Goals (MDGs) was to reduce Maternal Mortality Ratio (MMR) by around three quarters- 560 in 1990 to around 140 in 2015.  India failed to reach this number by a huge margin as the current MMR stands at 178. Assam, on the other hand, has the country's highest maternal mortality ratio of 328 per 1,00,000 births, (Register General, India, 2014) almost double the nation's average. The infant mortality rate (IMR) of Assam is 49 per 1,000 live births against national average of 39 (Register General, India, 2016).

According to the Health Survey of Assam, the upper regions of the state that comprise of Golaghat, Jorhat, Sivsagar, Dibrugarh, Tinsukia which are the major tea growing areas recorded very high MMR of 436. Child marriage, less span of time between the next child, inexistent maternal healthcare, lack of positive diet charts are some of the crucial reasons suffixing the demonic MMR and IMR figures. According to UNICEF, consumption of tobacco based substance and alcohol is higher among tea garden workers. In general, women tea garden workers put the tobacco under their lower lips and continue to work as the substance helps them to fight hunger leading to ulcer.

Although the state has around 62,000 Anganwadi centers, two most important factors contribute to rising figures of IMR. One is the seasonal heavy monsoon period where transportation of pregnant women to a nearby clinic becomes entirely a herculean task. Second is the unsafe home-based childbirth in underdeveloped areas of the state. The figures are highly alarming if one considers the rural female mortality rate. The annual Health survey of Assam reflects that a baby girl born in the rural areas of Assam has lesser chances of survival in comparison to its male counterpart before reaching the age of five.

Women constitute more than 50 per cent of the total workforce of Assam tea industry.  There are about 5,00,000 permanent tea garden workers and an equal number of casual workers in the state. There are about 800 big tea estates and around 1,00,000 small tea estates in the state. The state accounts for more than 50 per cent of the country’s total tea production. Assam produced a record quantity of 652.95 million kg of tea in 2015-16 financial year during which the country produced a record quantity of 1233.14 million kg of tea.  

Women dominate the tea plucking work in Assam tea gardens as the expertise of plucking tea leaves by women garden workers with their nimble fingers is considered to be an important factor behind the high quality of Assam tea.

Dr. Tulika Goswami Mahanta, Associate Professor of Community Medicine at Assam Medical College points out maternal deaths are supplemented by the delay in decision making and low priority on maternity. She said ‘’Hiding pregnancy is very common among women tea garden workers as they fear of losing their jobs and ultimately a source of income. This leads to the continuous hardship of plucking tea leaves while they carry the next generation of tea workers in their belly’’. Going by the WHO recommended patient doctor ratio of 1:1000, Assam right now is facing a shortage of around 30,000 doctors and about 60,000 nurses.

The Plantation Labour Act of 1951(PLA), regulates the wages of the 'permanent' tea workers, duty hours and stipulates that garden management has to provide the basic amenities of healthcare, education, drinking water, housing, child care facilities, maternal care and accident cover. But such basic needs are very far from the implementation level. Due to unavailability of any nearby hospitals, patients often bleeds to death, a risk known to the world as Postpartum hemorrhage (PPH). PPH accounts for 28 % of maternal death in the developing countries.

The act only encompass the permanent workers working under the tea estates and not the casual workers whose strength is almost about 5,00,000. These large workforce are still not benefitted by the 1951 Act policy and thereby remain susceptible to many diseases and health issues along with basic amenities of life. ''North Eastern Tea Association (NETA) has proposed to the Ministry of Labour and Employment regarding the implementation of Employee's State Insurance Act 1948, shortly ESI'' said Mr. Bidyananda Barkakoty, Vice-Chairman(Tea Board of India) and Advisor, NETA. The Union Labour Minister has promised to set up ESI Hospitals which will cover the complete workforce working in the Tea gardens.  

''Normally ESI doesn't cover seasonal work as Tea plucking is a seasonal business. But having said that, to address the present issue of tea workers certain amendments have to be made in the ESI Act which can then only be implemented by us'' said Pradip Sutradhar , Deputy Director, ESI.

The next step is to address the severe health issues related to working in the tea gardens. Anaemic, hypertension, substandard food habits are some of the critical issues that need an eye to look at. Almost 87-90% of young workers working in the tea gardens are anaemic which are caused by nutritional deficiency or low iron storage resulting from a previous pregnancy and heavy menstrual blood loss. This results in pre-labour dates and having a baby with a low birth weight.

Dr Mahanta said the consumption of high-salt strong tea that is served in tea gardens for the women workers as an energy drink to combat dehydration due to heat buildup should be prohibited as this leads to high blood pressure due to higher consumption of sodium.

Experts say that there is an urgent need to map rural flood affected areas where pregant women can be shifted to proper health care facility so that they don't have to bear the ferocity of monsoon floods. A convergent system comprising of Government, NGOs, centres like Brahmaputra Radio Centre and Media is required to address the problem of maternal and child healthcare.

Prabir Kumar Talukdar

( Prabir Kumar Talukdar is a freelance journalist. He travels around the country to capture stories. He is a recipient of  2015 Trust Women Photo Award by Thomson Reuters Foundation and Microsoft.  He can be reached at [email protected]. His mobile no is  73995-02650 )