Empowering India’s Women through Education and Healthcare

Categorized as: on October 28, 2012.

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On the road in India with guest blogger Gerry Levandoski: His second piece offers more detail on how and why we add education and healthcare to microfinance programs.

Gerry headshot  by Gerry Levandowski

(This is the second in a series of three guest posts from Gerry on the sights, sounds, and smells of India. Part 3 will take us on tour by car, on the zany roads of India.)

Kolkata, India: Monday morning, our tour group loads into three cars and drives the short distance to the Freedom from Hunger/India office in Kolkata, West Bengal. The cluttered, crowded office space in an older multi-story office building sits on a narrow side street stuffed with waiting taxis, three-wheeled tuk-tuks, and bicycle-drawn wagons. A three-meter tall water purification plant edging the opposite roadside increases the feeling of claustrophobia. This being election time, the ruling Marxist Party has stenciled their red hammer and sickle on multiple wall partitions.

Inside, we ride the tiny elevator three at a time up to a rooftop meeting room where Dr. Soumitra Dutta, Freedom from Hunger’s India Program Manager, orients us to India’s poverty needs and our programs here.

According to Soumitra, India has 1.2 billion people who can be roughly divided into thirds, 400M poor, 400M middle class, and 400M highly affluent. (The United States’ total population is about 312M.) As elsewhere in the world, with high illiteracy rates, early marriages, and a lax approach to birth control, mothers and their children make up the economic lower end’s majority. Freedom from Hunger specifically targets this population by partnering with microfinance institutions (MFIs) that provide such women security against far too common disruptions in family life like divorce, desertion, or husbands’ deaths (Collins, 2009, P. 23).

Indian daughters are frequently seen as financial liabilities because of the dowries and wedding costs that precede their going away to another home with little expectation that they will ever contribute to their parents’ and siblings’ welfare. The Times of India reported that estimates for the total missing girls since 1980 range from ten to forty-four million depending upon unnamed assumptions. How many of these daughters have actually been sold into slavery as child brides, house servants, sweatshop workers or as prostitutes?

A second Times story about feticide carried a surprising twist. In 2011, the states with the worst child sex rations were prosperous agrarian states. Rural areas and tribal societies tended to do better. Critics blame the illegal use of pre-natal diagnostic techniques to determine a fetus’ gender for the 1000 boy/914 girl national ratio. Empowered women value their daughters more. They have fewer children. They accumulate savings to send all their children to English private schools. (1)

Happy Wife = Happy Life

Dr. Dutta explained that Freedom from Hunger, with its relatively small $6.5M annual budget, cannot fund loans. Instead, the program amplifies MFI outreach by adding adult education and health protection services.

A standard feature in the microfinance industry is the formation of loan groups that gather weekly or monthly to make their loan payments. Freedom from Hunger trains teachers who use these self-help group gatherings to offer instruction using culturally sensitive, audience-appropriate materials. How do you convey complex subject matter like financial literacy, pre-natal and neo-natal health care, basic first aid, and malaria prevention to a largely illiterate audience? Pictures.

Freedom from Hunger has created posterboard curricula that they adapt for use on three continents. Furthermore, Freedom from Hunger doesn’t arrive with assumptions about what a community needs. It asks the women what they want to learn. This step alone empowers the women. It increases students’ willingness to try out new approaches to old, enduring problems. The women see these lessons as ways to improve general community welfare through their own efforts. They encourage and support each other throughout the journey. When improved financial circumstances, dropping infant mortality rates, and educational opportunities for their children follow, they become self-empowered to seek—to expect—more change. Village men’s lives improve, too. The burden of supporting the family is now shared, as are discretionary income’s benefits. In the villages, we hear numerous stories of husbands partnering with their wives in new entrepreneurial enterprises. Once the home gets wired for electricity, the most common first appliance purchased is a television.

Dr. Dutta’s presentation leaves me with an eagerness to visit Freedom from Hunger project sites that I had not anticipated.

Getting Outside the Office

On our site visits, each carload of Freedom from Hunger visitors heads to a different location. As we usually do, my wife Esther and I split up. A beaming Esther later returns bursting with excitement to describe the welcome her team receives: As they approach the meeting site, about fifty women wait outside. Their saris present a chaotic display of floral and geomantic designs on bright gauzy fabrics in every primary and additive color. A few glitter with woven gold. A male villager trumpets the visitors’ arrival on a conch shell. That signals the gathered hosts to begin an ululating chorus. Daughters step forward to hand the honored guests small bouquets, while several older women bless the arrivals by anointing each one’s forehead with saffron lines and carmine bindis. (2) Lavish welcoming ceremonies for VIPs are an Indian tradition.

FFH Esther Levandoski   

My wife, Esther, adorned with a VIP bindi and flowers; our group with hosts in East India.

My first visit lacks the same fanfare. We park the car in a large square near a school in a farming hamlet outside Bagnan (a busy railroad depot), and walk along narrow levees among grass-green fishponds and coffee-brown rice paddies. Women stoop at water’s edge, washing their clothes or scrubbing their arms and legs. I watch one shirtless man dip his finger in the muddy water and use it to brush his teeth. Our guide, an employee of the MFI Bandhan Financial Services, highlights what appears to be a pregnant cow standing in a pond munching water lilies.—He informs us that the cow’s bloated abdomen has resulted from eating plastic bags that she can’t digest. Trash collection is rare in India, so even countryside roads and pathways are littered.

Approaching the mud brick houses in the residential area, we first smell, then see, cow-dung pattycakes with feminine fingerprints embedded in every face, plastered on tree trunks and house walls to dry. The dung patties serve as fuel for heating and cooking. In a scene reminiscent of “Rumpelstiltskin,” we later drive past a girl squatting in a field making patties beside a dung mound five times her height. (3)

At last we arrive at a large ranch-style brick home with a terracotta roof. The women were inside conducting business, but they emerge to sit with us on plastic tarps laid out in the spacious rectangular courtyard. Once relocated, they proceed with the collecting and recording of their loan payments. Dr. Dutta introduces us to the women; then, we get to ask questions.

Recently, I read the remarkable book, Portfolios of the Poor: How the World’s Poor Live on $2 a Day. The financial acumen and habits documented in Portfolios reveals how superficial that day’s questions were, and how naively smug and condescending I’ve been regarding these women. Here is an example. We ask what they do with the money.

“Agriculture,” is really an answer for the Bandhan representatives. In reality, the money is fungible. This group is four years old. They’ve already paid off at least three previous loans; and their individual credit levels have reached $160-$440. Initial loans probably did go toward stated purposes, but as a group’s credit rating improves and loan amounts increase, the women do not necessarily rent larger farming plots that, without farm machinery or hiring workers, they are unequipped to manage. Instead, they might save some for the “hunger season” or as a hedge against income shocks like a health crisis, to finance their children’s educations, or improve their homes. Some might even make interest-bearing loans to people outside their self-help group.

How the money is spent hardly seems to matter. Bandhan reports a 98% repayment rate.

FFH loan payments

Loan payments being made at a Bandhan credit group in the village of Bagnan.

We walk back to the car feeling impressed by the women’s and the program’s achievements. Ann Griffith, a fellow teacher and the wife of Freedom from Hunger’s president, Steve Hollingworth, observes that we’re seeing success stories here. We would need to see control groups (the stereotypical India I had anticipated) to appreciate the true level of growth. Nonetheless, these women’s pride and confidence is palpably evident.

We next drive a couple miles to another hamlet to see a health forum. Here, sixty or seventy women attend a lecture on breastfeeding. We sit behind the lecturer who uses Freedom from Hunger posters to tell an anecdote about a woman whose bottle-fed child died and whose breastfed child thrived. She reviews proper positioning and handling for newborns and toddlers. Another poster emphasizes that water, cow’s milk, honey, and other liquids are unnecessary and possibly dangerous. (4)

At the end, the women get into a circle and hold hands while taking a pledge to breastfeed. Even the women beyond their child- bearing years take the pledge. They become teachers to their daughters, their neighbors, and the village children.

After the meeting, we get a chance to speak to the lecturer, a Bandhan employee earning $100/month, known as the village sastho sohayika (health helper). Dr. Dutta and Bandhan pioneered this position. Elected by her self-help group members, she is trained to assess the basic healthcare needs of her fellow villagers and to distribute over-the-counter drugs such as oral rehydration packets and Tylenol as well as sanitary napkins and contraceptives. She is available 24/7 to identify basic medical needs for men, women and children. If a patient needs more than she can provide, she contacts the Bandhan’s healthcare officer, who’s trained to refer patients to the government system.

In addition, the sastho sohayika makes follow-up visits to her clients’ homes to check on patients’ conditions and see if inhabitants wear slippers to the latrine to prevent ringworm, frequently wash their hands, are breastfeeding, are keeping water and food sanitary, and if any unreported issues exist. She makes no money for these diagnostic and home-visit services. After her training, Bandhan initially stocks her medicine cabinet with free supplies that she sells. From the proceeds, she buys new supplies and thereafter earns a profit on sales.

FFH India poster

Clients at a health class. Note the poster illustrating health practices. 

All of these supplies are available for free from government clinics, but these are often miles away and are notorious for being closed during stated business hours or for lacking supplies. In areas without health helpers, families usually pay only when the man of the house needs medical attention. Even with a physical injury, they will often go to a traditional doctor first because it is more affordable (Collins, 2009, PP. 89- 90). Delays in seeking more modern medical care may result in a loss of work and wages, or a worsening condition. In such environments, dehydration due to diarrhea is a killer among children. High infant mortality rates create the need for replacement children. In Freedom from Hunger villages, improved finances and medical services contribute to lower birthrates. (5)

The Amazing Microfinance Success Story

In 1976 Bangladeshi economics professor Muhammad Yunus loaned $27 to 42 women who made bamboo furniture. The women promptly repaid the loan and Yunis made a .84¢ profit (Wikipedia, 2012). From this inauspicious beginning, the multi-billion dollar microfinance industry was born.

Yunus began Grameen Bank and its policies became the industry standards. Single-sex groups (now almost exclusively women) received unsecured twelve-month business loans at about 20% annual interest rates. Applying a practice called social collateral, the group, rather than its individual members, was liable for loan repayment. Grameen representatives came to the village regularly to collect payments. Successful on-time repayment guaranteed new loan approval for increasingly larger amounts.

In the late 1990s, loan repayment rates had dropped to 75% in some areas. Severe flooding in 1998 led to even more dramatic drops in repayment rates. The MFI system required a major retooling, and Grameen again led the way. First, Grameen added choices to the repayment system that acknowledged poor households’ irregular cash flow issues. Groups could now obtain loans ranging from three-month to three-year durations. The social collateral rules gained flexibility. Individual borrowers in good standing were permitted to top up their loans, borrowing principal they had already paid back in order to meet a financial emergency or take advantage of an economic opportunity (Collins, 2009, PP. 155-158). The Bangladeshi government gave Grameen an exclusive license to offer savings plans to its clients, a service that later provided the bank with new loan capital when its traditional funding sources dried up in the 2008 global banking meltdown. The system had become self-sustaining. Dr. Yunus and Grameen Bank received the 2006 Nobel peace prize for their pioneering efforts.

Along the way, Yunus and his colleagues made several discoveries that took microfinance beyond being a successful social development program. First, women were far more reliable borrowers than men. Second, the female loan groups became activists who invested their money in solutions to community issues in addition to their children’s education, nutrition, and housing. Freedom from Hunger and Bandhan have played key roles in enabling their Indian clients to develop leadership goals and achieve their nonfinancial goals.

Bandhan dedicates 5% of its profits to support development services, including Freedom from Hunger’s programs and a “Poorest of the Poor” program in which they give a woman a couple of goats or a cow plus $2/month to support it. The goal is that within 18-24 months, these women are ready to seek loans.

The women entrepreneurs we met repeatedly told us that Bandhan really cares about their communities, but they had their complaints, too. They wanted lower interest rates. Lenders’ paperwork and management costs remain the same regardless of loan size. To make these loans feasible, interest rates typically hover around 20%. Bandhan, however, recently announced an interest rate cut to 10%.

The women want additional services, too. However, the Indian government currently bars all MFIs from offering saving accounts or crop insurance. While legislation permitting MFIs to offer these services slowly makes its way through the Indian legislature, Bandhan is seeking partners who will offer these services with Bandhan acting as the collection agent.

The MFI picture is not all hearts and flowers. KAS, another FFH partner, saw its $60M credit line dry up in the 2008 meltdown. The reasons were industry concerns rather than KAS malfeasance. Freedom from Hunger continues to support the women KAS serves. Even though they have no outstanding loans, the women continue to meet for the education.

Making Your Charitable Donations Work

Freedom from Hunger uses a research-based, data-driven approach to addressing individual community needs. Based on the work of poverty alleviation research leaders like MIT Economics Professor Dr. Esther Dufflo and Yale-based Dr. Dean Karlan, Freedom from Hunger studies successful programs and seeks to imitate what has already worked. Although not part of the organization’s current goals, here’s my favorite example: In their book  More than Good Intentions, Dr. Karlan and his co- author Jacob Appel describe an effort to improve school attendance by providing school uniforms to all target school students. Absenteeism dropped dramatically. Children were so sensitive and ashamed that their families could not provide them with what in most of the world is a standard school supply that they chose to stay away rather than feel the humiliation.

Freedom from Hunger is a well-run program worthy of far more support than it gets. Esther and I will continue to donate. Usually, we prefer to dedicate the majority of our charitable giving to programs addressing national and local issues here in the United States. However, after our Freedom from Hunger tour, any program we support will have to demonstrate accountability. If you want our donations you must tell us specifically how our money will be spent and show us evidence that your efforts are actually making a difference.

Empowerment

At the hotel after our visit to the KAS group, Bill Robinson, Freedom from Hunger Board Treasurer, described an eye-opening experience his group had had. During the education meeting, he noticed a young woman, a teenager, arriving late. Something about her bespoke of self-possession and confidence. After the meeting, while the guests were shaking hands with the meeting attendees, this same girl, Dhara, approached Bill and asked in clear English what he thought of the group. Bill said he was very impressed. Dhara then introduced him to Sadaf, her mother. After some conversation, the two women invited the visitors come see where they lived. All accepted.

The group left the older, more depressed neighborhood for an area, as Bill put it, “across the tracks.” Here the homes were newer, more spacious, better furnished. These women already had slightly better lives than the poor. They received and repaid loans used to upgrade and to operate their boarding house and attended the KAS education forums regularly.

Dhara, a sixteen-year-old high school senior, spoke fluent English. She would enter college in the fall. Her ambition was to join the air force and become a pilot. Dhara told the visitors how proud she was of her mother and gave Sadaf full credit for her success in school and her self-confidence. Will anyone tell Dhara her dreams are beyond her station?

FFH girl power

As a U.S.-based donor who gives mostly to domestic causes, when it comes to global giving, I believe in the power of girls to change our world.

LEARN more about Freedom from Hunger’s healthcare protection program in India and twelve other developing countries here.

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DONATE to end poverty through self-help here.

Citations:

1. A growing list of Indian states has converted to English as the public school medium of instruction.

2. Bindi literally means dot. This traditional decoration set between the eyebrows can be a red dot or a piece of jewelry. It highlights the sixth chakra, the seat of concealed wisdom. (Wikipedia, 2012)

3. Westerners often snicker about India’s sacred cows, but later in our India tour, a guide remarked that every cow and bull has an owner, and for millennia cattle have provided India with labor, transportation, milk and fuel for heating and cooking. They aren’t so much sacred as they are more useful alive than dead. Major cities like Delhi and Mumbai now ban free roaming cattle from downtown.

4. A sanitary water supply dramatically improves people’s lives. Without it, diarrhea even kills cattle.

5. Although not highlighted in this article, we also toured FFH projects in Bhubaneswar, a region southwest of Kolkata. In addition to services like Bandhan’s, MFI Gram-Uttan provides monthly health camps offering free health check ups and sponsors a women’s shelter where victims of human trafficking, HIV/AIDS and domestic violence are provided with housing and training.

Books cited:

Collins, Daryl, et. al. Portfolios of the Poor, How the World’s Poor Live on $2 a Day. Princeton: Princeton University Press, 2009.

Karlen, Dean and Appel, Jacob. More Than Good Intentions. New York, Dutton, 2011.

Join Gerry and WATCH this video to see how the healthcare program looks on the ground in India:

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