Nine months are almost over. It’s her time to deliver. Twenty-two-year-old Sarita has been in pain for the last 24 hours. She asks the doctor: “When will I be able to deliver the child?”

It is a question that haunts countless women in economically weaker sections of India. Most of these women are married off young and become mothers while they are still minors. As their underdeveloped bodies begin diverting nutrients to a developing foetus, anaemia kicks in. A lifetime of overwork and malnutrition, and an epidemic of Vitamin B12 deficiency, further contribute to the disease.

According to India’s National Family Health Survey of 2016 (NFHS IV), 53% of the women who responded were anaemic. This is the main reason women like Sarita suffer so much pain during pregnancy.

But underage pregnancy is just a part of their misery. Most of these women are married to men who either don’t know or don’t understand the concept of consent. And it often results in trauma for the wife, and recurring pregnancies at a very young age.

Twenty-three-year-old Sapna is a mother of four children in Indore, a city in India’s heartland state, Madhya Pradesh (MP). According to the NFHS IV survey, 27% of the respondent married women in the state suffer spousal violence.

Sapna with her children in her colony, in Indore. She is a mother of four children. (Photo by Rohit Jain)
Sapna and her children in Indore. Photo: Rohit Jain

Another Indore resident, Rama, 22, is angry at what happened to her the night before. “Even dogs can’t have sex without the consent of the bitches but men are worse than animals,” she says. “When I refused to have sex with my husband, he abused me and said ‘You are sleeping with someone else, you have another husband somewhere, and you are a whore.’”

Twenty-five-year-old Asha tells a similar tale. When asked if she and her husband discuss consent, she answers “I don’t want to be killed and be abused, I know I can’t live according to my wishes in this world.”

Rama among women during evening at her colony, in Indore. (Photo by Rohit Jain)
Women in Indore. (Photo by Rohit Jain)

These issues stem from the patriarchy that dominates Indian society. There are 23 million child brides in India, a statistic that prompted the country’s top court to rule, in October, that intercourse with an underage wife is a criminal offense.

“Why are women controlled by men? Why can’t they express their difficulties with having sex? Why can’t they take decisions regarding bearing or not bearing children? Why do they bear gender-based violence? Why don’t you speak?” asks Subhadra Khaperde, who organizes reproductive health camps in slums in Indore.

Khaperde works for the NGO Mahila Jagat Lihaaz Samiti (MAJLIS), which runs gender rights workshops as part of its Reproductive Health and Rights program for women living in the slums of Indore city.

A MAJLIS survey found that 76% of women residing in Indore’s slums are anaemic. Sitting at a women’s reproductive health camp in Indore’s Bhuri Tekri, an economically weaker colony, one can see a myriad of other problems these women face in terms of their reproductive health.

Sunita carrying her child fetches water at a slum area in Indore. (Photo by Rohit Jain)
Sunita, carrying her child, fetches water at a slum area in Indore. Photo: Rohit Jain

“We women cannot live our lives without working. We have to take care of the domestic work and our children and also work outside to earn income. Bearing children in the womb is very difficult and at that time we don’t get proper food and care. So we face a lot of problems in giving birth and our bodies break from the pain,” says Sunita, 35.

To make matters much worse, doctors in these areas do not help. Take the case of 25-year-old Suman (not photographed). “My husband suspects me of being involved in extramarital relationships because my vulva is very large and loose. He frequently accuses me of having sex with other men,” she says. Suman was unable to explain to her husband that the doctor had cut her vulva to facilitate the delivery of her child – a procedure called episiotomy – and had not bothered to stitch it up again because Suman, in her pain, had kicked the doctor.

Kiran, 32, with her son makes tea in her kitchen in slums of Indore. (Photo by Rohit Jain)
Kiran, 32, with her son, makes tea. Photo: Rohit Jain

Kiran, 32, also had her vulva cut whilst undergoing childbirth and later had it stitched. However, she felt so much pain while in hospital that on returning home she refused to go back to have her stitches removed. The stitches cause pain every time she has sex but she still refuses to go back to get them out — such is her memory of the pain. “I don’t want to go back to the hospital where I spent one month in pain the last time. It is better to bear this pain than go to the doctor again.”

Reproductive health nightmares

Women’s overall reproductive health can be unnervingly bad. “Most women suffer from infections of the vagina such as white discharge (leucorrhea), inflammation of the vagina, erosion of the cervix and cysts on it, and excessive bleeding during menstruation. And they suffer for long periods from pain and complications,” says Khaperde. “They don’t get proper treatment for this either in the government hospitals or from private medical practitioners because they are ashamed to speak about these problems. Our organization gets them examined by qualified doctors and gives them medicines. Often the husbands of the women are also infected and so they too have to be treated, even though they are reluctant to go to doctors.”

NFHS IV found that only 29% of the respondent women in Madhya Pradesh had undergone cervical checks. Examinations of women by doctors in the MAJLIS camps revealed that a shockingly high 67% suffered from cervical problems and 49% from vaginal infections.

Clothes used to clean menstrual blood kept to dry for reuse, in washroom at a home, in Indore. (Photo by Rohit Jain)
Clothes used to clean menstrual blood are dried for reuse. Photo: Rohit Jain

“Women’s menstrual cloths are never put out in the open to dry,” says 21-year-old Nirmala. “These rags have to be dried away from the gaze of men, otherwise it is sinful. We also feel shame if someone else were to see these rags. The menstrual blood is considered to be dirty and it is also [believed to be] used for sorcery by others. That is why we dry our menstrual cloths secretly inside the bathroom or in the animal shed.”

Given all this, it’s no surprise that a number of these women choose to be sterilised.

Raju Bai with her children at her home, in Indore. (Photo by Rohit Jain)
Raju Bai with her children at home in Indore. Photo: Rohit Jain

Raju Bai, who is now 40, was married at the age of 14 and gave birth to her first child at the age of 15. She is the mother of seven living children; while two others died.

“When I was in the ninth month of my sixth pregnancy, one day I felt great pain and when I went to sit on a chair to rest, the child came out from my vagina and fell on its head on the floor and died immediately,” she says. “I had wanted to get sterilized after the fifth child but my father-in-law said that this is sinful and should not be done. But after the ninth pregnancy, I became so tired that I went with five or six other women to the hospital and lay down to be sterilized.”

The latest data presented by the UN’s Family Planning 2020 (FP2020) partnership, shows that female sterilization accounts for 74.4% of  modern contraception in India. Meanwhile, male sterilization – the ratio of men who get a vasectomy – accounts for a mere 2.3%.

This is despite the fact that sterilization is simpler and less invasive to perform on men than on women. The vasectomy also has a quicker recovery time, complications are rare and deaths are even less common.

Twenty-six-year-old Rajni (whose name has been changed) was married off when she was 12 years old, just as she started menstruating. “After one year of marriage, neighbors began asking me why I had not given birth to a child. l could not understand their taunts and asked my husband whether he would divorce me if I did not have a child, and he said he wouldn’t do anything like that. Suddenly, one day I felt dizzy and felt great pain. Some months later I had my first child at the age of 15. I was a mother of three by the time I was 20 years old. I decided to get sterilized, as there was no saying when my husband would come home drunk and make me pregnant again,” she says.

Rajni (name changed) getting herself examined at a reproductive health camp in Indore. (Photo by Rohit Jain)
Rajni (whose name has been changed) gets herself examined at a reproductive health camp in Indore. Photo: Rohit Jain)

Gender experts believe that generating awareness about consent, safe sex and reproductive health are India’s best bet to improve the current situation.

As reproductive health and rights activist Savita puts it: “Most men don’t know anything about a woman’s reproductive tract. They ignore the need for safe sex and there is a culture of silence in society about this. Is it necessary that men’s desires must be satisfied always while women’s desires and happiness are considered to be unimportant? The answer is a resounding no. Women must talk about their problems and seek the solutions to them.”

The names of some women in this story have been changed. All the photos were taken with the subjects’ permission.