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Abstract
Drawing from fieldwork on frontline health workers in villages in the state of Odisha, India, this paper critically interrogates the complex ways in which frontline health workers negotiate between their intersecting gender and caste identities and their roles as modern professionals at the village level. It argues that the embodied identities of these frontline health workers become crucial in shaping other villagers’ views on their labour. Frontline health workers from caste Hindu communities often claim that the spatial demarcation between public and private becomes a way out in resolving the conflicting demands posed by their professional roles and kinship obligations regarding caste practices. However, contrary to this claim, this article argues that such a neat demarcation of space remains unsettled in practice.
Acknowledgments
I am indebted to N. Purendra Prasad for his constant encouragement and critical input. I am grateful to Shiju Sam Varughese, Mary Ann Chacko, Navaneetha Mokkil and Sudeshna Devi for their close reading of the manuscript. Thanks to R. Saravana Raja and Asima Jena for their suggestions. I am extremely grateful to the anonymous reviewers of South Asia, whose critical comments helped me enormously in refining the arguments of the paper in its final stage.
Disclosure statement
The author declares no potential conflict of interest with respect to the research, authorship and/or publication of this article.
Notes
1. My doctoral research, entitled ‘Women, Body Politics and the Dominant Health Discourses: A Sociological Study in Orissa’, was an attempt to understand the interconnections and contradictions between two seemingly discrete approaches to gender, body and health as articulated by the state health sector and village communities in Odisha. In order to understand the practices of the state health sector, I conducted an ethnographic study among grass-root health workers such as Auxiliary Nurse Midwives (ANMs) and Multipurpose Health Workers (MPHWs) in the Baunsuni Primary Health Centre (PHC) area of Baudh district. Since Anganwadi workers are an integral part of the primary health service delivery at the village level, the study also focused on the Anganwadi Centres in the Baunsuni sector of the Integrated Child Development Services (ICDS). In order to understand the community’s articulations of gender and health, I carried out an ethnographic study in Tikirapada village in Baunsuni panchayat.
2. In 2016, while working on the research project, ‘Gender, Caste and Symbolic Economies of Violence: A Study in Baudh District of Odisha’, I carried out extensive fieldwork in the villages in Baunsuni panchayat within Baudh district. The study involved observations, in-depth interviews and focused group discussions among the women across caste groups in the villages. A substantial part of the fieldwork focused on the frontline health workers, such as Anganwadi workers and Accredited Social Health Activists (ASHAs). Observations and in-depth interviews were carried out to grasp the caste dynamics in a comprehensive way. In 2019, I conducted a follow-up field trip.
3. I have used the term frontline health workers mainly to refer to Anganwadi workers and ASHAs.
4. The scholars subscribing to this thought argue that the idea of caste hierarchy is losing its tenor in contemporary times; instead of hierarchy, these scholars argue that caste survives as a form of differentiation and identity: see M.N. Srinivas, ‘An Obituary on Caste as a System’, Economic & Political Weekly 38, no. 5 (2003): 455–59; Andre Beteille, ‘The Reproduction of Inequality: Occupation, Caste and Family’, Contributions to Indian Sociology 25, no. 1 (1991): 3–28; and Dipankar Gupta, ‘Whither the Indian Village: Culture and Agriculture in “Rural” India’, Economic & Political Weekly 40, no. 8 (2005): 751–58.
5. M.S.S. Pandian, ‘One Step Outside Modernity: Caste, Identity Politics and Public Sphere’, Economic & Political Weekly 37, no. 18 (2002): 1735–41.
6. Satish Deshpande, ‘Caste and Castelessness: Towards a Biography of the “General Category”’, Economic & Political Weekly 48, no. 15 (2018): 32–39.
7. Deshpande, ‘Caste and Castelessness’, 32.
8. Trina Vithayathil, ‘Counting Caste: Censuses, Politics, and Castelessness in India’, Politics & Society 46, no. 4 (2018): 455–84.
9. Ajantha Subramanian, ‘Making Merit: The Indian Institutes of Technology and the Social Life of Caste’, Comparative Studies in Society and History 57, no. 2 (2015): 291–322.
10. Hugo Gorringe and Irene Rafanell, ‘The Embodiment of Caste: Oppression, Protest and Change’, Sociology 41, no. 1 (2007): 97–114.
11. Grace Carswell and Geert De Nave, ‘Litigation against Political Organization? The Politics of Dalit Mobilization in Tamil Nadu, India’, Development and Change 46, no. 5 (2015): 1106–32; Suryakant Waghmore, ‘Hierarchy without System? Why Civility Matters in the Study of Caste’, in Critical Themes in Indian Sociology, ed. Sanjay Srivastava, Yasmeen Arif and Janaki Abraham (New Delhi: Sage, 2019): 182–94.
12. Sarah Pinto, ‘Globalizing Untouchability: Grief and the Politics of Depressing Speech’, Social Text 24, no. 1 (2006): 81–102.
13. Waghmore argues that the way vegetarianism is institutionalised in contemporary times has led to expressions of disgust about Dalits and Muslims, who are considered to be beef eaters: Waghmore, ‘Hierarchy without System?’, 189.
14. Ramnarayan S. Rawat, Reconsidering Untouchability: Chamars and Dalit History in North India (Bloomington: Indiana University Press, 2011).
15. Manuela Ciotti, Retro-Modern India: Forging the Low-Caste Self (New Delhi: Routledge, 2010).
16. Divya Vaid, ‘Caste in Contemporary India: Flexibility and Persistence’, Annual Review of Sociology 40 (2014): 391–410.
17. For instance, see Anupama Rao, ed., Gender & Caste (New Delhi: Kali for Women, 2003).
18. Vasanth Kannabiran and Kalpana Kannabiran, ‘Caste and Gender: Understanding Dynamics of Power and Violence’, in Gender & Caste, ed. Anupama Rao (New Delhi: Kali for Women, 2003): 249–60.
19. Susie Tharu and Tejaswini Niranjana, ‘Problems for a Contemporary Theory of Gender’, Social Scientist 22, nos. 3/4 (1994): 93–117; and V. Geetha, Undoing Impunity: Speech after Sexual Violence (New Delhi: Zubaan, 2016).
20. Lucinda Ramberg, Given to the Goddess: South Indian Devadasis and the Sexuality of Religion (Durham and London: Duke University Press, 2014).
21. Sarah Pinto, Where There Is No Midwife: Birth and Loss in Rural India (New York: Berghahn Books, 2008).
22. In the context of Yellamma (the patron goddess of Karnataka to whom devadasi women from Dalit communities are dedicated), for example, Lucinda Ramberg points out that as a symbolic indication of the presence of the devi in their bodies, these women wear heavy locks of matted hair anointed with yellow turmeric. As devadasis are associated with illicit sexuality, reforming and reorienting these women within the frame of the heteronormative patrilineal family has become the main objective of the state and non-governmental organisation (NGO) reform campaigns. However, instead of directly addressing the sexual or religious aspect of devadasi dedication, the reform campaigns target the devadasis themselves as the objects of their reform; campaigns are carried out to cut their locks by framing this as a medical problem. The medical rhetoric of contagion, dirt and disease are used as rationale within the logic of biomedicine for cutting the Yellamma dedicated women’s locks of matted hair.
23. The ICDS programme was launched in India in 1975. However, in the Baudh district of Odisha, the programme was only implemented in 1993.
24. Scheduled Caste (SC) is a constitutional term and was originally created to designate the caste groups on the lowest rung of the Hindu social order. These groups were historically subjected to severe social discrimination, such as untouchability. Through a constitutional policy of affirmative action in the form of reservation (i.e. quotas within education, employment and politics for members of these groups), the government sought to include SCs in mainstream society.
25. Constitutionally, various tribal groups are categorised as Scheduled Tribes (STs). The reservation policy also seeks to include STs in mainstream society.
26. ‘Other Backward Class’ is a term used by the Government of India to classify the castes that are considered educationally and socially backward.
27. The Keuta caste and its allied sub-castes, such as the Gingara and the Dhibara, were formally included in the SC category in Orissa in 2002. Groups who have been subjected to untouchability have voiced their opposition to the inclusion of these caste Hindu communities in the SC category. This has led to the establishment of the organisation Asprusya Dalit Sarankhyana Surakshya Samiti (Untouchable Dalit Preservation and Protection Forum). This organisation asserts that a group’s historical subjection to untouchability should be taken as the primary condition for inclusion in the SC category. They argue that the constitutional aims of providing compensatory discrimination in the form of reservation is diluted by the inclusion of these caste Hindu communities within the SC category, since the category was primarily created to include the historically stigmatised and downtrodden within mainstream society.
28. The term ‘Dalit’ is often used as a synonym of Scheduled Caste. ‘Dalit’ literally translates to stigmatised and downtrodden, and the term is used to refer to the people who were/are historically subjected to the practice of untouchability. However, since some caste Hindu communities have entered the SC category in recent times, here I use the term ‘Dalit’ to exclusively refer to the caste groups that have been historically subjected to the practice of untouchability.
29. In these two villages, the households belonging to Dalit communities were significantly larger in number as compared to the caste Hindu households. During the time of recruitment, other caste Hindu women did not apply for the positions.
30. Self-help group of women of the village, the Anganwadi Worker, the Auxiliary Nurse Midwife and the Multipurpose Health Workers of the locality are members of this committee.
31. See Madhumita Biswal, ‘Caste, Class and Gender on the Margins of the State: An Ethnographic Study among Community Health Workers’, in Equity and Access: Health Care Studies in India, ed. Purendra Prasad and Amar Jesani (New Delhi: Oxford University Press, 2018): 245–62.
32. However, the system of reservation was not followed in its true sense.
33. Field notes, 2016, all translations are mine.
34. For analysis of labour and caste, see Meena Gopal, ‘Sexuality and Social Reproduction: Reflections from an Indian Feminist Debate’, Indian Journal of Gender Studies 20, no. 2 (2013): 235–51; and Sarah Pinto, ‘More than a Dai’, Seminar, no. 558 (2006): 41–50.
35. ASHAs are required to complete at least high school-level education. Many new ASHA recruits had also completed their higher secondary level of education. Since women in the villages tend to have a very low level of education, such educational achievements are recognised and seen as respectable within the community.
36. A dai is a traditional midwife.
37. cf. Cecilia Van Hollen and Meena Gopal: writing in the context of Tamil Nadu, these scholars point out that dais mainly belonged to barber castes who participated within the network of the patron–client relationship of the Jajmani system. In the context of Uttar Pradesh, Sarah Pinto notes that a Dalit woman would usually take care of the postpartum mother and child for four to five days; thereafter, a woman from the barber caste would usually continue to provide the mother’s daily massage for a variable period. In my fieldwork area, women from Dalit communities had never traditionally worked as dais for caste Hindu groups: see Cecilia Van Hollen, Birth on the Threshold: Childbirth and Modernity in South India (Berkeley: University of California Press, 2003); Meena Gopal, ‘Traditional Knowledge and Feminist Dilemmas: Experience of the Midwives of the Barber Caste in South Tamil Nadu’, in Feminists and Science: Critiques and Changing Perspectives in India, Vol. 2, ed. Sumi Krishna and Gita Chadha (New Delhi: Sage, 2017): 23–45; and Pinto, ‘More than a Dai’, 41–50.
38. The Meher caste group’s primary occupation was weaving; women of this caste delivered sarees to caste Hindu women. Keuta women ground grains and lentils and separated the rice grain from the husk for relatively well-off peasants, while men from this caste worked as small traders of rice and flattened rice. Women from the Dhibara, the fishing community, were mainly engaged in selling fish. Men of the barber caste, Barika, served as messengers and hairdressers for caste Hindus, while Barika women served caste Hindu women by cutting and decorating their nails. Both Barika men and women played an important role during death rituals, marriages and other life-cycle rituals. The Dhoba—the washer folk—played a crucial role in purificatory rituals, including death rituals.
39. Field notes, 2016.
40. Field notes, 2016.
41. Doreen Massey, Space, Place, and Gender (Minneapolis: University of Minnesota Press, 1994); and Doreen Massey, ‘Concept of Space and Power in Theory and in Political Practice’, Documents d’Analisi Geografica 55 (2009): 15–26.
42. Massey, ‘Concept of Space and Power’,17.
43. Leela Dube, Anthropological Explorations in Gender: Intersecting Fields (New Delhi: Sage, 2001); Geetha, Undoing Impunity; V. Geetha, ‘Caste, Gender and Spatial Politics’, in Gender, Caste and the Imagination of Equality, ed. Anupama Rao (New Delhi: Women Unlimited, 2018): 93–108.
44. Also see Gobinda C. Pal, ‘Caste and Access to Public Services: “Intensified” Disadvantages’, Economic & Political Weekly 51, no. 31 (2016): 102–07. Pal argues that the Anganwadi Centres and other valued institutions are located in the upper caste vicinity in most of the mixed caste villages, and that this is a reflection of the social power of the upper castes.
45. Both the Anganwadi worker and the Anganwadi helper are always women.
46. For example, the campaigns for equal access to education, as should be guaranteed by the constitution.
47. Caste concerns sometimes become less rigid when women work in villages other than their natal or husband’s village.
48. Field notes, 2006–07.
49. Veena Das, Affliction: Health, Disease, Poverty (Hyderabad: Orient BlackSwan, 2015): 15.
50. There is an ICDS programme at the level of every community development block, which is headed by a Child Development Project Officer (CDPO). Each ICDS project is divided into five–six sectors. Each sector is headed by an ICDS supervisor who is entrusted with the responsibility of overseeing the work of 20–25 Anganwadi centres. Sector-level meetings are conducted by the ICDS supervisors of a given sector in regular intervals to take stock of the situations and plan for future courses of action.
51. Vincent Dubois, ‘The State, Legal Rigor and the Poor: The Daily Practice of Welfare Control’, in Stategraphy: Towards a Relational Anthropology of the State, ed. Tatjana Thelen, Larissa Vetters and Keebet Von Benda-Beckmann (New York: Berghahn Books, 2018): 38–55.
52. For example, when a Dalit man protested about discrimination, he was accused of drunkenly harassing a caste Hindu woman (an Anganwadi worker). For a more detailed discussion, see Biswal, ‘Caste, Class and Gender’, 245–62.
53. Terrance MacMullan, ‘Habits of Hate: A Pragmatist Analysis of Habits of Racism and Nativism’, Journal of Hate Studies 9, no. 1 (2011): 93–112.
54. Field notes, 2016.
55. See Pinto, ‘Globalizing Untouchability’, 81–102.
56. See Massey, ‘Concept of Space and Power’.
57. ASHAs are not given fixed monthly salaries since they are categorised as part-time honorary workers. As per their performance, they are given a certain number of fixed incentives from the health sector. For example, when they facilitate a hospital childbirth, they are paid a certain amount as incentive from the state health sector.