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Why is maternal mortality a problem in India? It's all in the numbers.
As she tells me what happened, she does not shed a tear or show grief. She talks in a matter-of-fact style, answering most questions with hei (yes) or na (no). And while she has never told anyone about Islam forcing himself on her, she does not act like it is a big secret. Rather, it is simply the life she knows.
As we chat, children, men and women from the village repeatedly gather at the door to get a view of the action. The translators and I ask them to leave, over and over. We cannot shut the door because the home does not have electricity, and we depend on the natural light to see each other.
Islam also tries to stand by the door and watch. We ask him to leave, and he does. In a world where the men make the decisions, if he had wanted to stop the interview or insist on being in the room, he could have. But he allows his young wife to talk to us. We are therefore able to talk to Hasina and Islam separately.
Islam says that even though Hasina told him she was not interested in having sex, he pursued it because that is what married couples do.
“Since we’re married, we will live together in good times and hard times, so we have to go for it,” he says.
Islam says Hasina had problems during intercourse, but that when she felt discomfort, he stopped.
Hasina’s story differs. She says that despite her evident pain, Islam continued.
The teenager clutches a piece of her sari in her hand as she talks. After the first time having sex, she says, Islam forced himself on her once a week. Hasina keeps her eyes focused on the dirt floor and pulls her sari up to her face, resting it against her cheek. She says she did not once enjoy the sex, but she felt like it was her responsibility to her husband.
Asked if Islam ever used protection, she says she does not know.
Islam says there were problems early in the marriage related to Hasina’s young age.
“Because she was a small girl,” he says as he chews on a piece of grass, “she wouldn’t listen to me.” He would tell Hasina to get him a glass of water or do chores for him, and she would refuse. The community got involved and taught Hasina what it meant in their village to be a wife.
“My parents, neighbors and sisters told her, ‘He’s your husband, you have to listen to him,’” he says.
Islam has a strong jaw line and deep dark eyes. Light coming through holes in the home’s tin roof reflects on his full head of black hair, which he wears stylishly long in the front and brushed to one side. After the first year of marriage, he says, Hasina got better at following directions and doing what she was told.
It has been about two years since they got married and had their first sexual encounter, and a bump is evident under Hasina’s sari. The 15-year-old with a heart-shaped, delicate face who walks around her village barefoot like the other children says she was happy to get pregnant. She thought it would make her an adult.
“When women bear a child they get respect,” she says.
After chatting with us, Hasina goes to a small clinic set up in the village by the Centre for North East Studies and Policy Research. The organization, which receives support from the government, sends boats equipped with doctors, nurses and medical supplies to villages on the Brahmaputra to provide basic medical care. For many of the villagers — including Hasina — the boats provide them their first ever health care.
A nurse sits on a plastic chair in front of a bamboo home and asks Hasina questions about her background and pregnancy as children from the village gather around to watch. The antenatal checkup is Hasina’s first visit with a medical professional. The boats had come a month earlier, but Hasina had not come to the clinic because her in-law’s thatch-roof home is across a small stream, three kilometers away. Hasina says she has a government-sponsored community health volunteer, called an Accredited Social Health Activist (ASHA), but the ASHA worker had not told her about the boat clinic.
The nurse examines Hasina and discovers that the girl, like 73 percent of pregnant women in Assam, is anemic. Her hemoglobin level, which should be at least 11 grams per deciliter, is 6.4. Such severe anemia is a result of chronic malnutrition, say doctors from the boat clinic. The nurse gives her extra iron and folic acid tablets.
When pregnant women are anemic, they are at greater risk of premature delivery, having a low-weight baby, falling sick from infectious disease and dying during childbirth. If anemic women or girls like Hasina have a complication such as a hemorrhage and do not have access to emergency obstetric care, they face the threat of bleeding to death.
Hasina says that when she goes into labor, she will stay home rather than give birth in a medical facility. She knows she would receive 1,400 rupees ($30) from the government to give birth in an institution, but she says it would cost about 1,500 rupees to take a boat and then public transportation to get to the primary health center on the mainland plus to pay for some of the medications. The government’s National Rural Health Mission helps defray some of the costs of transportation, but Hasina says its not enough to make the trip worth it for her.
She also does not want to go to a health center because she does not want to be seen naked by male doctors, she says.
And finally and perhaps most importantly, Hasina says Islam wants her to give birth at home.
“Home is better,” she says.
The nurse scolds Hasina like a parent, asking her what will happen if she has a medical complication and she is in a tiny hut on an island far from any trained medical professionals.
Hasina shrugs and says, “If I die, I die.”
To this young girl, that is life.
This reporting was sponsored by a grant from the Pulitzer Center on Crisis Reporting.