Student Highlight: Mihir Chaudhary

This summer I spent about two months between Delhi, Agra and Indore with the Urban Health Resource Centre (UHRC). My goal was to research their health programming, specifically in relation to family planning. The UHRC, a non-governmental organization, has been operating in slums for over a decade. Through my partnership with the UHRC I had the opportunity to interview families and self-help groups of women[1] in UHRC sites throughout these three cities. What follows is an overview of my key findings from this summer.

Before describing the community-building strategies of the Urban Health Resource Centre it is appropriate to describe the context of the slums I worked in. Delhi, Agra and Indore are sprawling metropolises. Each city has a population of over one million. Additionally, these cities contain significant numbers of un-enumerated slums. This means that several slums do not fall under the purview of municipal authorities – they are essentially invisible with regard to health, education, and infrastructure services. Much of UHRC’s work develops in these slums. UHRC leadership aims to create grassroots self-help groups to build community resilience in the absence of state-provided services. My first point of insight is centered on the self-help group strategy.

Self-help groups are not a new strategy and they are especially common in India. Many lower-income women in both villages and urban slums coalesce into savings unions. This happens both naturally and through external action. The Urban Health Resource Center typically sends a field officer into a vulnerable, isolated slum to educate community leaders on the benefits of the self-help group. The groups I witnessed were already fairly mature. Indeed in some of the UHRC field sites new groups were organically emerging from the action of self-help group members previously seeded by UHRC. In any case, UHRC officers arriving in new slums face entrenched patriarchy. Women are spatially confined to their domiciles. Only through persistent effort does UHRC win household favor in forming self-help groups. The time required to bring women into the self-help group varies depending on the slum. By the time the women are regularly saving and meeting in the slum, UHRC officers will try to instrumentalize the group further. This involves using the self-help group as an educational vehicle. I interviewed many women on their knowledge of contraceptive methods and maternal health services. The most mature self-help groups had high rates of knowledge on these topics. And this knowledge was greater relative to non-group members. This is evidence of, on some level, an effective knowledge dissemination role of the group. It is important to note that information, like family planning knowledge, is often spread through the group by other non-governmental organizations. In Agra, Avaad, a peer-to-peer family planning network, used UHRC self-help groups to recruit capable peer leaders and to disseminate information and contraceptives. In an important sense, UHRC uses the financial incentive of savings and loans to facilitate group formation. Once the group is formed it can be effectively used as a platform for other activities.

One such activity that the group is often used for is activism. The most mature self-help groups in Urban Health Resource Center catchment areas were linked to the nearest municipal government representative. Formerly invisible slums developed direct ties to their government. Of course this process is initially facilitated by exogenous forces. In the case of the most politically active Agra groups, women had extensive training at the hands of UHRC representatives. But once a certain threshold of knowledge and confidence is reached, self-help groups become regular political bodies. Many groups had organized petition drives, marches, and direct meetings with municipal governors. One group, through extensive petitions and meetings with the local municipal commissioner, had convinced the government to pave the roads. Again, the central factor in allowing this activism was the creation of a unified group platform. It is important to explore here the limits to the group-based approach to information dissemination and activism. I share two here: network limitations and gender role reification.

Despite the many benefits of the self-help group strategy it raises important issues. The first is regarding group identity. Most of the groups I interviewed were formed of one caste[2] or, at most, two castes. These individuals lived in the same spatial zone in the slum, communicated with each other and supported each other even before the formation of the self-help group. In one sense, then, these groups merely formalize social networks that already existed. The groups did seem to further turn some families inward and limit the formation of diverse social networks. To take one example, a higher caste family in one slum in Agra, was completely unaware of the existence of self-help groups amongst families that existed a few meters away. These self-help groups consisted of lower castes. Instead of attempting to extend social networks, UHRC groups form a self-limited source of support. To be sure it is likely impossible for any organization to purposively create cohesive mixed-caste groups in Indian slums. But if we are to recognize these social limitations to self-help groups it may be wiser to categorize them as coping social capital rather than getting-ahead social capital. Indeed even years after the creation of many of these self-help groups the female members had not advanced significantly socially or economically. This is partly due to the continued rigidity of caste in urban slums and partly because of the limited inherent power of homogenous self-help groups.

Malcolm Gladwell, in his novel Tipping Point, describes Connectors as people who “link us up with the world…people with a special gift for bringing the world together”. Malcolm’s research reveals that the ability to build relationships, sometimes across rigid class and social lines, is a rather innate (or at least arbitrarily socialized) ability. Social capital based strategies that employ groups, and particularly specific individuals within these groups, to disseminate health information implicitly rely on Connectors. That these Connectors exist, and that a few of them seem to emerge within slums, is evidenced by our research. 

Within health groups the chosen leader is also very often a Connector. Other women recognize this and push this Connector to be the leader. For example, one of the leaders, Lakshmi[3] in response to a question inquiring about her health group’s leaders said:

“Yes [I am the leader]. I don’t want to keep doing it but they [the group] keep convincing me.”

The other benefit of group-based strategies is that they facilitate the emergence of latent Connectors. Often times structured meeting opportunities can allow Connectors to operationalize their inherent tendency to make relationships and link people. A health group cluster leader (i.e. woman who administers all health groups in a certain geographical unit called a cluster) said:

“[Before the group] we would meet informally in the basti. But we were not very close before.”

Thus the imposition of a structure to meetings could actually facilitate building close relationships – something that Connectors are known for. The same cluster leader also mentioned that health group meetings are a time for talking and exchanging information. She emphasized her role in sharing different information at different times of the year, “We talk about the weather and what illnesses spread in what weather.” Indeed Gladwell characterized another type of individual, a Maven, as someone who is “pathologically helpful”. This particular cluster leader, bent on spreading temporally relevant information related to illness, was afforded a captive audience through health group formation to do so. Thus, as a tool for information dissemination, the formation of groups can very organically attract people – Connectors and Mavens – most naturally inclined to spread health information for the sake of spreading health information.

Mihir Chaudhary 
Undergraduate Sociology Student 

Harvard University, Boston, United States

Intern with UHRC, June-July, 2011

Sources

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[1] A self-help group is a limited circle of women that save and loan money collectively on a monthly basis. These groups, called health groups by UHRC, were significant as mediums for information dissemination and activism.

[2] Caste refers to a social hierarchy based throughout Hindu India. There are four major varnas which are ranked based on their ritual purity. Certain castes (called scheduled castes) are associated with a low socio-economic status.

[3] All names used throughout are pseudonyms to protect the privacy of interview participants.