Social Change and Sustainability: Primary Health Care and the Jamkhed Model

Gender inequality is an issue without borders. In one lifetime Lalanbai Kadam was able to make the dramatic transition from a twelve-year-old child bride to a respected health worker and teacher in her village. The overwhelming gender inequality and social isolation faced by village women in rural Maharashtra Indian is part of the global health challenge that motivated Drs. Rajanikant Arole and Mabelle Arole in 1970 to create the Comprehensive Rural Health Project (CRHP). Amartya Sen asserts that the deprivation of women and gender inequality is a far reaching societal impairment. Women who do not attend school or own property, bare the burden of strenuous work, and are exposed to domestic and physical violence face greater health risk. This study examines the life histories of women village health workers (VHW) and uses CRHP data to assess social change. METHODS: Anthropological life histories and ethnographic fieldwork methods are used to compile data of women's lives and the generational change. Comparisons are made using village indicators of women's health and reproductive decision making. 32 VHWs each representing one village of the 132 eligible (26%) completed the full interviews over a period of 2 years. RESULTS: For women in CRHP project villages: the age of marriage changed from 12 to 18; birth of a woman's the first child changed from 15 to 19 years; girls attend school for at least 8 years; domestic violence virtually eliminated. CRHP programs and VHW initiated women's clubs, and microeconomic income generation schemes contributed to the sustainable social change for women and families.