The interview: Sarojini Nadimpally
AH: How have Covid-19 and the lockdown restrictions impacted on Sama’s work?
It hasn’t been easy. The immediate announcement of the lockdown, without any preparation, had a big impact on everyone, particularly the poor, migrants and people who are totally dependent on day-to-day [casual] work.
We have witnessed an upsurge of social and economic deprivation. In this precarious situation it has been critical to address the immediate issues of hunger, violence, access to healthcare.
When it comes to community-level outreach, Covid-19 and the response to it have forced us to do more work remotely. Our work, particularly outside of Delhi, and with girls and women from marginalized communities, is challenging because there is a lack of communication resources; you won’t find internet [access] everywhere and not everyone will have a smartphone. So it’s not easy. The Indian context is very different at the rural level. Even if you have a mobile phone, often it is controlled by men in the family. Women, and particularly girls, may have little access. We have a patriarchal society. It’s not something new, but the Covid-19 situation has exaggerated the existing inequities. Despite this, Sama has attempted to reach out in any way we can.
AH: Early on in the lockdown Sama filed a public-interest litigation in the Delhi High Court to ensure that women could still access maternal health services. How did this come about?
SN: Again and again we were coming across many maternal health issues. People were calling saying, ‘Where do we go? How do we go?’ It was not easy because when you are a health group, people expect to be helped. You feel helpless.
Pregnant women are experiencing substantial difficulties in accessing maternal and reproductive health services. The Covid-19 lockdown has suspended transportation and women are being denied care. Several women who are seeking healthcare for safe delivery or for newborn babies are experiencing trauma in Delhi and in other parts of the country.
This litigation was based on the case of a young girl from a poor background, who spent nearly 48 hours trying to access emergency services for her pregnancy and delivery. There were many such instances reported. First we wrote to the government and then we thought, no, these are maternal deaths that could be prevented, and we could get some positive relief through public-interest litigation. These situations reflect the ground reality, despite the advisories and guidance issued by the government on maternal and reproductive health services as essential services. Where is the implementation?
AH: What lessons do you think need to be learned from the Covid-19 crisis?
SN: The vulnerabilities that have emerged require a political, social and economic solution that is structural. These are not new issues. In a post-Covid-19 world a return to the status quo is highly likely; this will need women’s solidarity, movements, alliances to come together and challenge ‘business as usual’.
We need to think in a different way now. Authoritarianism, surveillance, discrimination – particularly against the Muslim community – have been reinforced through the Covid-19 response. They have to be dismantled completely.
You have to understand the experience of women at the intersections of marginalization: caste, disability, location, age and also the work they do. A sanitary worker is very different from a medical professional. Women comprise a large part of the informal workforce – domestic workers, factory workers, those in the hospitality industry and also sex workers. They have experienced a loss of livelihood, and it has raised the question of women’s rights as workers.
Frontline health workers, a large majority of whom are women, have also faced the brunt of the pandemic in terms of the lack of safe working conditions, shortage of PPE, loss of employment and wages – especially in the private healthcare sector. They have also experienced violence by vigilantes due to the impunity provided by the State.
AH: Part of Sama’s work is in the area of ethics for clinical trials. Have you been thinking about this in relation to Covid-19?
SN: In the last two months we have been mostly caught up in day-to-day responding to the crisis and I haven’t been able to follow what has been happening with the Covid-19 vaccine too closely.
However, this is how I would look at it generally: the take-up of any new vaccine has to be based on evidence of its safety, effectiveness and affordability. Further, the public systems need to have the organizational capacity to deliver this additional vaccine at the appropriate time to all the needy, without a negative impact on the coverage of the previously used vaccines, or on other services.
The vaccine has to go through proper clinical trials, maintaining all the ethical standards and protocols. I would ask, who’s sponsoring the trials? Who are the first populations to be tested on? Have you sought proper informed consent? Who are the ethics committees approving the protocols? Who will take the responsibility for any serious adverse event that may happen during the trials? Will the clinical trial participants be compensated? If there is a vaccine, will it be freely available and affordable to the poor? All the data should be transparent.
Discussion about vaccines is always framed as a binary – whether you are pro or anti. There is no other way people will look at it. We all had BCG [tuberculosis] and polio vaccines. If you question any vaccine, then you’re immediately labelled as anti-vaccine, and that is not correct.
A vaccine may take another couple of years, and it shouldn’t stop other public-health interventions. There is confusion and a paucity of correct information. Our preparedness to deal with a pandemic is equally as important. Basic things like testing and how we make sure that it’s equitable – because in the private sector testing is very expensive.
AH: What is one of the biggest challenges in your work?
SN: You do the research work and you come up with the findings, but will those findings result in any change at a policy level? How will the findings actually be implemented or looked at? OK, I might write a paper, but that’s not enough, right? So, often those challenges will remain and no matter how much we do, it’s not enough.