Chapter Nine - A Veiled Change Agent: the ‘Accredited Social Health Activist’ in Rural Rajasthan

Summary

She [the ASHA] is the link between the community and the health care provider[s]. [The] Department of Medical and Health at State and at Center is looking at ASHA as a change agent who will bring the reforms in improving the health status of [the] oppressed community of India. (GoR 2013; emphasis added).

This is how the government of Rajasthan (GoR) describes the accredited social health activist, the ASHA: a female, lay, community health worker. She has since 2005 been a core component in the government of India's (GoI) health policies. The now massive cadre of over eight hundred thousand ASHAs are the newest addition to rural India's front-line health workers.

In North India, the selection criteria for the position together with the kinship system results in most ASHAs being bahūs – that is, young women married into their husbands' villages. The prevailing hierarchal and patriarchal social structures of kinship, gender and caste place these young women in an essentially subordinated position. Here rural women, often poor and without apt education, generally have few opportunities for paid work outside the home, except for in agriculture or manual labour. Young married women are essentially tied to the home, and their scope of movement and communication are to a large extent controlled by their in-laws. The proper and respectful behaviour of a bahū, veiled and modest, render her fairly mute and invisible in the public life of the village. The social structures of rural Rajasthan thus give the ASHAs an appearance that contradicts the typical image of an ‘activist’. One could question if the role of a female social activist is fundamentally incompatible with that of a bahū. The considerable number of women who are now working as ASHAs thus calls for a closer examination: How do the women selected as ASHAs play out their new role and balance this with their ascribed role as subordinated, muted housewives? Does holding the position of ASHA extend the agency of these women?