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Hanna Ingber Win, for the Pulitzer Center
Tengatoli, India
The air crackles as a team of medical staff and crew walk across a peanut field, lugging a big generator from their boat into a village of 850 people. Near a collection of thatchroof homes, the crew sets up a projector on the dirt floor of a small bamboo structure that also serves as the community's schoolhouse. Well, it occasionally serves as a schoolhouse. The teacher lives on the mainland, a three to four-hour boat ride away, and only makes the journey along the Brahmaputra River to Tengatoli village in lower Assam to teach once a month. Sometimes once every two months.
Barefoot children and mothers holding infants trickle into the school-turned-cinema hall. The boat staff, part of a boat clinic run by the Centre for North East Studies and Policy Research with funding from the Indian government and UNICEF (see previous blog post on C-NES and the boat clinics), show a video on maternal and child health, including the importance of family planning.
Some of the video clips are in Assamese, and even though many in the crowd only speak Bengali, the language barrier does not seem to dissuade them from watching. Many who live on this island without electricity or televisions have never before seen a video.
One of the women watching is Anuwara Begum. Dressed in a vibrant yellow, orange and red sari, she wears her head covered, an assortment of bangles and a nose ring. Begum, who does not know her age but thinks she is about 30, grew up in a village on the mainland. Like many of the girls in her community, she got married at 12 or 13. She left her family and friends and moved to her husband's village on the island. Begum had her first child at around age 15, she says as she slowly rocks her fourth and youngest in her arms. This baby will be her last, she says through a translator.
She also says her husband agrees, which is crucial in a world where the wife – or, in this case, one of the wives – makes few decisions on her own.
"I belong to a poor family so we don't want more children," Begum says while sitting in a neighbor's home. Kids from the village gather outside the door, peering into the home of bamboo walls and a tin roof. Begum says three sons and a daughter are enough to help around the home and in the fields. Her husband does relatively well as a farmer, earning around 8,000 – 9,000 rupees a month ($174 - $196), depending on the harvest, but that income must cover him and Begum plus his other two wives and all 10 of his children.
"If there is another child, there's a problem of food, buying clothes and then educating him," Begum says.
Begum says she was a little jealous when her husband married his second wife, but she understood the need for her. She says that early in their marriage she fell sick and was not able to fulfill her responsibilities as a wife.
"My husband is a rich man; he has a lot of agricultural land. But I was sick so I couldn't do the household work," she says. "If I had been well, he wouldn't have had to marry again."
She says she now gets along well with the second wife, who has always shown her respect and has become like a sister to her. The third wife, who is about 16 or 17, lives in Guwahati on the mainland, where her husband has other business. Begum says that while her father had only one wife, most of the husbands in this island village have two. Asked if she wants a second husband, Begum turns her head to the side and laughs.
"No need for two husbands," she says.
The family's decision to have fewer children marks a dramatic change from previous generations of communities in lower Assam like Begum's. She comes from a family of eight children, and her husband is one of 10.
Less than a quarter of married women between the ages of 15 and 49 living in rural Assam use a modern form of contraception, according to the government's 2005-2006 National Family Health Survey. Factors such as early marriage correlate with higher rates of fertility.
While a change in family planning practices is coming slowly and is far from universal, public health experts in Assam say they are seeing an increase in the use of contraceptives in villages like Tengatoli.
Once Begum's menstruation cycle restarts after the birth of her latest child, she says as a chick walks over a sack of produce next to her, she will begin taking an oral contraceptive provided to her from the boat clinic. She tried using it in the past, but she forgot to take the pills regularly and eventually stopped. This time, she says, she is committed to it.
Family planning is considered an important aspect of maternal health and would help reduce Assam's maternal mortality rate, which at 480 deaths per 100,000 live births is the highest in India.
Fewer births means fewer maternal deaths. Furthermore, giving adequate spacing between the births of children enables a mother's body to fully recover after a pregnancy. Having fewer children also increases the chance each individual child will receive enough nutrition and medical care and have an opportunity for an education.
After the interview, Begum takes us on a walk down a dirt path running through the village, past clucking hens and a man chopping bamboo, to see her one-room home. We meet her 10-year-old daughter who has long brown hair, a sweet smile and a flower-shaped nose ring that matches her mother's. But not everything matches.
Begum says she and her husband will send their daughter to high school on the mainland. She wants her daughter to wait to get married until she is 18 and then have only two to three children. She agrees that it would be a big difference from the life she has known.
"I expect my daughter's life," she says, "to be better than my own."
Follow Hanna on Twitter: @Hanna_India
This blog post also appeared at The Huffington Post.