Dynamics of Empowerment

DYNAMICS OF EMPOWERMENT: IDENTITY, CAPABILITIES, CIVIC SPACES AND AUTONOMY RESPECTING ASSISTANCE IN ARUNACHAL PRADESH by Manjunath Shankar A dissertation submitted to Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland July, 2010 © 2010 Manjunath Shankar All Rights Reserved ABSTRACT Introduction: Empowerment has come to occupy center stage in development debates and policy discussions. WHO Commission on Social Determinants of Health has recommended that countries should tackle inequitable distribution of power, money and resources to address health inequities. In light of this, researchers have increased their efforts to measure empowerment using various indices and scales. But few have paid attention to the interactive relationship between agency and opportunity structure through which empowerment emerges and evolves. Methods: Using critical ethnography, this study explored the dynamics of empowerment in Arunachal Pradesh, India. Unstructured interviews, semi-structured interviews and participant observation were done over a period of two years in the program sites of Future Generations Arunachal, a community based non governmental organization working in comprehensive primary health care. The study focused on kitchen gardens, an activity taken by women’s groups in Palin and Ziro areas. Themes were drawn after coding the interview transcripts and field notes. Results: The context of Arunachal Pradesh, a tribal society undergoing tremendous transition was described in detail. A conceptual map was drawn of the socio political economic terrain over and through which empowerment has to emerge. Employing kitchen gardens as a metaphor, the study explored themes of identity, capability, civic spaces and the role of autonomy respecting assistance in the empowerment process. The ii concept of ‘Isopowerment’ was developed to view empowerment as a performative act of moral courage. The themes were weaved together while describing a critical event to interpret the empowerment process. Conclusion: Amartya Sen’s ideas on justice and capability approach together with David Ellerman’s autonomy respecting development assistance provide critical insights applicable to an empowering process. Empowerment is a process of self actualization through identity formation, where an individual balances his social and personal identity. It can be seen as a performative act where an individual acts beyond his ‘well-being’ based on his values. The process should be seen as an evolving strategy in a repeated non-zero sum game scenario. Development actors should kindle the autonomous motivation of people through a mentoring relationship to achieve empowerment. Thesis Readers: Alan Sorkin, PhD (Advisor) Robert Lawrence, MD, PhD (Chair) Pamela Surkan, PhD Betsy Taylor, PhD Timothy Baker, MD ,PhD (Alternate) Brian Caffo, PhD (Alternate) iii ACKNOWLEDGEMENTS There are many people who have influenced me and made me what I am today. I was able to invest a considerable part of myself in this endeavor due to the encouragement, advice, sacrifice, tolerance and advice of many people. I am sincerely grateful to all of them for the role they have played in my life. First, I would like to thank my mother, for many reasons. For one, she let me discover myself after ‘MBBS’, to be a maverick and to go against the grain. In addition she tolerated my ‘bachelorhood’; with standing increasing social pressure as my PhD dragged on into ‘unmarriageable’ age!! More than the financial support, it is the values she embodies that guide me that I am most thankful for. I would like to thank my brothers Vishwa and Shashi for supporting me both financially and emotionally; more than that for taking care of mother in my absence. My brother Vishwa and Sister-in-law Ramya for introducing me to United States and taking care of me initially, supporting me, guiding me and for showing me US through travel, which enriched my PhD experience. I am grateful to both of you. Shashi you are God’s gift to our family and I thank you-jakkan pakkan taka poli. Second, I would like to thank my advisor Alan Sorkin. He must be the most flexible advisor around. He has tolerated my ‘intellectual wanderings’ beyond the call. His every action from day one has always been to support me in every way possible. He was always there weather to write a recommendation letter or to give his view on an issue. This ethnographic study is in a way testimony to the fact that he can go to great lengths iv because of his faith in me. He never interfered with my ‘style’-in writing or choosing a topic which made me discover myself, thereby empowering me. No amount of words can ever thank my mentor Carl Taylor. I must be the most fortunate person in the current generation to have had him as my guide. I have written a tribute to him in preface but still feel it does not do justice. Sometimes I feel I must have exhausted all my good karma of previous lives to have interacted so closely with him. I would like to thank Bob Lawrence for supporting me over the years. He too has encouraged me in all my endeavors. His compassion for human rights and equity is indeed an inspiration. I have always been inspired by the work and values espoused by the Center for a Livable Future. I would like to thank the center for financially supporting this study. During the final stage, I was taken over by the dark side (qualitative), thanks to Betsy Taylor. She saw the potential in me which even I was not aware of. She encouraged me to take the leap of faith- from quantitative to qualitative, which has enriched this dissertation. She devoted much time and energy in advising me and guiding me during the data analysis and write up. I also want to thank Pamela Surkan for the role she played in my thesis. Damian Walker, Michele Hindin, Tim Baker, Henry Mosley, Maria Merritt, Ann Michele Gundlach and others have all acted as advisors and mentors during various stages of my thesis. I am grateful to all of you. I would like to specially mention Carol Buckley who went to great lengths in making arrangements. You are simply great. v To my fellow graduate friends- Adrijana Corluka(hugs), Nirali Shah, Alex Ergo, Sachi Ozawa, Laura Steinhardt, Wilbert van Panhuis, Monisha Jayakumar, Shivam Gupta and Eric Schneider for cheering me on in those bleak days. I would like to thank all the women in Arunachal Pradesh who gave me their time and tolerated my inquisitive questions. Their struggle for justice is truly inspirational. I hope my thesis captures a part of it. I would like to especially thank Biri Mema and Byabang Rocket for providing critical insights into the empowerment process. All of my colleagues in Arunachal- Nyaari, Aari, Chada, Tatu, Tam, Amko, Nakek, Aka, Rakap- you guys are amazing. Please keep up the good work. Much thanks to your hospitality. The staff of FGA deserve appreciation, they work in the most trying situation against tremendous odds. They have become my friends over the past two years. Kanno , Mone (I still fondly recall our kitchen adventures), Aiya ,Yam, Nika ,Nana, Anyak, Nakku , Ampi, Menna, bhai and others. Thanks a ton for having me over there and for taking care of me. Very special thanks to Daniel Taylor for providing partial financial support and facilitating this partnership to evolve. I have learnt much from you and hope to continue our collaboration in future. I am feeling Khushi Khushi writing this paragraph Last but not the least, I would like to thank my dear friend, Purvi Patel. She has been most patient throughout my ordeal and as supported, advised, scolded, begged, cajoled me in everyway for me to complete my thesis. I can’t even imagine what Baltimore and Johns Hopkins experience would have been without you. You made it so much sweeter. I hope it continues in future. vi PREFACE A PERSONAL TRIBUTE TO CARL TAYLOR I do not know how I became associated with a legend in public health. Against his wishes, I only audited his course that too informally. It was happenstance that I got a call in December 2006 from him, requesting to be his teaching assistant. Very soon he became my mentor and I was always perplexed by his answers. He neither gave me a firm answer to a query nor took a hard stand on an issue. He would discuss and narrate incidents from his life which wouldn’t make sense on that day. But those discussions would stick in the back of the mind, until you discovered the answers your own way at a later time. I would like to recall one incident related to my thesis which suddenly came to mind during the writing stage. Future Generations Arunachal (FGA) was launching a new ‘Pregnancy History Based Empowerment Project’ in the summer of 2008. They had planned a baseline survey in eight new areas. I and Bapu (Carl Taylor) were finalizing the questionnaire for the baseline. Needless to say I and Bapu had some disagreements. The questionnaire went through five rounds of iterations. First to go were the filter questions, replaced by more direct ones. Next were the questions in which same thing is asked in different ways in order to cross check. The last ones were different categories, doctors, paramedical, community health worker were all clubbed into ‘health persons’. Bapu would reprimand me saying “Why do keep asking same questions? Why don’t you ask it directly? You are confusing the woman?” He said this because he had unflinching faith in the people and their ability. As for me, I was a skeptic, I did not trust the person giving the answers (set vii booby traps to cross check), I did not trust the interviewers (do validation surveys on a sample), nor the data entry person (double entry).

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