A book review of Sabina Rashid’s “Poverty, gender and health in the slums of Bangladesh: Children of Crows”

By guest contributors Hilary Standing and Sally Theobald

Depth and detail – meeting the women whose lives you get to know intimately

This is an unusual book. It inverts the usual academic conventions. It doesn’t foreground theory or give us a lot of statistics. Instead, it gives us an utterly absorbing set of narratives of women and their families living in slum settlements over two time periods, each marked by crisis and uncertainty. Here, it’s the details that count – the worn and patched clothing, the missed meals, the constant resort to loans, the stories told to hide the fact that the family has been reduced to begging. The small but telling details that give us the warp and weft of urban poverty.

Bit by bit, these narratives unpick the micro-politics of slums, of what it is like to live with the constant fear and anxiety of keeping a roof over their heads when a sudden loss of income means there is nothing left to pay the rent, the outbursts of street violence that can erupt at any time. As you read it you can smell and taste what this kind of urban poverty is like. There is a critical empathy at work here – we get to understand rather than judge the sometimes unpalatable choices poor women make. Marrying their daughters off very young is bad for their health but better for their personal security.

The book is compulsively readable and accessible. It’s hard to put down. Sabina Rashid makes complex theories accessible through the detailed narratives of the women she studies. It shows us what chronic marginality looks like and how people experience and try and resist this in the most challenging of circumstances. You get to know intimately the women whose lives are shared, they linger in your mind long after you finish reading, leaving you wanting to know what has happened to them: how are they faring right now?

It also made us think a lot about that young researcher who stepped into these informal, (slum) settlements and immersed herself in these women’s lives, navigating the ethical and moral dilemmas it painfully produces, and who has spent half a lifetime observing and documenting change. 

What are the insights from this book for global public health?

First, it shows the importance of anthropological perspectives in understanding the relationship between poverty, inequality and health. In particular, the immersive quality of participant observation, of being on the scene closely engaging with these women and their social networks. There’s a richness and contextuality to this that no survey can ever replicate. We need to keep insisting on the need for this kind of research – not as an adjunct to mainstream methods in public health research, but as an essential part of research methodologies.

Second, It’s an important corrective to a sometimes overly optimistic interpretation of progress in women’s rights and gender justice. The narratives show how little has changed in the underlying precarity and gendered inequalities experienced by these women nearly two decades apart.  It provides a similar caution against equating urbanisation with increased wealth and social progress. Instead, in the microcosms of these lives, we see the larger national and global inequalities which constrain poor people’s lives and prospects for any improvement.

Third, there are important lessons here for public health research and practice. Sabina has taken the social determinants model of health and shaken it to its foundations. In discussing their experience of ill- health, the women often speak about chinte rog – worry sickness. It refers to illness that comes from their circumstances and experiences of poor living conditions and economic stress. They understand these links with symptoms and sicknesses all too well, that no amount of medicine or improved clinical facilities  can offer a “cure.” As one woman said, ‘chinte rog does not show up on an x-ray.’

Lastly it reminds us that public health disconnected from social, economic and gender justice can only ever nibble away at the edges of poor people’s ill-health. Poverty and patriarchy make you sick. And that is true for men too. It’s an old lesson but always worth repeating.

How the book works:

The structure of the book is logical, clear and compelling. Chapter 1 draws you immediately into the issues and challenges of people lives. Chapter 2 lays out the ethnographic methods and approaches that produce the depth, detail and nuance that is a key strength of this book. Chapter 3 introduces – with pseudonyms – the women whose lives we are about to know very well. Chapters 4-11 are paired, linking together the earlier research from 2002 with later periods during and post covid (2020/2-21). These illustrate through time how income earning opportunities, relationships, law enforcement, police and gang violence impact health experiences and outcomes. We learn how social suffering is enhanced during pandemics by government responses such as lockdown, and police actions. Chapter 12 – aptly called Dead End – integrates the learning, anchoring the depth, detail and nuance from the previous chapters conceptually and theoretically. Here, people’s lived experience is situated within larger systems and structures of disadvantage or structural violence. The book advances intersectional and syndemic analysis. It shows how poverty and injustice unfold in informal settlements in ways that are shaped by gender, age and precarity to impact, health, well-being and life chances in complex ways. While the learning is situated in the contexts of different informal settlements in Dhaka, the methodological, empirical and conceptual lessons have a wider resonance.

About the authors:

Hilary Standing is Emeritus Professor and Emeritus Fellow of the Institute of Development Studies, University of Sussex, UK. An anthropologist by training, her research has focused on global health, particularly gender, poverty and health equity. She chairs the Advisory Group of the UKRI/GCRF hub, ARISE,  Accountability and Responsiveness in Informal Settlements for Equity. She can be reached at h.standing@emeritus.ids.ac.uk

 

Sally Theobald is Professor in Social Science and International Health, Liverpool School of Tropical Medicine (LSTM), in the UK  and UKRI/FCDO Gender Senior Technical Advisor. Sally is co-Principal Investigator of the UKRI/GCRF hub, ARISE,  Accountability and Responsiveness in Informal Settlements for Equity. Her research focuses on gender, equity and justice in informal settlements, fragile contexts and Neglected Tropical Diseases. She can be reached at Sally.theobald@lstmed.ac.uk, on Twitter/X at  @sally Theobald, or on LinkedIn: https://www.linkedin.com/in/sally-theobald-58607825/?originalSubdomain=uk