3.3.1. Intrapersonal

• Health belief

“Tobacco is considered as goddess Lakshmi so during the menstrual periods we do not touch the tobacco plants until we take a shower.” (G4, P4)

“Now so many people are facing many problems by having tobacco, by smoking the beedis so many people have got kidney problems, doctors tell them to stop smoking but they say yes there, and will not follow it in the house, but then they continue to smoke.” (G1, P3)

“I used to feed my child after work, without washing my hands because washing it would take a lot of time.” (G2, P3)

“We cannot pluck the leaves if we wear all that. It will be difficult to work for us when we wear gloves. It keeps on sliding down from our hands and we cannot pluck the leaves quickly and we will feel like falling if we wear the boots.” (G2, P3)

“We wear a long shirt that covers our hands and also tie a cloth to cover our heads, we work after doing this.” (G2, P2)

• General and occupational health experiences

“I usually get headaches three to four days a week for the past three years. I used to apply headache balm, took medicines from the medical stores or took injections from the hospital. I cannot do any work if I get headache. I will usually get it during evening hours, and during the morning. The last few days if I get it in the morning it stays till evening. The pain reduces only after getting an injection from the hospital.” (G5, P4)

“Sometimes I go to the hospital because of body ache. My blood pressure will be low. Doctors tell me not to expose to the sun for long, not to work more and take rest. They tell me that my health is good, and I should take tablets for low blood pressure. In the last 2-3 years after my child was born, they told me that I have less blood (anemia). If they give blood and a tonic, I will be fine. They give tonic and powder (supplements) in the government hospital. I take it. I have a body ache and then the regular common cold. Other than that, I do not have any disease. This is common, I get itching, that is all.” (G4, P3)

“We have to do the tobacco work. It is compulsory and we cannot sit simply without doing it. We must go together with our husbands. I will be questioned if I am late. Sometimes when I get a head ache I will be having no time to rest even for five minutes. I will take the tablet but cannot rest, and they will be screaming and will not understand our pain. They will ask us to pack the boxes and will scold us if we will be late, even though we do not take the medicine properly. Also we must be on time with them.” (G1, P5)

• Reproductive health

• Menstruation

“I have a regular menses. Sometimes it will be for three days and sometimes for five days. I have no problems except lower back pain.” (G3, P4)

“We tie a cloth to cover our head while working. We wear that cloth as a pad if we get periods at work. We cannot speak loudly because there will be five other people. We do not disclose it to all. We adjust among ourselves. When someone get their periods, we make them sit separately and make them work. We will not make them move around much.” (G4, P1)

“We used to do the same tobacco work even during that time. I used to get stomach pain and lower back pain after I came from work. Despite that, I do the household work and cooking at home.” (G2, P5)

“Some will tell us, nothing will happen, you can come. Some tell us not to come. They will not allow us to touch. Some will not say anything.” (G4, P4)

• Pregnancy and Childbirth

“During pregnancy, I used to feel like vomiting while doing the tobacco work. I have vomited while putting the fertilizers.” (G2, P4)

“We used to bend and do the activities like planting the saplings until we came to our 5th month. After the 5th month, the stomach starts to increase, so we sit and do works like tying the leaves and separating them.” (G2, P3)

• Post-natal period

“If there was someone to take care of the baby, we would leave the child and go for work; otherwise, we would carry the baby. Aged people will take care. Either father-mother or father-in-law and mother-in-law. Now, we must take care of our children. If there is work, we have made the baby sleep there and do our work.” (G4, P4)

“After my first delivery I started my work in three months. I worked keeping the baby next to me. Sometimes, I would leave the child in the anganwadi from morning to evening. I have suffered a lot.” (G4, P1)

• Other reproductive health experiences

“White discharge started during my last childbirth. Now my son is 16 years old, and I am having it since then. Initially I had little white discharge and along with that I had itching as well. I showed it to the doctor, and they said it is very common in women and they said there is no problem in it. There was smell there in the beginning. Now the itching has reduced a little bit after being consulted with the doctor 2-3 times. But it reoccurs after some time, and it reduces again after washing in hot water.” (G2, P6)

• Menopause

“I had lower back and stomach pain. I could not sit down, and I used to find it very difficult. I had been bleeding for five days. I had lot of stomach pain and bleeding for a month on my last period. They gave me an injection saying that it would be like this at the beginning of menopause. Since 1 ½ years, I have not got my period. I am working the same as earlier. I do all the household work at home without a single day leave. I even work at the fields and even go to daily wage work.” (G5, P7)

• Substance use

“I eat chewing tobacco (kaddipuddi) along with betel nut and leaves two to three times a day. I keep it in one corner of the mouth and will spit it after some time.” (G2, P1)

“I have been chewing tobacco for the past 25 years and nothing has happened to me. I eat 15 times per day. I don’t know why I started, but I used to get teeth pain and swelling. At that time the old people in the village asked me to use this for reducing pain, and then I started having it.” (G5, P4)

3.3.2. Interpersonal

• Family support

“My husband helped me during pregnancy and delivery. He did not send me to my father’s house. My husband took care of me.” (G4, P2). Another participant said, “During that time, I used to be in my mother’s place; my sisters-in-law and my mother used to be there for my support.” (G5, P3)

“No one helped us during that time. We were doing all the work. People would feel jealous. I would bring water even nine months pregnant, do the cooking, cleaning, washing vessels. Everybody would go out to work.” (G4, P1)

• Friends and neighbors

“When I was pregnant, I had fallen down and my neighbor helped me and took me to the hospital.” (G1, P1).

• Family health

“My husband has pain in one of his thighs and blood pressure, for the last four to five years it is increasing. He also works in tobacco fields” (G2, P7). Another participant said, “My mother-in-law is not well. She has breathing problems like asthma. She was doing tobacco work. Now she cannot stand the smell of tobacco.” (G4, P3).

• Substance use in family

3.3.3. Organizational

• Wages

“Men are paid Rs. 300 and women are paid Rs. 200. Along with Rs. 300, men will be given alcohol. If we ask them for more wages, they will start fighting with us. The prices of daily needs have been raised. One litre of oil costs Rs. 200 and they tell us that they do not have money growing in plants to give us wages whenever we ask. The women will be satisfied even if they are paid Rs. 100. They will just take the money and will not question about it.” (G3, P4)

• Tobacco board

“Support must be given from the tobacco sector, as we are working for them for many years. If they provide such support it will be even more helpful and we will also be happy. If they conduct health camp from the tobacco sector, it will help us.” (G1, P7). Another participant said, “We have not got any facilities madam. Those who built the tobacco barn have got some facilities. They give it to the farm owners with license and not to the daily wage workers.” (G6, P3)

• Alternate employment

“Even we feel like coming out of the village and working in garments, but the problem is our husbands will not allow us to do any other work outside the village.” (G5, P5). However, participants were interested in rearing cows as mentioned by a participant, who said, “We can have a living if they get us a cow. We will give the milk to the dairy and get money.” (G3, P3)

“If there is any company which can hire people like us who cannot read and write, they usually hire only literate people. If they provide an opportunity even, we can work in such companies.” (G5, P4)

• Needs

“We are anemic after doing the tobacco work, so if they give us money, we will buy the medicines.” (G3, P6)

3.3.4. Community

• Health care services

“Most of them go to big hospitals for Cesarean section. At that time they will need more money to pay the hospital bills, so if they give some money for the workers from the board it will be very useful for them.” (G1, P1).

• Health care providers

“My husband would take me to the hospital. Sister (nurse) would give us all the information. She would tell us about the gap between children and operation (family planning). After delivery they came after seven months and they advised for an operation. Since I have anemia, I got the operation late. She helped me in everything.” (G4, P2).

“My mother-in-law and ASHA worker had helped me during pregnancy.” (G3, P4)

• Needs

“The transportation in our village is very poor. The ambulance people used to give us reasons when we called them. By the time they came to us, the delivery would have already happened.” (G3, P4)

3.3.5. Public Policy

• Policies / schemes

• Needs

“If we face any problem related to our health and we need to go the hospital and take the treatment there, but we do not have sufficient money, at that time the government should support for the women like us who depend on daily wages. I am suffering from stomach ache but I have never got it checked from the doctor as I am scared what if they ask me to undergo an operation. The government should help such people.” (G2, P7)