It is stiflingly hot at Thirumani, a village in Tumakuru district’s Pavagada taluk bordering Andhra Pradesh. It is nearing noon and the temperature is close to 37 degrees. A woman with an infant in her lap reaches for a water bottle to quench her thirst. She sits on the floor near the entrance of the local government hospital with her daughter in her lap staring into a distance..This is 20-year-old Sowmya. Her eyes white and pale, the young mother has come to see a doctor as she was feeling constantly tired. She also has to get a routine test for her four-month-old baby..“I have been waiting for the doctor here since 10 am. There is no sight of his arrival yet,” she says as she fans her face with a newspaper. “It is very hot inside. That is why I am sitting here,” she smiles..Sitting close by are two other women, also with infants in their laps. They were there to have their babies vaccinated. These women have travelled from Thappaganadoddi, a village in the same taluk. They explain that this hospital is their best bet to find a doctor and avail treatment. Pavagada has seven primary health centres, two community health centres and one hospital..The women, hailing from Thappaganadoddi village, wait with their children for the doctor at the govt hospital.Sowmya has been coming to this hospital every alternate day for injections. Doctors have told that her haemoglobin count is dangerously low and that it would be very risky for her if she does not take medication..“My count is five, I am told,” she says in Telugu. This count is less than half of what women her age ought to have (a minimum of 12). Sowmya’s pale face, eyes and finger nails make it obvious that she’s anaemic. She manages to communicate only the basic phrases in Kannada..Lack of affordable healthcare.Sowmya’s husband, a daily wage labourer, is the sole earning member of the family. For her, even one trip to the hospital means compromising on one meal..“I have to shell out Rs 12 to reach here by bus. I have been asked to come to the hospital to take injections every alternate day. These injections cost Rs 150 each. My husband earns between Rs 200 to Rs 250 a day,” she says, explaining that the medication’s cost is way beyond her family’s budget..She has been aware that her haemoglobin has been low for several years. Affordability and access to healthcare was the issue..“I cannot shell out so much to reach the hospital. But now, doctors have told me that I have no choice. I need to breastfeed the baby as well. So, I have to take care,” she says..Ask her if this is her first child and the frail young woman initially refuses to divulge details. After a pause, Sowmya continues, “This is my third. All of them are girls,” cuddling her baby. Originally from Andhra Pradesh, she was married off when she was 12, and had her first child even before she turned 18..“My Hb was five when I delivered the third child. It had been very low even when I gave birth to my other children,” she adds. Sowmya says she was not prescribed iron tablets..On the other hand, Sowmya does not get to eat nutritious food that could help improve her blood count. Three meals a day is luxury for her. “I eat rice and dal or sometimes just rice and chutney,” she says. Rice is what she consumes for all three meals. Vegetables and fruits for her family of four is only a weekly affair..“If my husband gets a lot of work, there is enough money to buy vegetables. On the other days, it is generally spices in dal,” she says..Sowmya reluctantly also confesses that she eats fruits at the most once a week. That is, if there is money left after meeting all other expenses..“I have three girls. We have to think about their future. They have to be married off. We have to save enough for that as well,” she says..Access to healthcare difficult.Anganwadis give new mothers a nutrimix supplement, a hot meal and some eggs and milk as well. But Sowmya is unable to avail that because the anganwadi is more than a kilometre away from her house. “I cannot leave the two kids back home. It is not possible to take all three along. It is also a long walk,” she adds..Madhavamma, another resident of Pavagada, has a similar story. At 24, she is mother to a boy and a girl. “I was married off seven years ago. I had a child before I turned 18,” she says..Madhavamma is also anaemic. “The doctors told me that my count is around 8. I need to take medication. I was given a strip free of cost in the government hospital. But I have not gone for a follow-up as I could not consume the medication. I feel it causes some gastric irritation,” she adds..When TNM approached three women to see what their meals looked like, all of them said that they consumed fruits and vegetables only about once a week..\r\t\r\t\t\r\t\t\t\r\t\t\t\tName \r\t\t\t\r\t\t\t\r\t\t\t\tAge \r\t\t\t\r\t\t\t\r\t\t\t\tBreakfast\r\t\t\t\r\t\t\t\r\t\t\t\tLunch\r\t\t\t\r\t\t\t\r\t\t\t\tDinner\r\t\t\t\r\t\t\r\t\t\r\t\t\t\r\t\t\t\t \r\t\t\t\r\t\t\t\r\t\t\t\t \r\t\t\t\r\t\t\t\t \r\t\t\t\r\t\t\t\t \r\t\t\t\r\t\t\t\t \r\t\t\r\t\t\r\t\t\t\r\t\t\t\tSowmya\r\t\t\t\r\t\t\t\r\t\t\t\t20\r\t\t\t\r\t\t\t\r\t\t\t\tRice and dal\r\t\t\t\r\t\t\t\r\t\t\t\tRice and dal \r\t\t\t\r\t\t\t\r\t\t\t\tRice and dal (if there is enough)\r\t\t\t\r\t\t\r\t\t\r\t\t\t\r\t\t\t\tGangamma*\r\t\t\t\r\t\t\t\r\t\t\t\t45\r\t\t\t\r\t\t\t\r\t\t\t\tNothing\r\t\t\t\r\t\t\t\r\t\t\t\tRice and dal \r\t\t\t\r\t\t\t\r\t\t\t\tRice (if there is any left)\r\t\t\t\r\t\t\r\t\t\r\t\t\t\r\t\t\t\tAnsuyamma*\r\t\t\t\r\t\t\t\r\t\t\t\t22\r\t\t\t\r\t\t\t\r\t\t\t\tBiscuits\r\t\t\t\r\t\t\t\r\t\t\t\tRice and gun powder (chutney powder)\r\t\t\t\r\t\t\t\r\t\t\t\tRice or bread\r\t\t\t\r\t\t\r\t\r.*Name changed.Anaemia and resultant problems.In Karnataka, anaemia is a concern in districts that fall in the Hyderabad-Karnatak region and north Karnataka areas. Yet another district that sees large numbers of anaemia cases is Tumakuru..The last National Health and Family Survey commissioned by the Ministry of Health and Family Welfare showed that 52.7% of women aged between 15 and 49 who are not pregnant in Tumakuru district have a haemoglobin count of less than 12 g/dl. As many as 72.2% of pregnant women between 15 and 49 are also anaemic. These include women who have been on iron tablets or supplements as well..A senior specialist at the Tumakuru Government Hospital explains that even as the maternal mortality is lower than the state average, anaemia is one of the leading causes for maternal deaths here..“Poverty is a concern here. Some women eat less and also skip medication. They do not turn up for follow-up treatment even after being diagnosed. If anaemia is treated at an initial level, a lot of issues can be addressed. This will also avoid morbidity. Mothers are at a risk of other post-natal complications and cannot lactate if they are anaemic,” he adds..Apart from maternal deaths, anaemia also causes menstrual irregularities, cramps and severe weakness. It is a challenge for lactating mothers as well as they find it tough to breastfeed if anaemic..Child marriages galore.When TNM spent several hours interacting with women across various age groups in Pavagada taluk, it was evident that Sowmya was just one of hundreds. These are women married off very young, some when they were as young as eight, and who had borne children while still in their teens..Venkatesh, an activist with Tamate, a group that works on local issues, explains that in the taluks bordering Andhra Pradesh, the brides generally hail from Andhra Pradesh. “They are married off at a young age. This is sometimes due to financial concerns,” he added..Summers worse for poor taluks.On either side of the highway are a few green fields, mostly paddy and musk melon, in between stretches of bare land. In the distance, all one can see are brown patches, most of which hold failed crops. These fields have just thorny bushes and trees that have completely withered..In stark contrast to other rural areas around Tumakuru district, Pavagada has a rocky terrain, mostly comprising dry stretches of land. Most agricultural fields are already dry even as the summer is just setting in. With very little grown here during summers, the taluk depends on food from other places..“Very little greens are grown here. It’s the same with vegetables. It is only tomatoes, chillies and musk melons that are grown in abundance. In summer, the prices go up and we cannot afford to buy them,” said Raghava from a nearby village..People usually consume plain rice with dal or gun powder (dry chutney powder) during summers when vegetables are not available..K B Obalesha, Tamate secretary, explains that the district is dependent on rainwater for farming..“There is water scarcity. Most people here are landless labourers. For a farmer to even get one crop yield a year is a challenge. In such a situation, they have little to eat. This is one of the primary reasons why women are anaemic. Poverty is a serious issue here,” he adds..The per capita annual income in 2011 was Rs 19,106 and 98% of households were reported to be below the poverty line (BPL). .With severe scarcity of food and water, most people from these parts migrate to Bengaluru, while the others who stay back survive off what little is available.