"As societies build walls of separation between communities,
ICAAD works to remove each brick to illuminate our common humanity"

End Maternal Mortality Now (EndMMNow)


Today, some of the highest rates of maternal death occur in Assam, India, where indigenous and low-caste workers on tea gardens lack basic healthcare, housing, and nutrition despite domestic and international laws mandating full protection.

Women in these communities have insufficient access to essential healthcare services and minimal exposure to legal resources that would inform them of their rights. Due to their devastatingly low agency and awareness of their rights, female tea garden workers in Assam suffer from the highest rate of preventable maternal mortality and infant mortality in all of India.

To address these gaps, ICAAD is working with Nazdeek and PAJHRA and local activists in Assam to combine community mobilization and technology with legal intervention to increase access and accountability in the delivery of reproductive health services, thereby reducing the number of preventable maternal deaths and increasing access to lifesaving medical treatment.


Tea-garden workers lack basic healthcare, housing, and nutrition

Impact Thus Far

  • 45 women empowered to use mobile tools to document health system gaps – visit http://endmmnow.org/ to view map and reports
  • 150+ serious human rights violations identified
  • Food rations for pregnant women now regularly provided at 527 centers – 28,000 women impacted on an on-going basis
  • HIV testing kits for pregnant women provided at no cost at health centers
  • Pregnancy registration costs eliminated, able to get access to government benefits
  • Legal complaint filed for bribery by health officials to treat pregnant women
  • Legal complaint filed for “right to survive pregnancy” by requiring blood banks

Assam meeting small

Problem Space

Tea garden workers earn the lowest wage in the organized sector in India and suffer from shockingly high malnutrition and anemia. Additionally, tea garden workers have insufficient access to health facilities and essential services. Existing facilities are severely underequipped and understaffed, and many villages are located in underserved and remote areas. As a result, Assam has the highest maternal mortality rate in India and families have minimal access to legal resources to seek redress.

According Mousumi Gogoi, a scholar at the International Institute for Population Sciences, Assam has a maternal mortality rate of 390 per 100,000 live births compared to 221 for the rest of India.

The Supreme Court of India has recognized the right to health as a fundamental right, and various High Courts have held that maternal mortality is a human rights violation.

The Central Government and the State of Assam have enacted a series of policies to curb maternal and infant mortality rates and guarantee universal health care, however, extremely limited awareness of government policies among communities combined with a lack of monitoring and weak community engagement has resulted in gross failures to implement policies that ensure access to basic health entitlements for Adivasi women. The existing monitoring system is inefficient and unaccountable, and community members unaware of their entitlements.

A 2009 study by the Guwahati University investigating Primary Health Centers in the

Sonitpur District found that:


Hospital websize



Ninety percent of maternal deaths are preventable. India leads the world with the highest number of maternal deaths. Assam leads the country with the highest maternal mortality ratio.

Nazdeek, ICAAD and PAJHRA are combining community trainings, technology and legal intervention to increase accountability in the delivery of maternal health services in Assam.

Using SMS-based technology, 44 women activists, many who are women living in the tea gardens, are identifying and reporting maternal health rights violations in tea garden and public health facilities. The women activists are also documenting the delivery of food benefits, crucial for pregnant women and their families, through the Public Distribution System and the Government’s Anganwadi Centres. The project is monitoring service delivery in 16 health facilities across two blocks in Sonitpur District, Assam. The project relies on open source technology offered by Ushahidi.

The information received is subsequently verified and collected on this online platform to map the areas of concern and patterns of violations. The data collected will provide local activists and lawyers with ground data necessary to combat maternal mortality and save mothers’ lives.

Go to www.EndMMNow.org to view the reports.


assam tea banner


Nazdeek is a legal capacity building organization committed to bring access to justice closer to marginalized communities in India. Nazdeek partners with grassroots activists and lawyers to build community-based legal networks to increase accountability in the protection of social and economic rights.





Sukti Dhital, Co-Founder Nazdeek





Francesca Feruglio, Co-Founder, Nazdeek


Promotion and Advancement of Justice, Harmony, and Right, of Adivasis (PAJHRA) is a grassroots membership organization led by Adivasi. Their goal is to empower, promote, and protect the rights of the Adivasi community through advocacy, capacity building, and community organization with a focus on the protection and promotion of the Adivasis’ indigenous identity.

Barnabas Kindo

Stephen Ekka

EndMMnow was initially supported by the Information Society Innovation Fund (ISIF), Asia.

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