The names of the workers have been changed for their safety and security of employment.

Assam, IndiaRama is scared. She is six months pregnant and is increasingly worried about the health of her unborn baby.

This 22-year-old casual worker earns her living by picking tea leaves in the state of Assam, in northeastern India.

She does not take a break from hard work even though she is in pain.

"Sometimes I feel good, sometimes not very well," she said. "I'm new to this field, so I do not know what to expect."

Her hut, located in a village near Tezpur, in Sonitpur district, Assam, is one of dozens of workers in the fenced compound of the tea plantation that stretches for miles, surrounded by of green fields, which makes it beautiful but extremely isolated.

"We are totally dependent on the tea garden," she told CNN from her village.

Small and slender, Rama struggles with the exhaustion that accompanies a pregnancy, aggravated by working six days a week, nine hours a day.

She is worried about the health of her baby.

Recent blood tests show that Rama's hemoglobin is low, which makes it anemic and presents a high risk of excessive bleeding during delivery, a scenario that is not unusual in the planting.

Many neighbors have had complications during childbirth, she added, with sometimes fatal consequences for the mother and the child. According to experts, this situation is fueled by poor working and living conditions, prolonged working hours and minimal access to health care during pregnancy.

"I'm scared when they talk about surgery or a kind of cut-off when there's a slight birth problem," Rama said.

According to government figures for the period 2014-2016, 237 women die per 100,000 live births in the state of Assam. It is therefore the most dangerous place in the country for childbirth.

The situation has improved in recent years, rising from 480 per 100,000 in 2006, according to data released by the Indian government, but the state remains a special case compared to the rest of the country.

For India as a whole, the rate is 130 deaths per 100,000 live births and in developed countries like the United States it is 14, according to figures from the World Health Organization. of 2015.

But statistics or stories will not prevent Rama from working. She can not afford.

World famous tea

These tea plantations are the starting point of the famous Assam tea, known for its powerful taste and aroma.

India is the second largest tea producer in the world, after China, with Assam, its largest tea-producing state, home to about 800 tea plantations.

Assam tea exports have an estimated value of $ 250 million and end up in tea cups all over the world, in countries like Russia, Iran, the United States, the United States. United Kingdom and China. India is also one of the biggest consumers of tea, accounting for 19% of the world market.

The plantation where the Rama tea harvester works is not accredited by the Rainforest Alliance, which verifies working conditions to ensure that they meet certain health and safety standards.

Rainforest Alliance employees check plantations registered with the NGO every year to ensure compliance. "If you do not meet all the criteria, you are excluded from the system," said Harkirat Sidhu, coordinator of the advisory program at Rainforest Alliance in India.

The world's largest tea companies, Hindustan Unilever Limited and Tata Global Beverages, supply tea for their international brands such as Yellow Label and Tetley at accredited plantations. But they have other local brands that do not come entirely from Rainforest Alliance-accredited plantations, such as Hindustan Unilever's Taj Mahal tea.

A spokesman for Hindustan Unilever told CNN that 40% of its tea for the Indian domestic market came from uncertified plantations.

"For non-certified gardens, we have traceability to factory level, but we do not have the traceability on the green tea leaves bought by the plant for the manufacture of tea", reads in a statement sent to CNN. "Our goal is to transfer the remaining 40% to plantations from sustainable sources by 2020."

In addition, a spokesman for Tata Global Beverages told CNN: "In India, we are getting 100% accreditation." Given the complexity of the supply chain, process is not simple. "

"In our international markets, we are 100% certified by Rainforest Alliance for our Tetley brand," the statement said.

At the same time, local health and social workers continue to raise concerns about the welfare of tea workers in Assam and recent report by the World Bank Independent Ombudsman, the Compliance Advisor (CAO) Ombudsman, agreed.

To address the issues raised, CNN visited two uncertified gardens in Assam, where women workers, such as Rama, shared their experiences of poor access to health care and inadequate working conditions, especially during pregnancy. Small plantations like these represent nearly 50% of the Assam market.

A spokesman for Hindustan Unilever said the company had purchased "a small amount of tea" for its Indian domestic market last year at these two plantations, while Tata Global Beverages said it did not "clean up" tea. supply tea from these plantations.

Maintain maternal health

One of the owners of a plantation visited by CNN, speaking by phone, declined to comment on the specific health problems of his workers, but said his estate provides ambulances, medical vans and transportation to hospitals for women when needed.

"Medical problems (such as excessive bleeding) that occur are problems that are not in our hands, but we can do everything we can," he said.

At the same time, the Indian Tea Association told CNN that "workers are eligible for primary health care under the Plantation Labor Act", with free drugs provided to a worker, as well as care and maternal care to cover the treatment of anemia, vaccination, institutional deliveries and maternal and child health projects.

Jayshree Satpute, a human rights lawyer who works with local plantation workers, disputes the claim that medical facilities are accessible to most women workers. "If you look at the infrastructure in the field, that's not enough," she said. "There are not enough doctors, hospitals do not have enough facilities, not enough beds, primary health centers do not have enough infrastructure there are not enough doctors, there are not enough staff. "

Rama says he has personal experience of weak infrastructure, saying that although his plantation has an ambulance, his arrival is long and difficult to obtain.

"He's always busy transferring patients to the hospital," she said. "Sometimes he even comes out of the city."

Lawyer Satpute said she saw many women in late pregnancy working on the plantation, many of them having given birth there. "Most of these tea plantation workers are very anemic and have not been able to access health facilities or have been able to enroll themselves. "

Knowing her condition, that's what Rama fears: she will not receive any medical treatment for her child and for herself.

Life on the plantation

With baskets in their heads, crowds of women were leaving each day, moving from one site to another – surrounding the same plantation – usually taking a break once a day, even when they were pregnant, like Rama.

Rama earns about 1,000 rupees, or $ 14 a week, and should pick up about 24 kilograms of leaves a day. If she and other people like her do not meet these goals, their daily wage is reduced, she told CNN, as well as to other workers. At the end of each day, they drag their bags of leaves to be weighed, recorded and collected by the plantation managers.

Workers are divided into two groups: temporary and permanent, with the majority of the 1.5 million tea plantation workers in the region being temporary, according to Satpute. More than 70 percent of the workforce is women, she added.

Eligibility for maternity benefits does not discriminate against temporary workers, the Indian Tea Association said. And according to the country's maternity benefits law, a woman is entitled to paid leave if she has worked more than 80 days in the past year, before starting work.

But not all workers seem to be aware of these laws.

Rama, for example, says she feels that only permanent workers are entitled to health benefits such as maternity leave. It's a common misconception, says Satpute.

Casual workers often work throughout their pregnancy and rarely go to appointments at the hospital because they can not afford to lose even the salary of a day.

"It's hard, but the job is the job, I have to do it," said Rama, adding that taking a break was frowned upon and that this often resulted in the supervisor reprimanding.

She explained how she was slowly going to work these days, but with caution. "When they see us resting, they ask," Who will pay your salary? "

Rama admits that she largely ignores the health care needed to keep her baby healthy.

And officials believe that local habits add to this unconsciousness to aggravate situations.

"Some of these people have salt in tea, while the normal population uses sugar and consumes a lot of salt," said J.V.N Subramanyam, director of the National Health Mission in Assam. "There is a lot of alcoholism and little nutritious food available on the lines of work," he said, pointing to the prevalence of anemia.

Women often need supplements and blood transfusions, but are too far to get it or to be informed.

"Nobody told me what to do," Rama said. "What can we do?"

In theory a lot.

A range of Indian government initiatives aim to make pregnancy safer for the poor of India.

Since 2005, the government provides free antenatal care, blood tests and cash payments for every baby giving birth in a state-licensed, state-licensed hospital and receiving its first cycle of vaccines.

It has also launched nutrition-focused programs in which pregnant women are entitled to free meals at local community centers. Each state government then usually adds more benefits.

But due to a lack of awareness, widespread illiteracy and inaccessibility, women in tea plantations are not aware of these options, say social workers, leaving many fatal victims.

A number of factors contribute to the problem: excessive bleeding during labor, the cost of medical expenses in urban hospitals or the fact that they do not know that their pregnancy could pose a high risk. They reach hospitals too late, or not at all, and all the facilities they build have minimal equipment and expertise, local social workers said.

Live an inheritance

Assam tea plantations are an inheritance bequeathed to India by the colonial-era government, where local tribes were employed or, in some cases, put to the service of servitude, for the picking of tea leaves . Whole generations have resided in the plantations, transmitting over time the legacy of servitude and human rights violations.

The men and women who work today see the same future for their children.

Plantations are governed by the Plantation Labor Act of 1951 – intended to include virtually all plantation workers in the country and to guarantee their rights – which establishes a standard wage which, according to experts such as Satpute, does not has not kept pace with the job market.

The average salary of an unskilled agricultural worker in India is 320 rupees, or about $ 4.50 a day. A person working in Assam's tea plantations earns about half of that amount, or Rs. 167 or $ 2.27 a day, plantation workers said to CNN.

Satpute says that some plantation owners even restrict the movement of their workers – a claim that is denied by local authorities.

"They are free to go anywhere," said Manoj Kumar Deka, deputy district commissioner of Sonitpur district in Assam. "They go to markets, they go to hay (local festivals), they like it, there is no problem."

Desperate for care

"The government is aware that it is a major human rights issue," said Subramanyam of the National Health Mission, citing the problems encountered. by workers to access health care.

There are 35 tea plantations in Sonitpur district alone and more than 800 in Assam, all of which need sustained efforts for their health facilities, he said.

There has been progress. Over the past five or six years, the state government has made sustained efforts to improve access to health care, said Deputy Commissioner Deka.

The state government has deployed new ambulances, more dispensaries and even mobile medical units, small vans equipped with emergency medical care, as well as doctors and nurses, does it have? declared.

But the resources remain insufficient, told CNN a dispensary supervisor, who did not want to be identified.

Local social workers described how some of the existing clinics are dilapidated sheds served by a visiting physician who comes twice a week to work for only two hours. The result: a woman who arrives at the clinic will be seen by the nurse and a non-medical supervisor, while the doctor is called, according to the supervisor.

"If something (medical facilities) is planned in the tea garden, things could become more practical and the conditions could improve a lot," said a social worker at CNN.

Plantation hospitals should have a doctor, a nurse, a midwife and a pharmacist every day, but they only come once a week, according to Satpute, co-founder of his legal work, Nazdeek, an NGO working in Assam and all over India. promote the well-being of teapot workers.

Work rooms often have rusty gurneys on which women are supposed to give birth. With a few shelves filled with medication and no equipment such as an oxygen tank or an ultrasound machine, women depend on the skills that doctors possess, which is often not enough, said a social worker.

It is common for women to need blood transfusions and, according to a national initiative in this area, pregnant women are entitled to free blood during delivery. But the practice is difficult to implement due to the shortage of blood banks in Assam gardens, according to Subramanyam, responsible for all government-funded medical schemes in the state.

A healthy level of hemoglobin is 12 grams per deciliter of blood, but many pregnant women who visit Assam hospitals only own one-third, with only 3 to 4 grams per deciliter, said Dr. Reena Dutta Ahmed, former associate. Professor at Assam Medical College (AMC). "They always walk"

Of the women who die in Assam, most die of anemia and hypertension, Ahmed said.

Rama fears a similar fate for herself, having heard of some women who died during their delivery.

She sought help. To increase her strength, she says she's been trying to get more food from local medical workers – something she says can not afford herself. The answer? Go buy your own food.

And she is also worried about getting the medical equipment she will need. "When we need blood, etc., it should be provided," she said.

"We do not receive any help."

Swati Gupta reported and wrote of Assam, Meera Senthilingam edited from London.