Maternal Health of Tribal Communities in Rayagada District, Odisha
This study was conducted in collaboration with the National Alliance for Maternal Health and Human Rights (NAMHHR) and was a qualitative enquiry into local practices and interactions with the health system in Rayagada district, Odisha.
While the inclusion of maternal mortality reduction in the MDGs has brought much wanted attention to this important health issue, there is evidence to suggest that reduction of a complex problem into a race to achieve stipulated indicators has ignored contextual realities and left a large number of people behind. In India, the effort to address maternal mortality hinged on national programs that employed health system strengthening along with incentives to draw women into health facilities for delivery, and reduction of financial barriers in availing institutional deliveries. The result has been a definite but unequal increase in the proportion of institutional deliveries. In Tribal communities, domiciliary deliveries are still common. One of the reasons for the failure of maternal health schemes in reaching tribal populations is that, although ambitious, they have been influenced by various international agencies and do not necessarily emerge from a local contextual understanding and do not take into account existing cultural practices of these communities.
In this background, we undertook a study in Rayagada district of Odisha to understand the maternal health practices of tribal women who deliver in the home. In this district, 38% of deliveries still take place in the home and these remain out of the purview of maternal health schemes.
Objectives of the study were to understand:
What constitutes pregnancy care in prenatal, post natal periods and childbirth.
Normative practices during pregnancy, delivery, post-partum period and for new born care both.
Perceptions about and experiences with the public health system.
The study used a qualitative methodology. In-depth interviews were conducted with recently delivered and pregnant women from the Kondh tribe, non-participant observations at health facilities, key informant interviews with traditional healers and formal health providers.
The exploration of traditional practices of women during pregnancy and delivery shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring much external intervention. Traditional practices are primarily geared towards protecting the mother and child, through conducting pujas or through restricting diet. Women go through childbirth in the familiar surroundings of their own home and family, continuing to work until the time of delivery, which is an important economic consideration for them. There is awareness of complications in pregnancy, and the necessity to take the woman to the health facility in such situations. This suggests that there is a well established traditional practice of birthing in the community which also recognizes the need for health system interventions. However, there has been no effort to build on this traditional understanding by the health system. For instance, traditional health providers who are important stakeholders have not been integrated into the health system. No effort is made by the health system to build on the traditional understanding of safety of woman and child, in order to encourage uptake of ANC and PNC services. Instead, the system continues to rely on incentives and disincentives to motivate women.
Despite the immense difficulties that women face, however, they do access health facilities, where services of which do not meet their expectations. The barriers of distance, language, alienating environment in the hospital, out of pocket expenses and experiences of gross violations have further compounded the distrust that women have in the health system.
The single minded focus on institutionalizing deliveries seems misdirected in such a situation where a complex web of barriers, makes access to health care facilities so difficult. The study emphasizes the need for providing support to deliveries occurring in the home, trust-building measures between the community and health system, efforts to cater to the specific cultural needs of tribal women and to preserve beneficial parts of traditional practices.
Study Report: Maternal Health in Tribal communities: A Qualitative Enquiry into Local Practices and Interactions with the Health System in Rayagada District, Odisha. (ADD REPORT LINK)