Think of the inaccessible areas in the district where youths carry pregnant women traversing through extremely muddy, undulated hilly terrain and then finally turbulent Nagavali or Kalyani river to reach to the hospital at Kalyan Singhpur. Most of the time, pregnant women are carried by a stretcher provided by the Health department from these areas. And they are accompanied by the local ASHA to the PHC or CHC or to the District Headquarters Hospital as a referral point.
“Generally poor tribals were avoiding the allopathic hospitals earlier. They did believe in their traditional healing systems and several deaths went un-noticed. The child births were usually conducted by the untrained dhais in the village and the pregnant women hardly went to the local hospital for delivery purpose. I am a tribal and have three grown-up children. like many pregnant women of the village of my time, my wife never went for an institutional delivery. I still remember a few mother and child deaths due to extreme labour pain and complicacies. But now the situation has changed. The presence of health delivery system in the form of Anganwadi worker and ASHA at our doorstep has created a new hope among the tribal women. As both of them are from the community and readily available and accessible to the community, there are several mutual consultations. Village women also consult the local ANM whenever she is available, though her presence and visits are not frequent. The belief in the hospital health system is strengthened. Villagers are now depending on the local hospital when they are sick”, said local tribal youth leader from Padeikani village in Kalyan Singhpur Akshey Pidisika.
According to a study conducted by the Centre for Health and Social Justice (CHSJ) in collaboration with the National Alliance for Maternal Health and Human Rights (NAMHHR), in Rayagada district, 38 per cent of deliveries still take place in the home and these remain out of the purview of maternal health schemes. In the tribal communities, domiciliary deliveries are still common. 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 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 child birth 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.
Most of the villages in Niyamagiri hills, the abode of Dangaria Kandhas, a Primitive Vulnerable Tribal Group(PVTG), are still inaccessible by road in spite of district administration’s sheer effort to facilitate connectivity. Members of this PVTG have a lot of blind beliefs. There were instances of abandoning the whole village if there were a few deaths within a particular time limit, even if it was a simple gastroenteritis disease. Generally, they treat the patients with home remedies, through faith healers and even at times through quacks. When the disease becomes acute and the patient is on the verge of death, they leave him/her to the providence.
“But things are changing now. Dangarias are invited to attend republic and independence days in the district headquarters. Their visits to district cultural extravaganza Chaiti and Car festival are also facilitated by the district administration. This has led to a cultural synthesis. With various other exposures, they have started to believe in the local hospital. And this is exactly the reason why more and more pregnant women are at the local PHC for delivering their babies. The process is late, but it has yielded result. Infant Mortality Rate(IMR) and Maternal Mortality Rate(MMR) have drastically come down. Maa Gruha-Maternity Waiting Home is playing a vital role and that needs to be,” said social worker Purandar Bantha, serving these PVTG members.
“Inaccessibility is a reality in this area. Though Government services are not foolproof or comprehensive, still one must take advantage of available infrastructure and human resources like hospital, Maa Gruha, ASHA, AWW, ambulances, stretchers, temporary health centres, free medicines, mobile clinics, etc,” said convenor of Rayagada Nagarika Mancha Ajay Rath.