Name of Organization: Gandhi Manav Kalyan Society. About GMKS

Transcription

1 Base Line Survey Report on Reproductive and child Health In three tribal villages of Jhadol and Kotra block, Udaipur district, Rajasthan Submitted to: CHETNA Kanubhai Dahybhai Mehta CHETNA Pravruti Kendra 1834, Desai Ni Pole, Opp. RBRC Girls School, Khadia Ahmedabad Gujarat, India Submitted by: GANDHI MANAV KALYAN SOCIETY 806, Bhadviya House Nr Hotel Ankur, Shastri Circle Udaipur - Rajasthan - mksudr@rediffmail.com Phone

2 Name of Organization: Gandhi Manav Kalyan Society About GMKS GMKS is non Profit; non Government voluntary organization has been formed in the year 1985 and since then has tried to play the role of a catalyst in the development process of the Southern Rajasthan area especially tribal areas. The approach has been multi-sectoral and covers the physical, human and institutional aspects. The strategy has been to involve the people at all levels through the building up of groups at various levels. In the past 22 years this has been implemented in a variety of ways, depending on the resources available and the situational context. Wherever possible, GMKS has worked in collaboration with both government and non-government agencies and has been an active member in a number of networking efforts in the NGO circles. At present Gandhi Manav Kalyan has been reaching pinnacle of its efforts and closely works with various international agencies, Government of India and State Government. In additional to that GMKS is member of Agriwatch (A National body provide agriculture market to farmers) and member of Organic Farming Association of India and Chairperson of its Rajasthan Chapter. Address: Registered/Field Office: Village and Post Ogna, Tehsil Jhadol, District Udaipur , Rajasthan, INDIA Coordination Office: 806 Bhadviya House, Near Ankur Hotel, Shastri Circle, Udaipur, Rajasthan, Pin: Organization Mission MKS strives for a self reliant TRIBAL SOCIETY in which people develop their capabilities of managing their own resources to contribute in a SUSTAINED SELF DEVELOPMENT process through AWARENESS-RAISING, ORGANISATION AND CONSCIENTIZATION. Area of Operation GMKS is working in total 80 villages of Jhadol & Kotra blocks of Udaipur district in Southern Rajasthan. GMKS has adopted sole strategy to provide support to a village for 8 to 10 years than shifted to another village. In future GMKS is also planning to work in other tribal districts of Rajasthan

3 Summary of BLS Survey Tribal people of Rajasthan have their own culture, customs, norms, values and practices. They generally live in high hilly terrains, which are inaccessible from district headquarter and other parts of the state. Tribes constitute 12% of the total population of the state. Bheel, Gharasiya Meena and Gameti are the major tribal communities dwell in Udaipur, Banswara, Dungarpur and Chittorgarh districts of Rajasthan. Present study has been done to understand the health behaviors, practices and attitudes of eligible men and women for their reproductive health context. The study covers all aspects of RH which includes mean age of marriage, age at the time of first conception, average children in the family, contraceptive prevalence, delivery at home, Government health services and attitude of eligible couple for this, RTI and STD prevalence and breast feeding practices in the tribal communities. The situation of tribal mothers and their infants is very devastating. Around 89% deliveries take place at their homes and untrained traditional health attendants provide all healthcare services in the villages, which are largely based on traditional heath care systems of the region. This provides an adverse impact on the health of mothers as well as on infant and young children. The traditional health care system of the region does not follow early initiation of breastfeeding (within one hour) and exclusive breastfeeding for six months, which are compulsory for overall growth of the infant as prescribed by Indian Ministry of Women and Child Development, WHO, WHA and UNICEF. The rate of early initiation of breastfeeding is as low as only 15% in the tribal areas. Around 80% mothers do not give first breast milk (colostrum) to newly born infants. Their traditional believe is that colostrum creates stomach problem to the infant. That is why they prefer to give goat s milk for 3 to 5 days immediately after the birth of the infants. Even the cases of reproductive tract infection and sexually transmitted infection are quite high among the tribes. There is lack of awareness as well as shyness to go for the treatment of RTI and STD. Besides that Polygamy is very common phenomenon and it determine by the economic status of person, and sex is open in this region. Thus we can say that sex is not a social taboo before marriage. The average age of marriage in theses tribes is 15 to 18 years and half of the adolescent girls become pregnant between this age group, which gives adverse impact on their health as well as the health of new born child.

4 Around 70 percent of the couples have lack of knowledge of modern family planning method as they only know about Tubectomy and Vasectomy called Nasbandi in local dialogue. Thus it is clear mark to work on the create awareness on informed choice for family planning. Besides that we should ensure the availability on modern methods in the interior as well as clarity on existing myths and misconception related to family planning method. These apart, there are innumerous number of biomedical, ayurvedic practitioners and local healers who cater the needs of health services in tribal areas. They are known as specialists in ritual care practitioners (bhopas) who also perform jharameans sweeping away the illness. These tribes have immense belief on indigenous and traditional method of treatment and cure, and depend on those so-called health specialists. Tribal people also prefer traditional method for birth spacing and permanent sterilization like Jadi-buti. Rajasthan and District RCH Profile RCH Profile Udaipur Status (%) Rajasthan status Community* Status Girls marriage below the age of 18 years Mean age of Boys marriages Girls Current use of Any method contraception Modern method Unmet need ANC Delivery Immunization Limited Spacing At least one TT injection Received IFA Full ANC * Govt. Institute Home Attend by skill person 3 injection of DPT Measles Full

5 Source RCH 2, Udaipur * Present Base Line Survey * Complete ANC include 3 check ups( weight, urine, blood and abdominal examination), 100 IFA tablets consumption and 2 TT, for the present study Basic information of the community and need for BLS Tribes in India generally live in tuff terrains and accessibility to the health services is very frivolous. Marginalized communities such as these tribal groups have never received due care and proper health services. Poor immunization, high prevalence of malaria and diarrhea among the children, high rate of STD and RTI, and low institutional delivery, and poor maternal health few among many, have brought deleterious effects on children and mother. Utter dismal situation like this one, which claimed many lives of women, children and adults who over the years suffered in many communicable and non-communicable diseases. GMKS is working in tribal locale of Udaipur district since couple of years. GMKS covers total 80 villages in Jhadol and Kotra block of Udaipur district, where around 70% tribal population dwell. Health situation of tribes is pathetic and vulnerable, and become more alarming when come to mother and child health. More than 90% of delivery done at home by untrained Dai. 89% women in tribal villages not let her child for breastfeeding till 5 days after birth. 60% of pregnant women are not immunized in these project villages. According to Research done by Breast Feeding Promotion Network of India (BPNI) says, If a women do exclusive breast feed to her child (including colostrums), 47% of Infant Mortality Rate will be reduced in India. Unfortunately 65% women do not receive antenatal care and IFA during delivery for the treatment and cure of various diseases; tribes are depending on traditional method and on super natural power so called Bhopa. Thus the situation needs more attention and appropriate intervention. GMKS-CCF has started to endeavor in total 17 villages initially in approach to give better health services to the tribes. Total population of 17 villages is 9072, in which 83% are tribes. There are only 3 Primary Health sub- centers in total 17 villages, which covers merely 35% of the population and 65% of the population depends in

6 indigenous and traditional method for treatment and cure. Generally a tribal couple/ person prefer traditional method for birth spacing and permanent sterilization like Jadi buti. Government has recently started, National Rural Health Mission, with objective to reduce maternal mortality rate and infant mortality rate in rural India through ASHA, AWW, ANMs, and Sahyogin. Population in these tribal villages scattered in hilly areas so that professionals generally do not prefer to go and give services in remote areas. As result they do not cover 45% of the population. Objective of the Base Line survey: 1. Antenatal care and Immunization Services 2. Extend safe delivery 3. Contraceptive prevalence 4. Unmet need for family planning 5. Awareness about family planning 6. Utilization for Government services and user satisfaction. Research Tool Survey Questionnaire Focus Group discussion Methodology For the purpose of Base Line survey in our project villages, Gandhi MKS has chosen three villages according to the distance from Primary Health Sub Centre. Further to this, sample size was 317 among total three villages. Sampling Method Families 2. Focus Group discussions 6 Sample size For the purpose present study, we have selected three villages i.e. Galdhar, Kantharia and Chokalabhara on the basis of distance from Primary Health Sub Centre. Following is the profile of selected villages:

7 Profile of selected villages: Name of village Total population Total population of Schedule Caste Distance from pukka road Distance from sub centre Galdhar KM Kantharia KM 4 KM Chokhala bhara KM Finding of Focus Group Discussion Total 6 FGD have been done in three villages with male and female. On an average 15 men and women in respective FGD have participated. All participants were tribal mostly from Bheel, Gameti and Gharsiya communities. Most of the participants were illiterate and were married. Major finding have been included in the interpretation of tables.

8 Tabulation and Interpretation Table No. 1- Sex Ratio S.No. Sex Number 1 Male Female Ratio The above table revealed that, out of 317 house hold interviewed, the sex ratio among these families was which shows that there is no big problem of declining sex ratio as other communities in Indian states and districts. Table No 2- Educational Status of respondents S.No. Education Number Per cent 1 Illiterate Primary( up to class 5 th ) 3 Secondary( up to class 10 th ) 4 Senior Secondary ( up to class 12 th ) Total The above table reveals that around 80% of the people are not literate shows that the situation is frightening among tribes.

9 Table No 3- Age of Eligible women S.No. Age Group Number Percentage years years years years years years years and above Total * For the purpose of the study, we define eligible women, are those women who are in the age group of and married. The mentioned table shows that more than 29 per cent of eligible women interviewed falls between the age group of and 5.63 per cent of eligible women fall between the age group of and above. Further to say that the fertility rate is high between the age group of 15 to 34 years. Table No 4- Pregnancy Status S.No. Pregnant Number Per cent 1 Yes No Total Above table shows that at the time of interview 12 per cent of the women were pregnant.

10 Table No 5- Use of Any method to avoid pregnancy S.no. Type of method using Number Percentage 1 Not using any method Using Any Modern Method Sterilization Modern Spacing method Any Traditional method Specify The above table revealed that per cent of the women are not using any method to avoid pregnancy which is very large number; it shows that the level of awareness is very low as well as there are not realizing the benefits of having three years of spacing. In additional to that use of traditional method is higher rather than modern method. It is clearly revealing that female sterilization is highest, and vasectomy (male sterilization) is negligible.

11 Table No 6- How long wait for Next Child S.No Wait for the child Number Percentage 1 Soon/Now Within 12 months Within months After 24 months Not sure Above table revealed that among eligible women around 30 percent of women can wait for the next children for one year only. It shows that women are not aware about the consequences delivery place less than three years and health benefits of three years spacing. Table No 7 - Unmet need Limiting and Spacing S.no Unmet need Limiting Spacing 1 Eligible couple unmet need for family planning Number Per cent Number Percent

12 Table No 8 Reason for not using Family Planning method S.n o Reasons 1 Lack of knowledge about family planning method Numb er Percentag e Opposed to family planning Husband opposed Other family members opposed Not like existing method Afraid of sterilization Can not work after sterilization Worry about side effects of method Costs too much Health does not permit Difficult to get method to Inconvenient to use method Difficult to become pregnant after use Fear of using any family planning method Above table shows number of reasons that why people are not using family planning method. Around per cent of the eligible couples are not aware about the method, which is very high. Again per cent of people are afraid about going for sterilization women were accepted that their husband opposed for this eligible couples afraid about the side effects of the method. Thus we can say that we should strongly work on awareness generation on family planning method, encourage male counterpart to support their wives and also work on Behaviour Change Communication for proper and correct use of method and side effect management. In these communities, have certain myths and misconception related to family planning method i.e. pills may create irregular vaginal bleeding and vasectomy could make male impotent.

13 Table No 9- Age of girl at the time of marriage S.No. Particular Number Percentage 1 Number of girls married before attaining 18 years Above table shows that around 84 per cent of girls are married at the age of less than 18 years. Thus it is well established fact that health of such girl and health of children needs more attention and maternal morbidity and child survival are alarming issues here. Generally, married adolescent girl s lives with their husband fully or partly in the tribal communities of Southern Rajasthan. Table No 10- Age of first conception S.No Age Group Number Percentage 1 Less than 15 years years years After 21 years Not conceived yet Mentioned table shows that half of the married women conceived between the ages of 15 to 18 years, thus it is quite clear that their health status would be alarming and in our intervention we should give more focus to extend the age of first conception through promotion of birth spacing methods.

14 Table No 11- Married Girls conceived during adolescent S.no. Particular Number Percentage 1 Married Girls conceived during adolescent Above table showing that 56 per cent married adolescent girls conceived which is very high, in fact in developing countries it is common, but in such tribal belt it is very high as well as delivery done at home by untrained person. Table No 12- Out come of conception S.no Particular Number Percentage 1 Live Birth Spontaneous Abortion Still Birth Mentioned table reveals that out of total 198 married girls conceived, 7.58 of girls had got still birth and 2.53 girls had natural abortion. It shows that still birth is exist in these communities and more high in the cases of married adolescent girls.

15 Table No 13- Place of delivery S.no Name of place Number Percentage 1 Govt./Municipal hospital Private hospital/ Maternity hospital PHC Parent s home Your home( Husband) Total Above table revealed that of the delivery done at husband s home and only 3.28 delivery done at government hospital. It exposed that the rate of institutional delivery is very low. We should promote institutional delivery and include it in our core health strategy. Table No 14 - Delivery by Skilled birth attended S.no Who assisted during delivery Number 1 Nurse ANM Doctor Other person Traditional Birth attended Trained Birth attended Total Percentage Mentioned table exposed that around 74 percent of delivery attended by traditional birth attended and only 1 delivery taken place by doctor. This shows that most of the traditional birth attended are untrained and do not have mamta kit with them to facilitate delivery.

16 Table No 15 Reasons for not going to health facility S.No. Reasons Number Percentage 1 Not necessary Cost too much Too far/ no transport Poor Quality Services No time to go Family did not allow Better care at home Lack of knowledge Fear of injection Above table showing the various reasons of not going to health facility, it is reflecting that around 79 percent of the men think that it not necessary it shows towards the negligence of health. Simultaneously 35 percentages of the people have lack of knowledge on health issues. It has been revealed form Focus Group discussion held with men they accepted that they have lack of knowledge on existing health facility, ANC check ups, registration of pregnant and other issues. But they seemed to be concerned about the health of their wives as they said that they arranged vehicle and money for the crucial situation at the time of delivery.

17 Table No 16 Availability of immunization card S.No Availability Number Percentage 1 No No single family has available immunization card at their home. Probably they lost it. One way it shows that they have no importance for this as well as less concerned about the card. Table No 17 Received full immunizations S.no Particular Number Percentage 1 BCG, DPT1,2,3 OPV 1,2,3 and measles ( Complete immunization) * Complete Immunization include BCG, DPT1, 2, 3 OPV 1, 2, 3 and measles for the purpose of the study The above table shows that only 5.26 percentage of the children received complete immunization even it was included after the consultant with mother and based on their recall. And rest of the children received two or three type of immunization. The percentage of receiving immunization is very low as there are some myths exist.

18 Table No 18 ANC received during pregnancy S.no While pregnant went for ANC Number Percentage 1 Yes No Total Above table exposed that 70 percentage of pregnant did not receive ANC. As they feel that conducting delivery at home is easier rather than going to hospital. Table No 19 Place of ANC S.no Where check up Number Percentage 1 Government Hospital Private hospital and clinic PHC Parents home Husband s home Above table shows that around 89% of delivery conducted at her husband s home and around 5 percent conducted at her parents home. The tribal communities prefer to done delivery at home as they feel it is more easy for them as well as economic. Besides that this is hilly region which hamper to go for far distant place with poor transportation facility.

19 Table No 20- No of times ANC received S.no Time Number Percentage 1 1 time time time Above table shows that percentage of pregnant women received ANC only two time which was again not complete. It may because of poor infrastructure and less trained staff at sub centre and PHC level. Table No 21- Type of ANC check up received S.no. Type of check up Number Percentage 1 Weight Measurement Height Measurement Abdominal Examination Blood test Urine test Above table reveals that most of the pregnant women received ANC check up as only Abdominal Examination, most of the women did not receive complete ANC.

20 Table No 22 - Receipt of TT injection S.no Receipt of TT injection Number Percentage 1 1 time time Above table shows that percent of women have received TT two times and rest of them received only one TT injection. Table No 23- Receipt of IFA tablets S.no Receipt of IFA tablets Number Percentage Above Above table shows that around 48 percentages of women have received 100 IFA tablets and rest of them received between IFA tablets.

21 Table No 24- Consumption of IFA tablets S.no Consumption of IFA tablets Number Percentage Above table shows that only 5 percent of the women have consumed IFA tablets and women have consumed only up to 30 IFA tablets. Now it has been exposed that women who have received IFA tablets are not consuming it. Thus we have to take some steps to convince the women to take IFA as well as have to work on myths and misconception related to IFA tablets. Generally women think that IFA tablets may cause nausea, dizziness and constipation. Table No 25- RTI symptoms among men S.no Symptoms Number Percentage 1 Sores, blisters or ulcers in the penis Swollen and painful lymph glands in the groin Discharge from the urethra Itching, burning and pain during urination Pain during intercourse Above table reveals the various symptoms of RTI among men percent men have been reported itching, burning and pain during urination, 3.94 men reported about Discharge from the urethra.

22 Table No 26 - STI Prevalence S.no STI Prevalence Number Percentage 1 STI Prevalence among men Above table shows that percentage of men having Sexually Transmitted Infections, the number is quite large and it was also exposed during Male FGD that men were shy about talking on STI and RTI. Table No 27 Treatment sought for RTI among men S.no Particular Number Percentage 1 Number sought treatment for RTI Mentioned table shows that only 25 percent of men went for the treatment of RTI. Rests have not gone probably they are unaware about the consequences as well as shy.

23 Table No 28 RTI symptoms among women S.no Symptoms Number Percentage 1 Foul smell,unusal vaginal discharge 2 Pain during inter course in lower abdomen 3 Genital sores or blisters or without Pain or burning during urination Painful or itchy genital region Swollen and painful lymph glands in the groin Above tables shows the various symptoms of RTI among women women have reported pain during intercourse and also lower abdomen pain. Table No 29 - Treatment sought for RTI among women S.no Particular Number Percentage 1 Number sought treatment for RTI Mentioned table shows that only percent of women went for the treatment of RTI. Rests have not gone probably they are unaware about the consequences as well as shy.

24 Suggestion 1. There is clear need to promote institutional delivery and we should collaborate with Government Janani Surksha Yojna scheme. 2. People do not have correct knowledge of contraceptive, thus it lead to myths and misconception and most of the couple do not know about the correct use, proper information of modern method. 3. Although government Programs and NGO programs are there in the villages but all the awareness programs should be clearer and focused and more need based as well as per the special context of tribal. 4. We should be give focus on counseling, care and interpersonal communication with the women and her male counter part on reproductive health issues. 5. More focus should be given to male participation and family support at different level. Limitations of the Base line Survey 1. When investigator asked about the immunization of the children all the families have not card in their hand they lost it, damage it or rear it. We have to enter the data as per mother s recall which may not be accurate. 2. About the question of Reproductive Tract Infection and Sexually Transmitted infections, men and women were shy and less talked about the symptoms and for the treatment.