Trendsetter of Tunpar
By Patralekha Chatterjee
Koraput, Orissa: Sadamani Majhi is an unlikely trendsetter. But this shy, 22 year-old tribal woman from Tunpar village in Koraput district of Orissa has sparked a trend by delivering her first child in March this year at a primary health centre. No tribal woman in Tunpar had stepped out of her home to give birth to a baby ever before.
Sadamani is illiterate. Her husband, a labourer, has also never attended school. On the face of it, the couple are like any other in this village of 900 odd people. But with Sadamani taking the lead, many expecting mothers in Tunpar now want an institutional delivery.
The immediate incentive for the spurt in demand for institutional deliveries in this remote, tribal backwater in one of the poorest states in the country is no doubt the Janani Suraksha Yojana (JSY), (safe motherhood plan) a central government sponsored scheme under the National Rural Health Mission. The JSY offers financial aid to mothers from poor families for delivery expenses in government health facilities.
In Tunpar, a local primary school teacher – one of the few with a telephone connection in his community -- and the newly recruited ASHA (accredited social health activist) – the village-based health worker, convinced the family that they should take Sadamani to the newly upgraded PHC, some 25 kms away from the village, and arranged for a jeep to transport the expecting mother.
But if government incentives and schemes are now better received among the tribal communities in Tunpar, one factor is the initiation of MAPEDIR in the tribal-dominated district of Koraput in 2006.
This initiative is part of the UNICEF Maternal Mortality Advocacy Project funded by United Kingdom’s Department for International Development (DFID).
In this very village in May last year, a woman died while giving birth to a child. The family, desperately poor, had accepted the death with a mixture of resignation and fatalism. But the death inquiry got people talking. In recent months, awareness has been growing about the risks of home deliveries and the danger signs that signal a ‘high risk’ mother. Villagers say they also realize that delays in referring a pregnant woman with obstetric complications to a hospital could be fatal.
“Ninety percent of women in this village and in neighbouring villages deliver their babies at home. Most girls are married off between 14 and 16 despite legal restrictions. There are many underage mothers. Most women have 5 to 6 children. But some women now say they want to go to the hospital,” says Dubali Nandibadi, a woman member of the local village panchayat.
These are early days. But MAPEDIR may have just triggered a mini-revolution among the tribal families of Tunpar. “There have been 5 institutional deliveries after the death inquiry in the village last year,” says Kabita Mohanty.
The flickers of change in a tribal community in Koraput are not the stuff of headline-grabbing news. But their significance can be understood if seen in the context of a few figures: Koraput district reported the lowest percentage (19.98) of literacy among tribes during 2001, when the last census was taken in the country.
Many of the tribes in villages like Tunpar still believe in deities, spirits, ghosts and black magic. Koraput is also one among the 8 districts in Orissa implementing the government’s Navajyoti scheme to tackle neonatal mortality.
“One of the main reasons for maternal deaths here is the lack of transport. Bringing an expecting mother from a remote village to a health facility poses logistical challenges. The villages are scattered. In the tribal pockets, many women die of post partum haemorrage because they are severely anemic. On top of that, they deliver at home with the help of untrained attendants.” says Indira Panda, a lady health visitor (LHV) working at the upgraded primary health centre (PHC) at Laxmipur block where Sadamani delivered her first child.
In 2003-2004, the PHC at Laxmipur which was recently upgraded reported 60 institutional deliveries. In 2005-2006, that figure shot up to 221. Much of the change is due to the monthly meetings being held at gram panchayats (village council). During such meetings, awareness about Janani Suraksha Yojana is spread to motivate health and child development workers to make the community more aware of the reasons behind maternal and infant deaths.
MAPEDIR is also helping tone up the district health system. Panda says her understanding of maternal deaths in her area has increased appreciably after the training and after investigating a few maternal deaths. “Now, I know that delays can be at three levels - the delay in decision making at the family-level stemming from lack of awareness about danger signs, the delay in transport from home to facility and in referral transport from facility to facility, and delay in receiving medical care after reaching a health facility,” she says.
Following the launch of MAPEDIR, ASHAs, the local village level link workers, have been directed to arrange for referral transport at the first stage of labour pain in a woman. This, Panda hopes, will save many lives.