Using Three Delay Model to Understand the Social Factors Responsible for Neonatal Deaths Among Displaced Tribal Communities in India.

In the tribal region, risk of death among neonates is influenced to a great extent by factors related to the mother such as situation of the mother prior to and post pregnancy, care received before, during and after pregnancy, birth order, and care received by the child during the first few years of his/her life. There is paucity of basic epidemiological data on reproductive health outcomes of displaced people (Hynes et al. in JAMA 288(5):595-603, 2002). Therefore, this study aims to examine the social factors responsible for neonatal deaths among displaced tribal communities in India. Sequential exploratory study design was used to collect data from displaced tribal communities in the state of Odisha and Chhattisgarh during 2016-2017. A purposive sampling method was used to select the sample from the definite population. Results indicate that in total 115 (59.3%) women had experienced at least one child deaths. Analysis of neonatal deaths suggests that about 39.2% women experienced at least one or more neonatal death during the last 5 years. Women who chose to deliver at home experience higher neonatal deaths (47.1%) in comparison to the women who delivered at the health facility (26.0%). The logistic regression analysis indicate that mothers education, place of delivery, utilization of the services, possession of Below Poverty Line (BPL) card and Particularly Vulnerable Tribal Group (PVTG) status are significant predictors of neonatal mortality. The probability of occurrence of neonatal mortality is 60% lower for literate women as compared to the illiterate women. Findings of the study identified three phases of delay that affect displaced tribal women in accessing and receiving health care services. Displaced tribal women are late in recognizing health problems of neonates and delay in seeking medical care due to rooted cultural barriers. Women who participated in this study had low levels of risk perception about delivering children at home and visiting traditional healer for the treatment. This is mainly due to their personal experiences of uneventful deliveries conducted by mothers-in-law or Traditional Birth Attendants (TBA) and sociocultural beliefs. There is need for provision of culturally sensitive instruction to service providers. This would further motivate service providers to sensitize the displaced tribal communities on various free healthcare services available to them.

Reproductive health care status of the displaced tribal women in India: An analysis using Nussbaum Central human capabilities.

Scheduled Tribes (STs) of India are characterized by distinct cultures and a close relationship with the land they inhabit. Tribal people make up to 5% of the world's population but 15% of such people are living in poverty. They face deprivations caused by social, economic, and political exclusion. In India displacement due to development projects is pushing the tribals out of their habitat dispossessing them of their traditional forest resources. Women and children in displacement suffer more than the male counterpart especially in the process of moving to a new setup. The objective of the author is to study the reproductive healthcare status of displaced tribal women in India. In this paper, the author underlines the capabilities of tribal women in post displacement settings. The study was conducted in three wildlife sanctuaries in the Indian States of Odisha and Chhattisgarh namely Simlipal, Chandaka-Dampara, and Achankamar. Sequential explanatory study design was employed for collecting the data. A total of 194 displaced tribal women within the reproductive age group of 15-49 years were surveyed and Focus Group Discussion was conducted among the displaced women. Women who had given birth in the last five years were selected using a purposive sampling method. Key findings of the study suggest that women lack awareness of child spacing capabilities (57%) and the unmet need for family planning is comparatively higher. More than half of the women face domestic violence that curtails their capabilities to avail reproductive healthcare services. It also reduces the immediate wellbeing of their children. Women in this study lack control over the decision on reproductive healthcare. Due to this, women lack social and political freedom. The Government of India has taken fewer initiatives to promote effective reproductive healthcare services. Also, there is limited awareness in the rehabilitation colonies on protection from domestic violence.