Santhali women caught between birth and death

In Santhali villages in Godda, along Jharkhand’s border with Bihar, many slanting stone megaliths that mark the community graves are those of young women who died in childbirth in recent years. Tribal families in the hamlets scattered in Sundarpahari and Poreyhat – many of whom speak only Santahli – recount desperate struggles for medical help when young women in their families in advanced stages of pregnancy experienced complications.

Gopin Soren and Dhetmay Murmu whose only daughter 19 year old   Sadbeeti Soren died during her first pregnancy last year in Paharpur village Sundarpahari block in Godda district Phot Anumeha ayadav

At Paharpur village in Sundarpahari, Gopin Soren spoke haltingly as rain fell over the hut where his 19-year old daughter Sadbeeti, pregnant for the first time, died last year. “On Thursday we went to my son in law’s home in Borhwa, everything was fine. The next morning my wife and I got a message that my daughter had fainted. We reached and called a local medical practitioner. He tried to give her a saline drip but he just could not find her vein,” he recounted. At 5 pm he, Sadbeeti’s husband, and two relatives carried Sadbeeti six km on a cot to Paharpur.

Back in their village Gopin asked the village sahiya (health worker) Phool Marandi for help to reach the health sub-center at Sundarpahari 20 km away. The sahiya called the call-center to request a Mamta Vahan – a free of cost ambulance service for rural women through privately-owned vehicles started in Jharkhand in 2011. By now Sadbeeti was having convulsions, a condition called eclampsia. “I decided to call the vehicle owner Pintu directly. I called him thrice between 7 and 9 pm. He said he is out right now. I understood that he does not want to come. The villagers had attacked a person caught stealing the electricity transformer in the village a day earlier. Maybe he feared that there will be more violence,” she said. At 2 am, Sadbeeti died eight months and two weeks pregnant.

matal-marandi-and-denmay-murmu-whose-daughter-talbiti-marandi-a-graduate-from-mahila-college-godda-died-last-year-after-giving-birth-for-the-first-time-in-ghangrabandh-village-in-poreyha.jpg
Twenty km away in Ghanghrabandh village in Poreyhat, Denmey Murmu described she had watched her only daughter Talabiti Marandi, 22, die after giving birth. “Eight hours after she gave birth she started clenching her fists and she said she had a burning sensation. Sarojini the sahiya refused to call a vehicle so we hired a private vehicle for Rs 1,300 after mortgaging my jewellery for Rs 2,000,” she said. On January 19, Talabiti Marandi a graduate from Mahila College, Godda died on her way to Godda government hospital.

Most Santhali and Pahariya families here survive on a diet of rice and potatoes. Pregnant women are meant to get Iron and Folic Acid (IFA) supplements tablets – each costs 20 paise – after their second trimester but Jharkhand government stopped distributing these for two years after the central government discontinued providing the tablets between 2010-12.

“Many women have severe iron deficiencies and are at high risk because after the delivery their blood does not clot, the uterus does not contract and the woman may die of post-partum bleeding. Government has schemes to provide four ante-natal check-ups so complications can be prevented. For instance, eclampsia is common among women in later stages of pregnancy and manifests as high blood pressure. If doctors detect this early, they can put the woman on hypertension medicine till the foetus is removed through a caesarean section,” said Lindsay Barnes of Jan Chetna Manch who has worked among rural women in Bokaro villages since 1993.

Godda hospital that caters to the district’s population of 13 lakh has 40 beds and two ambulances. It started providing facilities for a caesarean section only last year. It was supposed to get a blood bank in 2000 but the space marked for this is being used as National Polio Surveillance Project office and doctors’ restrooms. In case of complications, patients are referred to the government medical college in Bhagalpur in Bihar, 70 km away. Godda should have a Mamta Vahan in each of its 201 panchayats but only 111 vehicles have been hired right now as officials say they could not find vehicle owners in all panchayats.

Earlier, a government enquiry was done in 2011 after 25-year old Mary Hasda in Tetaria village had reported that staff at the district hospital left a cloth inside her birth canal after she delivered a stillborn baby. She had reported that the hospital staff asked for Rs 500 bribe after she gave birth to the stillborn baby.

“The enquiry team interrogated the family – which spoke only Santhali – as if they had done a crime,” said Soumik Banerjee, a researcher who documented 23 maternal deaths of women 18-23 years of age in the two blocks between April 2011 and March 2012 – an average of nearly two deaths a month.

The full report was published in The Hindu on September 7.
A week later, taking suo moto cognizance, National Human Right Commission asked Jharkhand government to respond in four weeks. Jharkhand government is yet to respond.

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When public health schemes turn anaemic

Since 2010 when the central government discontinued the supply of medical kits containing Iron Folic Acid, vitamin A, zinc tablets and Oral Rehydration Solution packets under National Rural Health Mission (NRHM) to states, village anganwadis and health centers have turned anaemic pregnant women and adoloscent girls away.

These are essential for reducing anaemia and birth defects which affect 69.5 percent women and girls between 15 and 49 and over 70 percent of all children below five in Jharkhand – the highest levels of anaemia according to National Family Health Survey 2 and 3 done in 1999 and 2006.

“There are eight pregnant women and several adolescent girls in the village but we do not have any stocks of tablets,” says Rukmini Devi, the anganwadi sevika in Bhandara. Photo by Manob Chowdhury

“There are eight pregnant women and several adolescent girls in the village but we do not have any stocks of tablets,” says Rukmini Devi, the anganwadi sevika in Bhandara. Photo by Manob Chowdhury

Over six lakhs, or nearly 12 percent, of children below six years of age in Jharkhand suffer from severe malnutrition. Children born underweight due to anaemia among women is a significant factor. Under a central scheme, 100 IFA tablets are to be given all pregnant women and weekly IFA supplements are to be provided to all adolescent girls between 16 and 19 years of age. Recently, adolescent boys have also been included in the scheme.

“District civil surgeons were asked to procure this but some bought expensive non-generic IFA tablets and exhausted funds. A month back the tender process was completed and now those will soon be supplied to all districts,” said Dr Praveen Chandra, Director NRHM in Ranchi. In 2011, former health minister Bhanu Pratap Shahi, former health secretary Pradeep Kumar and other department officers were named as accused in a Rs 130-crore NRHM scam related to purchase of medicines. The CBI is now investigating the case.

The state Social Welfare, Women and Child Development (SWWCD) website shows a budget of Rs 2.53 crores for purchase of “medicine kits” but officials in Ranchi say this meant only for purchase of first-aid. The department launched the Rs 70 crores Jeevan Asha program last month with focus on reducing malnutrition but this too does not have a component especially for IFA tablets.

At Khunti

More than two years after she gave birth to her youngest daughter, Shanti Oraon, an adivasi farmer in Bhandara village in Khunti district has been unable to resume working in the fields. “She has breathing trouble, and could not start walking even after she turned two and a half years old. I must stay at home with her all the time,” she says of her infant daughter lying wrapped in a bedsheet on the floor. Across the road from Shanti Oraon’s house, Pooja Devi watches her one-year-old play with a plastic bangle in her mouth. “She weighed less than three kgs when she was born. She falls ill often even now,” she says.

Bhandara lies a little over 30 kms from Ranchi, the state capital, and is on the outskirts of Khunti’s district center and market. Despite good connectivity with roads and easy accessibility, Bhandara and the adjoining villages Belahatu and Chikor have not received supplies of IFA since 2009.

Shanti Oraon recounts that during her four pregnancies she received IFA tablets, each costs less than 20 paise, only before the birth of her second child more than four years ago but none before the birth of three of her children. “There are eight pregnant women and several adolescent girls in the village but we do not have any stocks of tablets to give them,” said Rukmini Devi, the anganwadi sevika in Bhandara as she prepared a meal of rice and soyabean nuggets for the seven children below six years of age who turned up for lunch that afternoon from among the 89 enrolled as per the anganwadi charts.

“Over 3/4thd of girls between 15 and 19 are not in schools so there must be focus on how to reach them. In our surveys we have found that even when pregnant women get IFA tablets there are beliefs that these tablets can make your child darker – because the iron tablets can make the stool darker. Encouraging women to take tablets will require regular counseling,” said Job Zachariah, Head UNICEF Jharkhand.

Read the full story in The Hindu here.

In Jharkhand, entire hamlets wait for ration cards

Bhojan Adhikaar Yatra, a campaign demanding a comprehensive food security Bill, reached Jamshedpur on Tuesday after traveling through Bihar, Chhattisgarh and West Bengal.

In 2009, the Jharkhand Government reduced the price of rice to Re.1/kg and entitled families with Antyodaya cards to get rice for free. But the distribution of Below Poverty Line (BPL) cards continues to be based on a survey by the Bihar Government 15 years ago, and many poor families are still excluded from PDS. The Government did a fresh survey last year, but the date for issuing fresh ration cards based on this survey had been shifted thrice this year.

In districts adjoining Ranchi, including East Singhbhum and Lohardaga, which are among 35 districts most affected by Left Wing Extremism and have been identified by the Central Government for “focused development,” a majority of villagers still don’t have ration cards.

“Even one family doesn’t have a ration card. They did a survey in our village last year, but none of us got a ration card,” said Kanhu Hembrom, Gram Pradhan of Musabani, a hamlet of 70 households adjoining the CRPF Battalion 193 camp at Ghatshila in East Singhbhum. At Kekrang village in Lohardaga district, parts of which lie in the hills and are accessible only on foot, only 20 out of 110 households have a ration card. Nagesiya says he migrated to work in a brick kiln in Tripura for one year, but returned when he earned only Rs. 6,000 after working for eight months. In a 2011 survey — done by economist Reetika Khera, who supports the RTF campaign and teaches at the Department of Humanities & Social Sciences of IIT-Delhi — in the districts of Dumka and undivided Ranchi, only 25 per cent of households surveyed said they were getting their full PDS entitlement. More than a quarter of the households reported that one family member missed meals in the previous three months, and 12 per cent said that they hadn’t consumed daal even once the previous week.

Read the full report here.

Sterile ban

Primitive Tribal Groups (PTGs) living in Chattisgarh, India, struggle to provide for their families and are forced to lie about their identity to overcome the sterilisation restriction owing to a three decade old order of the Madhya Pradesh government that restricted PTGs from being targeted during the sterilisation drives of the time.

Sarguja: A three decade-old Madhya Pradesh government order has several adivasi families in Chattisgarh in a quandary. They struggle to provide for themselves but are turned away by government officials if they try to restrict their family size.

“I do not want more children but the ‘mitanin’ (village health worker) says she cannot take me or anyone from my community to the clinic for an operation,” says Phool Sundari Pahari Korva from Jhamjhor village, located in the forests of Sarguja district in north Chhattisgarh. She has five children – her oldest is 18 and the youngest, a daughter, is six months. All of Sundari’s four younger children have frail limbs and bellies swollen by malnutrition; the skin on her younger son’s chest has peeled off due to an infection.

The reason that Phool Sundari, a Pahari Korva adivasi, was denied sterilisation at a local government clinic: A 1970s order of the Madhya Pradesh (MP) government that restricted Pahari, or Hill, Korvas and four other Primitive Tribal Groups (PTGs) living in Chattisgarh from being targeted during the sterilisation drives of the time.

The original intent was to protect the PTGs, a term recently amended to Particularly Vulnerable Tribal Groups, from ‘extinction’. The PTGs were adivasi groups dependent on pre-agricultural technologies that had stagnant or declining populations. But 30 years on, the Chhattisgarh government has continued to enforce this anachronistic order adding to the economic burden of these families.

Sabutri Bai, Sundari’s neighbour, recounts that she got sterilisation done after giving birth to her sixth child three years back but was surprised at what followed. “When the staff at the Lakhanpur clinic found out I am a Pahari Korva, they were going to dismiss the nurse who allowed me to get operated,” she says. “It makes no sense. We have 1.5 acres land. How do they expect us to provide for more and more children?” asks her husband, Phool Chand Ram, who used to work under the rural employment guarantee act, MNREGA, two years back but gave it up when he got wages only a year later. Their eight-member family survives by selling firewood, earning Rs 100 (US$1=Rs 55) for every two-day trip they make into the depleting forest.

Over 50 kilometres away, in the villages of Batauli block, the situation is similar. Pahari Korvas struggle to provide for their families and are forced to lie about their identity to overcome the sterilisation restriction. “I stopped producing nursing milk after I gave birth to my fourth child. I could only give my babies rice-water. When I wanted to get the operation done, the malaria link worker (a government health worker) said I should give my caste as Majhwar or else the Shantipada hospital would not do it,” says Mangli Bai Korva of Govindpur village.

The original order, passed on December 13, 1979, identifies PTGs, including Pahari Korvas, Baigas, Abujhmaria, Birhor and Kamar tribes, in 26 blocks in MP to be excluded from sterilisation but allows them access to contraceptives. “You have been given district-wise targets for sterilisation. An exception should be made for tribal communities whose population is stagnant or decreasing… they should have access to other contraceptives if they require. …Everyone except these communities will be encouraged to get sterilised…,” reads the two-page order.

Adivasi families in Sarguja, however, say they have never heard of temporary or permanent contraceptive methods such as birth control pills, condoms, or the copper-T, an intrauterine device. Further, while the order permits PTG families to go in for sterilisations after procuring a certificate from the Block Development Officer, neither health workers nor tribals are aware of this provision and most have no direct access to block officials.

A discussion among Pahari Korvas in Batauli, on whether or not the government should allow the operation, generated diverse reactions. While the youngsters burst into giggles, Shri Ram Korva, who has six children, wonders loudly with faultless logic, “If the thought is to preserve our population, then that is good. But if we are forced to say we are Majhwar or Oraon at the clinic, won’t we stop being Korvas anyway?” Jhoolmati Korva, a village elder, has the final word, “If the couple wants it, they should be able to get the operation even after giving their correct name.”

Sarguja has over 4,500 Pahari Korva families. Since 1996, they have been the focus of several development schemes, which promote agriculture, animal husbandry and horticulture, executed through the Pahari Korva Development Agency. But despite good intentions and adequate resources – last year, the agency had a budget of Rs 3.72 crore – district officials admit not much has changed. “Schemes do not get implemented properly because there is little coordination among various departments. We are now trying to involve the Pahari Korva Mahapanchayat in planning the use of funds,” says R. Prasanna, the District Collector. “Maybe if the Mahapanchayat made a collective appeal, the government will reconsider the sterilisation order,” he adds.

In the three decades since the order has been in force, the PTG population has increased but their access to health and nutrition has stayed as uncertain as ever and it is this fact that is central to the debate over the restriction. National Family Health Survey-3 data shows that compared to the national average of 46 per cent of underweight children, 70 per cent children born in PTG families are underweight. Malaria and diarrhoea epidemics are frequent every monsoon. In the instance of Pahari Korvas, the Infant Mortality Rate (IMR) is 166 deaths per 1000 live births, more than double the national average, says a 2007 study by researcher Sandeep Sharma. The study also records the crude death rate as well as birth rate among these adivasis – more children are born, but many more die.

So, is the government hiding dismal malnutrition and high mortality numbers with a sterilisation ban? “Independent surveys show the government undercounts the level of malnutrition. For three years between 2007 and 2010 the state reported zero deaths from malaria and diarrhoea to the central Ministry for Health and Family Welfare,” says Sulakshana Nandi, a public health activist based in Raipur. “Block and district clinics in Raipur and Mahasamund were out of stock of contraceptives when we visited this January. PTGs are in a bind because they neither get adequate nutrition nor access to contraceptives,” she adds.

The ban has been a matter of public debate in the state since an investigation by journalists in Kawardha district last year traced how dalals (middlemen) from MP were luring Baiga tribals across the border for sterilisation for Rs 1,000, ironically as part of MP government’s continued sterilisation drives. Since then PTG communities such as Kamars in Gariaband district and the Baigas in Kawardha have organised public meetings demanding that the government remove the ban and focus instead on improving access to public services. “Baigas want to restrict their family size for their well-being, not because of Rs 200-300 that we could earn as incentive for sterilisation in clinics in MP,” asserted Bhaigla Singh Baiga, a community leader while addressing the Baiga Mahapanchayat meeting in Taregaon in May 2012.

Government officials have taken notice of these demands. “I agree that the demographic situation has changed and that informed choice should be available to everyone. It is, however, incorrect to blame high mortality on the failure of state services; ‘anganwadis’ can provide only supplementary nutrition, substantive nutrition has to come from the household,” says Kamalpreet Singh Dhillon, Director-Health Services in Raipur.

But nutritious food continues to be elusive for the Pahari Korvas living deep inside the Mainpat and Khirkhiri hills who wait for both their right to food and their freedom to decide family size.

(This story was first published by Women’s Feature Service on September 17, 2012.)

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Following the publication of this report, Planning Commission sent a directive to the Chhattisgarh government to issue clarifications to ensure that PTGs may not be denied sterilisation facilities. A follow-up report published by Alok Gupta in Down to Earth with data on PTGs population in Chhattisgarh on November 8 here.

http://www.downtoearth.org.in/content/chhattisgarh-tribals-get-sterilisation-facilities-after-30-years