1. Health, Public Policy and Human Development: A Way Forward to Address SDGs
Was achieving MDGs, a dream for the indigenous population? A Study of Tribal Dominant EAG States, India
Ambarish Kumar Rai
&
Bal Govind Chauhan
Ph.D. Scholar,
International institute for Population Sciences, Mumbai
India –
March 31, 2017

2. Introduction One of the (MDGs) of ICPD 1994: 1990 to 2015
To improve the maternal health by reducing the maternal mortality ratio by three-quarters,
To achieve universal access to maternal and child health by 2015.
In India, these goals were not entirely achieved because a lot of regional variation.
About three lakhs women died in 2013 due to maternal causes during and after pregnancy and childbirth.
about 99% of these deaths contributed by developing nations (WHO, 2014).
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3. Cont…
India took several steps to reduce such deaths and improve the health status through universal health plans since after its independence.
The National Health Policy of 1983, came into light with aimed at Health for all by 2000 through universal comprehensive primary health services
Failed due scarcity of financial resources and public health administrative capacity.
India has a highly complicated social structure with having a number of different castes and classes
Makes much difficult to achieve the universal goal of health access to all by many folds.
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4. Cont…
The tribal population groups of India are known to be the autochthonous people of the land.
The concept of ‘Tribe’ emerged in India with the coming of the British. The concept of reservation emerged and through that emerged the idea of scheduled tribe in independent India.
In India, 427 groups have been recognised as scheduled tribes. They form approximately 8.6 per cent of the total Indian population.
These tribal groups inhabit widely varying ecological and geo-climatic conditions (hilly, forest, desert, etc.) in different concentration throughout the country with different cultural and socioeconomic backgrounds.
Due to their remote and isolated living, tribal groups are difficult to reach.
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5. Cont…
These communities are understood indigenous population and not considered as the part of main social streams.
Inhabit the lowest rank in the societal hierarchy and mostly engage in primary activities or agricultural labourers with minuscule land holdings.
In the patriarchal society, where being a woman itself a major factor to have the second level of the citizen by social norms regarding the rights in the family, the taboo of poor social group plays a much vital role to make a double fold burden to access such basic rights.
Schedule communities contribute about 50% of all maternal deaths in the country.
One of the important factors that affect negatively the health situation prevailing in STs is poor utilisation of healthcare services. The same is true about the utilisation of maternal health care services.
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6. Need for the Study
In India, the EAG States are one of the most backwards regions and recognises the need of addressing health inequity existing in the region.
The region has a significant proportion of the tribal population and prominent disparities among all these social groups.
Regarding MM Ratio, the position is so poor in the EAG states, especially in tribal dominance states like Odisha (222) and Madhya Pradesh (221) while the average for India was 167 in the period
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7. Cont…
The coverage of both antenatal care and institutional delivery is worse in tribal communities compared with the rest of the population
The women and child from the tribal groups are more sufferers due to not having their basic needs like food, house and health care requirements.
So there is a need to understand the level of accessibility and improvement in maternal health care services utilization and important factors that influencing the services utilization among all the social groups in the region.
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8. Objective
To examine the trend and pattern of maternal health care utilisation in tribal dominance states of EAG states.
To identify and quantify the factors associated with inter-group differences in mean level of outcome between tribal and non-tribal in use of maternal health care services
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9. Methods & Materials Data Methods
Study has used the second and third round of District Level Households and Facility Surveys.
Methods
Bi-variate Analysis: used to find the prevalence of maternal health care services utilization
Multivariate Regression Model: used to predict the odds ratio and to understand the prime determinates of maternal care services utilization
Fairlie-Decomposition Model: to decompose the gap between tribal and non-tribal in use of maternal health care services.
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10. Selection of Study Region
The study is based on one of the socioeconomically backwards areas of the India called Empowered Action Group (EAG) states, having total eight states.
Among these, four states Chhattisgarh, Jharkhand, Odisha and Madhya Pradesh have more than 20% of its population is STs population.
So these states only selected for the study as tribal dominance state.
These selected states were considered as a homogeneous region for STs Population since these all are adjoined to each other.
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11. Outcome variables
Full ANC: Full Antenatal Care (Full ANC) has been defines as at least three antenatal care visits, consumed 99+ Iron Folic Acid (IFC) tablets and took at least one tetanus-toxoid injections during pregnancy.
Safe Delivery: It defined as either institutional delivery or home delivery assisted by doctor, auxiliary nurse midwife, nurse, midwife, lady health visitor or any other health personnel.
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12. Results 1: Utilization of Full ANC services in Non-Tribal and Tribal in Study Region, DLHS- 2 & 3
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13. Utilization of Full ANC services in Non-Tribal and Tribal in Study Region, DLHS- 2 & 3
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14. Logistic Regression (Odds Ratio , CI of 95%) Determinants of ANC, DLHS-3
Background Variables
Non-Tribal Full ANC
Tribal Full ANC
Exp(B)
95% C.I.
Lower
Upper
States
Jharkhand®
Odessa
1.991***
1.758
2.255
2.086***
1.562
2.787
Chhattisgarh
1.168**
1.008
1.353
1.347**
1.037
1.750
Madhya Pradesh
0.671***
0.593
0.758
0.610***
0.451
0.824
Place of Residence
Rural®
Urban
1.333***
1.205
1.475
1.410**
1.003
1.983
Mother Age
<20 Year®
20-29
1.252***
1.081
1.449
1.181
0.851
1.639
30 Years and above
1.443***
1.183
1.760
1.481*
0.954
2.301
Birth Order 1®
2-3
0.835***
0.762
0.915
0.877
0.703
1.094
4 and above
0.566***
0.475
0.676
0.581***
0.399
0.847
Wealth Index
Poor®
Middle
1.291***
1.133
1.470
1.495***
1.147
1.950
Rich
1.696***
1.497
1.921
2.000***
1.458
2.743
Mother's Education
<5 Year®
5-9 Year
1.092
0.937
1.272
0.997
0.755
1.317
10 or more year
2.026***
1.704
2.409
2.014***
1.388
2.923
Husband Education
5-10 Year
1.255**
1.019
1.545
0.700
1.421
10 and more Years
1.561***
1.258
1.936
1.286
0.873
1.896
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15. Non-Tribal Safe Delivery
Logistic Regression (Odds Ratio , CI of 95%) Determinants of Safe Delivery, DLHS-3
Background Variables
Non-Tribal Safe Delivery
Tribal Safe Delivery
Exp(B)
95% C.I.
Lower
Upper
States
Jharkhand®
Odessa
2.491***
2.214
2.802
3.265***
2.546
4.186
Chhattisgarh
0.861**
0.756
0.979
1.350***
1.083
1.683
Madhya Pradesh
2.019***
1.820
2.241
2.639***
2.130
3.270
Place of Residence
Rural®
Urban
2.123***
1.911
2.358
2.645***
1.912
3.660
Mother Age
<20 Years®
20-29 years
0.982
0.869
1.108
1.166
0.920
1.477
30 Years and above
1.188*
0.995
1.419
1.361*
0.956
1.938
Birth Order 1®
2-3
0.503***
0.461
0.548
0.516***
0.433
0.615
4 and above
0.352***
0.307
0.403
0.338***
0.252
0.453
Wealth Index
Poor®
Middle
1.335***
1.209
1.475
1.267**
1.028
1.561
Rich
2.143***
1.934
2.375
2.518***
3.317
Mother's Education
<5 Years®
5-9 Years
1.233***
1.103
1.379
1.119
0.911
1.374
10 Years or more
2.450***
2.112
2.844
1.744***
1.280
Husband Education
5-10 Years
1.013
0.871
1.178
1.264*
0.967
1.653
10 Years and more
1.246***
1.060
1.465
1.731***
1.284
2.333
Received full ANC
No®
Yes
2.169***
1.948
2.416
1.920***
1.547
2.383
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16. Fairlie Decomposition Analysis Results: the mean differences in the use of maternal healthcare services among Non-STs & STs in study region, DLHS-3
Full ANC
Safe Delivery
Mean prediction among STs
0.150
0.359
Mean prediction among non-Tribes
0.215
0.628
Raw Differential
0.065
0.269
Total explained
0.051
0.136
Explained
64.8
74.7
Unexplained
35.2
25.3
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17. Determinants variables of Full ANC care utilizations in Tribal Dominance EAG States
In case of visit for Full ANC, Non-tribal communities, Dwelling States, Women’s age, education of both partners, place of residence and Wealth Status of HHs were very significant determinant and were more likely to use Full ANC to their reference category. While higher birth order also shown significant for Full ANC care but higher the birth order were less likely to visit for ANC.
Except Husband’s Education, Similar trends have been seen for Schedule Tribe womens.
In case of Safe Delivery, in Tribals, Dwelling States, education of both partners, place of residence, Wealth Status of HHs and Who visited for Full ANC were highly significant determinant and were more likely to use Full ANC to their reference category. While higher birth order also shown significant for Full ANC care but higher the birth order were less likely to go for Safe Delivery.
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18. Cont…
Fairlie decomposition analysis shown that after controlling other factors, the coverage of all two services is lower among STs than among the remaining population.
For instance, the probability of full antenatal care is among STs compared with among non-tribal.
Similarly, the probability of safe delivery is and among women of Tribes and the non-tribal, respectively.
More than 56% of such differences of ANC and about 75% of difference in safe delivery are explained by the factors included in the analysis.
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19. Cont…
Among the explained gap, about 65-75% of the gap is explained by the differences in the distribution of only some selected predictors such as household wealth, woman and her husband’s education.
Household wealth is the main contributor explaining 33% for full antenatal care to 62% for safe delivery of the gap in between STs and the non-tribal mothers.
Importantly, antenatal care visit has a greater contribution in explaining the gap in Safe Delivery as 16% between women of tribal and non-tribal.
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20. Conclusion
The study shown that Social groups was a very important determinant to access the basic needs of maternal health care services.
The women who belongs to the Indigenous social communities like STs were poor user of public health facilities because of their poor educational and economic status.
Overall, they are at more disadvantageous position only due to their social and cultural traditions which was comparatively more difficult to penetrate for any interventions.
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21. Policy implications
It is strongly required to educate and making aware more to the STs social group, especially the women for knowing their basic right regarding to access the Maternal Health care facility.
There is a need to make tribal people economic independent.
So to enhance the status of such tribal women, the equity approach is required with governmental and non-governmental efforts with actively participation of the women.
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22. Thank You..!
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