Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

Abstract

BackgroundOver the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health system. The result has been a definite but unequal increase in the proportion of institutional deliveries, across geographical areas and social groups. Tribal (indigenous) communities are one such group in which the proportion of institutional deliveries is low. The persistence of these inequities indicates that a different approach is required to address the maternal health challenges in these communities.MethodsThis paper describes an exploratory study in Rayagada District of Odisha which aimed to understand tribal women’s experiences with pregnancy and childbirth and their interactions with the formal health system. Methods included in-depth interviews with women, traditional healers and formal health care providers and outreach workers, observations in the community and health facilities.ResultsThe exploration of traditional practices shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring external intervention. There is a well-established practice of birthing in the community which also recognizes the need for health system interventions in case of high-risk births or complications. However, there has been no effort by the health system to build on this traditional understanding of safety of woman and child. Instead, the system continues to rely on incentives and disincentives to motivate women. Traditional health providers who are important stakeholders have not been integrated into the health system. Despite the immense difficulties that women face, however, they do access health facilities, but barriers of distance, language, cultural inappropriateness of services, and experiences of gross violations have further compounded their distrust.ConclusionsThe results of the study suggest a re-examining of the very approach to addressing maternal health in this community. The study calls for reorienting maternal health services, to be responsive to the requirements of tribal women, cater to their cultural needs, provide support to domiciliary deliveries, invest in building trust with the community, and preserve beneficial traditional practices.

Factors Affecting the Utilization of Maternal and Child Health Care Services in Tribal Dominated Population States of India

“…6,7 The complex phenomena of utilisation of maternal and child health services affected by many factors, studies are established the association between various factors and utilization patterns with one or more factors. 8 Inadequate access and under-utilization of modern healthcare services are reported to be major reasons for poor health in the tribal dominated states. 9,10 Several studies have examined factors affecting utilization of maternal health services.…”

Utilization of delivery and postnatal health services by indigenous women of a hilly, remote district in India: a struggle for safe motherhood

“…14 The percentage of institutional deliveries was high, which was in contrast to previous studies in tribal areas. 15 This could probably be due to high literacy, support from family, and high number of spontaneous abortions and still births in the area. Few respondents preferred home deliveries due to adverse outcomes of previous institutional deliveries, rude attitude of staff in Lahaul and financial constraints to access services outside their district.…”

“Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?

“…Indigenous health traditions typically understand health in a holistic manner and include respect for land, kinship structures as well as connect with ancestors as important aspects of healing and wellbeing [41,42]. The provision of culturally safe care which both respects and reflects these values is an important facilitator of better healthcare access, that will ultimately lead to improved health outcomes for Indigenous communities [43][44][45]. The lack of efforts to integrate traditional beliefs around healing, death and connection to ancestors into the health system's approach to providing services, led to passive resistance from the communities.…”