Rita Mandal (34) of Bali Sahi, a hamlet under Dhepaguda panchayat of Gajapati district inhabited by Saora tribes, gave birth to five children, of which three died. Though a series of pregnancies without interval led to ill health, she felt helpless because women of her community had no choice regarding pregnancy.
Similar were the cases of Sumitra, Sebati, Sugami and most other women between 30 and 40 years of age. Pregnancies without space led to ill health of most of these women. “Due to physical weakness, it was painful for me to go to the forest to collect firewood and other forest produce or work in my family farm,” said Arati Raita (32), mother of three children.
Use of any contraceptive method to stop or delay pregnancy is against community norms of particularly vulnerable tribal groups (PVTG) like Saora and Dongria Kondh. After awareness programs, the tribal women of Odisha are now breaking this age-old practice.
Lack of awareness
The women lacked awareness on reproductive health. “They didn’t know that pregnancies without interval was the real culprit for their ill health,” Kumari Dalabehera, Dhepaguda cluster coordinator for integrated district intervention (IDI), told VillageSquare.in.
IDI is implemented in 21 PVTG village panchayats from six blocks of Gajapati and Rayagada districts by Odisha government, in partnership with the UN Population Fund.
Experts observe that barriers, including limited awareness, socio-cultural norms and misconceptions need to be addressed for behaviour change. Realising the necessity of awareness, meetings were organised for men and women, at panchayat and block levels as part of the program.
Kesharpadi is a remote village on the lower slopes of Niyamgiri Hills with a population of about 100 Dongria Kondhs. Kamche Kutruka (32), a Dongria Kondh of Kesharpadi in Rayagada’s Muniguda block, is a mother of six children.
Her responsibilities include household chores and working in dongor, the patch of land on hill slopes where crops, vegetables and millets are grown, while bringing up the children. “Though I face difficulties due to my ill health, there is no way out,” she said.
Bearing children without spacing and carrying out arduous works such as collecting forest produce led to ill health of tribal women. Photo: Basudev Mahapatra/VillageSquare
“It was not the community norm to use contraceptives to delay or avoid pregnancies. Most women of the community used to deliver six or seven children in a row,” Kamche Kutruka told VillageSquare.in. “Also, we were unaware of the contraceptive methods available.”
Strictly following the community norms, very few Dongria Kondh women take interest in availing the reproductive health services provided under different government schemes, said Jhili Behera, IDI cluster coordinator for Sibapadar panchayat.
“When the anganwadi worker and I visited the village in June 2018, women were not interested in discussing their health issues,” said Behera. However, consistent efforts for about six months started fetching results.
“I tried to make women understand the importance and necessity of pregnancy spacing to keep them healthy as they do a lot of physical labor, working all the time either at home or at the dongor (forest),” Behera told VillageSquare.in.
Behera’s first success came with Chilika Kutruka (24), mother of two, showing interest in Antara, a contraceptive injection to be taken every three months, to delay the next pregnancy. Following Chilika Kutruka, in February 2019, five more mothers of Kesharpadi opted for Antara, rolled out in Rayagada and Gajapati districts.
Oral pills are not ideal as the women may forget to take it under too much of work pressure, observed Behera. Hence, most of the women show interest in Antara. Only one woman uses the intrauterine contraceptive device (IUCD) Copper T, and another underwent sterilisation in 2018, after having eight children.
“Effective communication is important to bring social and behavioral change,” Sagarika Raika, IDI cluster coordinator for Bhubani panchayat in Gajapati district’s Gumma block, told VillageSquare.in. “Pictorial presentation is more effective.”
“Instead of simply speaking about the program and asking the tribal men and women to change their practice, I used pictures and diagrams to explain various issues arising out of uninterrupted pregnancy, and possible remedies,” she said.
The Kilkari audio jingles produced by Ministry of Health and Family Welfare and dubbed in Saora and Kui, languages, spoken by Saora and Kondh tribes respectively, were of immense help to attract members of the communities, said Sanju Dalabehera, Sagada cluster coordinator of Rayagada’s Gunupur block.
Breaking age-old traditions, tribal women like Pramila Sabara have opted to use Antara, a contraceptive injection, to delay pregnancies. Photo: Basudev Mahapatra/VillageSquare
“This was a new experience for them to listen to jingles in their own languages. People, particularly women and girls, listened to the jingles describing reasons of and remedies to various reproductive health issues,” Dalabehera told VillageSquare.in.
Such communication methods mobilised women and girls to attend meetings on village health and nutrition days. Women started discussing issues they had never discussed before.
“We told them about reproductive health, need for spacing between pregnancies, and about the methods of spacing so that they can make an informed decision of their own,” said Sabita Padhi, auxiliary midwife for Sagada and Abada panchayats of Gunupur block.
“We also educated them on use of contraceptive methods at the community health center (CHC) on family welfare days,” Himanshu Kumar Dash, superintendent medical officer at Jagannathpur CHC of Gunupur block, told VillageSquare.in.
Awareness among men
The awareness programs helped melting down of the social stigmas that ruled the community behaviour since ages. “Men showed concern for the women and allowed them to go for contraceptives, which was against established norms,” said Padhi.
“At the meetings, we came to know the reasons of our ill health. Our men also understood the problems women face due to continuous pregnancies,” said Rita. “It’s not only about giving birth to many children but also about raising them properly.”
After attending the meetings, Rita could convince her husband for sterilisation. While at least 11 women of Dhepaguda panchayat have undergone sterilisation, expectant mothers like Gayatri Mandal (20), have decided to opt for birth control after two or three children.
“Our men realised that health of women is important for the family and proper upbringing of the children,” Sumitra Sabar (35), mother of five children, told VillageSquare.in.
“Having many children is burdensome as it’s more important to raise every child properly, give each one the education she or he requires for a better future,” said Sumitra’s husband Ganapati Sabara.
Use of contraceptives
“With new contraceptive methods like Antara available, women from conservative tribal groups are now using one or the other to avoid pregnancy. They are now serious about health of their own as well as of their children, and they understand the need to bring up healthy children,” observed Shaktibrat Mohanty, chief district medical officer, Rayagada.
In addition to communication, active participation of community-level volunteers and health service providers like the accredited social health activist (ASHA), auxiliary nurse midwife (ANM) and anganwadi workers are responsible for the changes, he said. A few ASHAs and ANMs used contraceptive methods to motivate other women.
“In order to make it successful, eight ASHAs opted for Antara on the roll out day at R. Udaygiri CHC of Gajapati district. Many of these ground-level workers have chosen other methods too. They are the real ambassadors,” Rojalin Swain, IDI state project officer, told VillageSquare.in.
On post-intervention contraceptive acceptance behaviour of Saora and Dongria Kondh women, Dukhini Lima, ASHA for Putasingh under Gunupur block, said, “Young mothers with single child or two children prefer Antara for spacing the next pregnancy. Mothers with two or three children mostly go for sterilisation.”
“The changing behaviour of PVTG women certainly bears a lot of possibilities with regard to upholding their reproductive health rights and building healthy families,” Prafulla Kumar Padhi, additional district public health officer (family welfare), told VillageSquare.in.
Basudev Mahapatra is a journalist based in Bhubaneswar.