Health status of Tribal Women of Mayurbhanj, Odisha: A Case study

Abstract

The present study is on the health status of tribal women of Mayurbhanj. It covers a sample of 130 tribal females of Bhumij, Bathudi and Sabara communities of Shamakhunta block of Mayurbhanj District of Odisha. The paper attempts to analyse various demographic indicators such as sex ratio, age at marriage, age at menarche, age at menopause, fertility and mortality differentials and their health consequences. The results indicate that these communities have better sex ratio compared to state and national averages, the women attain menopause at a later age while having early menarche. It is found that the introduction of NRHM has slightly improved the heath care infrastructure and delivery of health services but still it needs special health care strategies to reduce health disparities among tribal women of this region.

Keywords: Health, sex ratio, age at marriage, menarche, menopause, fertility and mortality.

1 Introduction

The tribal population in India is 8.6 percent of the total population of the country (Census of India, 2011). Maharashtra, Odisha, Gujarat, Rajasthan, Chhattisgarh, Jharkhand, Andhra Pradesh, Karnataka, West Bengal and Madhya Pradesh are the states, which have larger number of Scheduled tribes. These states account for 83.2% of the total Scheduled tribe population of the country (Census of India, 2001). Tribal groups are homogenous, culturally robust, have developed strong magico-religious belief system, and they wish to survive and live in their own style. Like other social groups, the tribal women face problems related to reproductive health. The W.H.O has defined health as “a state of complete physical, mental and social well being and not merely the absence disease or infirmity’’ (WHO 1948). Tribal mothers have high incidence of anemia, and girl child gets less than the required nutritional intake (Maiti, Unisa and Agrawal, 2005). There is a need for proper understanding of the different health aspects of tribal women and their specific health needs so that relevant health measures can be prepared and implemented. This study investigates the health status among the tribal women of Bhumij, Bathudi and Sabara community of Mayurbhanj, Odisha. The district Mayurbhanj occupies a unique position being endowed with lush green vegetation, different fauna and rich cultural heritage. The district has a rich mineral base and is home to the Similipal Biosphere. Mayurbhanj District extended from 21⁰ 16 ^’ North to 22⁰ 34^’ North Latitude and 85⁰ 40’East to 87⁰ 11^’East Longitude The Administrative Headquarters of Mayurbhanj is located at Baripada. As per 2011 Census, the total population of the district is 2519738, and the ST population is 56.6% of the total district population. The sex ratio is 936. Literacy rate is 63.17%, 73.76% among the male and 52.71% among the female (Odisha Development Report, 2004).The health index for Mayurbhanj is 0.782, higher than that of the state, which is 0.468. The infant mortality rate of Mayurbhanj is 55, which is slightly higher than the state average of 54. Mayurbhanj having maximum tribal concentration is taken for the reference for comparison, as it is one of the most important Scheduled Districts of Odisha. A majority of its geographical area is inhabited by about 53 types of tribes. Major tribes found in Mayurbhanj include, Santals, Kolha, Bhuyan, Bathudi, Gond etc. Baripada the Sadar subdivision consists of nine Community Development Blocks inhabited by Munda , Lodha, Ho, Santal and sizeable non tribal population. Among the Scheduled area districts, the status of Mayurbhanj with respect to certain Socio-demographic indicators is much better in comparison. The female literacy in Mayurbhanj is 24.79, which is much above the newly formed Koraput (7.32%), Nawarangpur (2.7%), Malkangiri (3%), Raygada (7.69%), Gajapati (12.66%) (Acharya and Das, 2012). In Mayurbhanj, 40.7% of currently married women are found to have married before 18 years of age (Annual Health Survey (AHS), 2010-11).

The average age at menarche among girls ranges from 10-16 years (Shah, 1958). Mean age at menarche is 15.2 in Odisha (ICMR Bulletin, 2003). In Mayurbhanj, the mean age at menarche is 13.11 years. The mean age at menopause of most populations for which measurements exist falls between ages 40 and 50, but the age at menopause of individual women ranges from less than 40 to near 60. Regional level studies in the Indian subcontinent show that around one fifth of Indian women reach menopause beyond 49 years of age (Adhi et al., 2007; Mahajan et al., 2012). Age at menopause among Bengali Hindu Women of West Bengal is 44.87 years (Dasgupta, Pal and Ray, 2015). In the studied population the mean age at menopause is observed to be 43.58 years. However, in India some measures of women’s health have shown improvement since the introduction of the NRHM in 2005 (Nair and Panda, 2011). Yet India is far behind most of the emerging economies. It seeks to integrate health with the determinants of health for which inter-sectoral convergence between departments like Panchayati Raj Institutions (PRI), Women and Child Development (WCD), Rural Water Supply and Sanitation (RWSS) and Education is made essential. The main components of NRHM are RCH II, Immunization, National Disease Control Programme, Janani Surksa Yojana, Rogi Kalyan Samiti and other initiatives. But the health policies so far adopted are yet to bring satisfactory results (Padhi and Mishra, 2000). In the present study an attempt is made to undertake a comprehensive health related study among Bhumij, Sabara and Bathudi communities of Mayurbhanj district of Odisha. This study throws some light upon four reproductive variables i.e. age at marriage, age at menarche, first conception and menopause in the life of these tribal women. Needless to say, fertility and mortality are the essential factors in maternal health problem.

2 Methodology

The present study is based on both primary and secondary sources of data collection. Primary data was collected using anthropological fieldwork technique during three months from March 2014 to May 2014. Data gathered through scheduled questionnaire, interviews, case studies and focus group discussions were analysed using SPSS (16.0) and were compared with secondary data. An attempt was made to collect data from ever-married women of Bhumij, Bathudi and Sabara community of all three villages of Shamakhunta block of Mayurbhanj District. A sample of 130 households was collected using household census form consisting questions on household census, name, age, sex, income, education, occupation etc. A schedules questionnaire was used to collect information on reproductive profile including age at menarche, marriage, menopause, fertility, mortality etc.

3 Results and Discussion

Table 3.1 Total population of Bhumij, Bathudi and Sabara communityin Mayurbhanj district

From the above table it reveals that in the district of Mayurbahaj the sex ratio as per Census data of all the three tribal communities Sabar, Bhumij and Bathudi are respectively 1009.4, 987 and 1004.6, better than the State and National averages.

Table 3.2 Age and Sex wise distribution of Bhumij Population in Balidiha, Shamakhunta Block, Mayurbhanj District, Odisha.

Figure 3.1 Population pyramid of Bhumij of Samakhunta Block, Mayurbhanj, Odisha

From the table and figure above the demographic parameter of Bhumij of Balidiha Panchayat in Odisha suggests that the population pyramid, which shows a building base and tapering top represents high mortality and low life expectancy with a better sex ratio i.e. 1058 (i.e. 1058 females per 1000 males).

Table 3.3 Population structure of Bathudi community, Danamara, Shamakhunta Block

Figure 3.2 Population pyramid of Bathudi of Samakhunta Block, Mayurbhanj, Odisha

From the table and figure above the demographic parameter of Bathudi of Balidiha Panchayat in Odisha suggests that the population pyramid, which shows a thin base, bulging middle and tapering top represents high infant mortality and low life expectancy with a better sex ratio i.e. 1075 (i.e. 1075 females per 1000 males).

Table 3.4 Age and Sex wise distribution of Sabara Population in Balidiha, Shamakhunta Block

Figure 3.3 Population pyramid of Sabara of Samakhunta Block, Mayurbhanj, Odisha

From the table and figure above the demographic parameter of Sabara of Balidiha Panchayat in Odisha suggests that the population pyramid, which shows a thin base, bulging middle and tapering top represents high infant mortality and low life expectancy with a better sex ratio i.e. 1064 (i.e. 1064 females per 1000 males).

Table 3.5 Sex ratio of India and of different states in India vis-a-vis the present study

Table 3.5 shows that the sex ratios (number of females per thousand males) of the tribal communities under study are not only better than corresponding ratios for India and Odisha but also that of many other states.

Table 3.6 Monthly Income among the Tribal women of Mayurbhanj, Odisha

Table 3.6 shows that almost all tribal women belonging to three studied communities earn less than Rs. 2000 per month. The difference in monthly income when compared among the three communities are found not statistically significant (χ²=4.110, df=2, p=.128).

Table 3.7 Educational status among the Tribal Women of Mayurbhanj, Odisha

Table 3.7 shows that two-third of tribal women are non-literate. Within the three communities, the percentage of non-literates is found to be higher (82.69%) among Bathudis where as it is lowest (40 %) among the Sabaras. The difference in educational status when compared among the three communities are found statistically significant (χ²=24.872, df=8, p<.002).

Table 3.8 Occupational status of women of Mayurbhanj, Odisha

Table 3.8 shows that housewives constitute the largest share (63.85%) followed by agriculture and daily labour (33.85%). The difference in occupational status when compared among the three communities are found statistically not significant (χ²=6.306, df=8, p=.613).

Table 3.9 Age at menarche among the Tribal women of Mayurbhanj, Odisha

Table 3.9 shows that one-third tribal women belonging to three communities attained their menarche at the age of 13 and one-fourth attained it at the age of 12. The difference in age at menarche when compared among the three communities are found statistically significant (χ²=5.236, df=2, p=.007).

Table 3.10 Mean age at menarche among the women of different states in India and that of the tribal communities under study.

Table 3.10 shows that the age at menarche, observed among the studied population compares well with the corresponding age observed in other states except Odisha and Punjab. Among the studied population, the early onset of menarche is observed.

Table 3.11 Age at first marriage among the Tribal women of Shamakhunta block, Mayurbhanj, Odisha

Table 3.11 shows that 80 per cent of tribal women marry before the age of 20. The difference in age at first marriage, when compared among the three communities are found statistically significant (χ²=7.324,df=2 ,p<0.001).

Table 3.12 Mean age at first marriage among the women of different states in India and that of the tribal communities under study

Table 3.12 shows that the mean age at first marriage of tribal women of Bhumij, Bathudi and Sabaraj exhibit early mean age at marriage i.e 15.65, 17.87 and 16.83 respectively as compared to the mean ages of other states.

Table 3.13 Age at menopause among the Tribal women of Shamakhunta block, Mayurbhanj, Odisha

X²=1.722, df=2,p=.183

Table 3.13 shows that late menopause is seen in Bhumij women i.e. at age of 51yrs and above, as compared to Sabar and Bathudi women. However, the difference in age at menopause when compared among the three communities is found statistically not significant (χ²=1.722,df=2,p=.183).

Table 3.14 Mean age at menopause among the women of different states in India and that of the tribal communities under study

The table 3.14 shows age at menopause among the women of different populations in India and it reveals that the Bhumij community exhibits higher value.

Table 3.15 Fertility and Mortality indicators of different tribal communities of Mayurbhanj, Odisha

The Table 3.15 reveals that all the tribal communities in the present study exhibit higher values for fertility as well as mortality, when compared with that of national average.

3.1 Discussion

The population pyramid of Bhumij, Bathudi and Sabar represents an unusual reduction of child and aged population due to high rate of fertility and mortality. A prominent constriction is observed at the base of the Bathudi and Sabar (Figure 3.2 and 3.3) as compared to the Bhumij population (Figure 3.1). The constriction at the top also reflects high mortality. It is significant to mention that such pyramids bear resemblance with the developing countries population pyramid, which has high fertility, high mortality and low life expectancy.

Sex ratio measures the balance between males and females in human population. Large imbalances in this aspect affect the social, economic and community life in many ways. A higher or lower sex ratio reflects the status of the socio-cultural, maternal and child health care programmes existing in the population. The sex composition of the population in India is found to be favourable to males. Female disadvantage in mortality attributed as the cause for the low sex ratio; F/M over the last 30 year has been 941(1961), 930(1971), 935(1981) and 927(1991). As compared to the general population, during the same period of thirty years, there appears to be a more even distribution of males and females among the Scheduled Tribes so that sex ratio has been 987(1961), 982(1971), 983(1981) and 972 (1991). This suggests that the females in the tribal society are not neglected; the social and cultural values protected their interest. The tables 3.1, 3.2, 3.3 and 3.4 show the distribution of sex ratio and it was observed that the sex ratio of Bhumij is 1058, Bathudi is 1075 and Sabara is 1064. The lowest ratio is seen Haryana and Punjab (Table 3.5) and the sex ratios for India and Odisha are 940 and 978 respectively. It shows that present tribal population has better sex ratio than state and national averages. Higher sex ratio indicates a comparatively better health status among the tribal women of Mayurbhanj district of Odisha. The deviation in sex ratios may be attributed to lower birth rate or higher death rate of males and also due to high incidence of male deaths. Another factor responsible may be very high incidence of alcoholism among males leading to death.

Schedule Tribes have been known for their high poverty, which found to be true in these tribal communities of Bhumij, Bathudi and Sabara. Income wise distribution of house holds shows that the monthly income is below Rs2000. They do not have fixed income. Table 3.6 shows monthly income wise distribution and it shows that all the three communities fall below the poverty line.

Education is an important thing in one’s life as it enables one to face day-to-day problems in an informed manner and hence effectively. The problems relating to health, population growth, early marriages etc. can not be overcome by the community that lacks education. Table 3.7 shows Educational status of female in Bhumij, Bathudi, and Sabara community. It was found that most of the females are not literate, and only one female in Bhumij community is having higher educational qualification i.e. she is a graduate and holds a degree of Bachelor in Education (B.Ed). The percentage of non-literate among Bhumij women is 74.42, Bathudi women is 82.69 and Sabara women is 40.00. However, 6.98 percent Bhumij, 7.69 percent Bathudi and 20 percent Sabara women have completed education up to class nine, whereas 16.28 percent Bhumij, 7.69 percent Bathudi and 40 percent Sabar women have completed matriculation i.e. class ten. Amongst Bathudi women 1.92 percent attended higher secondary education and none amongst Bhumij and Sabara women. The Sabara community is better educated than Bhumij and Bathudi. The differences observed are due to the differences in availability and accessibility of educational facilities in this area.

The socio economic condition depends upon the income of the people through occupation. In the present study it has been found that most of the tribal women prefer house work. As they live in mostly forest environment, the women are engaged in collecting forest products like timber, Sal leaves, honey, medicinal plant, etc. They also cultivate seasonal crops in their agricultural land. After the end of agricultural season they go to work as daily labourer. Table 3.8 shows Occupational Status among the women of Bhumij, Bathudi and Sabara communities of Mayurbhanj, Odisha. In all the three communities, the percentage of agricultural daily labourer is almost same i.e. 34.88 in Bhumij, 32.69 in Bathudi and 34.29 in Sabara communities. Most of them are housewives and the percentage is almost equal i.e. 62.79 in Bhumij, 65.38 i.e. Bathudi and 62.86 in Sabara. The percentage of employment and business is very low or negligible in all the communities.

The time of first menstruation is called Menarche. It is the physiological process, which enables a girl to become a conceivable mother. An enumeration of average age at menarche of girls shows that it ranges from 10-16 years (Shah, 1958). The mean age at menarche, as shown in Table 3.10, among Bhatra women of Bastar, Chhattisgarh is 12.83 years (Verma and Verma, 2014 ), Gujjars of Delhi is 13.99 years (Dabral and Malik, 2004).This age in Kolkata is 12.3 years, Delhi 13.84 years, Chandigarh 13.2 years, Maharastra 13.38 years (Rokade and Mane, 2008) Sterility rate is relatively low in women of low menarchial age which increases with the increase in menarchial age, age of mother at birth, season, month of birth, diet, family size and adult body size are the factors determining the age at menarche (Wolanski et al,1998). In the present study the average age at menarche in these tribal groups is 13 years. But in Bhumij community comparatively early menarche is seen, among the girls, in the age group of 10 years. Table 3.9 shows age at menarche among the women of different Tribal communities i.e. Bhumij, Bathudi and Sabara of Mayurbhanj, are 12.65, 13.58, and 12.97 respectively.

The age at which the girls are given in marriage depend on social values. Girls in tribal societies are given in marriage generally after puberty. There are a few micro-level studies, which deal with the age at marriage of individual tribe, e.g., female age at marriage Ao Naga (16-20 years), Bhil (16 years), Chenchu after puberty, Khasi (13-18 years), Gond (18 years), Munda (18 years), Karen (late 20s). As per NFHS-3 (National Family Health Survey) about 17.0 percent females in the age group 15-19 years were married. Besides, 1.6 percent females below 14 years of age were married. In the present study early marriage is seen among the tribal communities in the age group of 10-11 years. The maximum marriage occurs in the age group of 18-19 years. In Bhumij community the percentage of early marriage is higher due to low education and income and the differences observed are significant. Table 3.11 shows the marriage age of females in Bhumij, Sabara and Bathudi community. It may be observed that of all the marriages, the percentage of marriage in the age group of 10-11, was 4.65 percent in Bhumij community, 3.85 percent in Bathudi community, whereas no marriage in this age group had taken place in Sabar community. In the age group of 18-19, a higher percentage of Bathudi women are found to have been married (28.85) than those of Sabar women (17.14) and Bhumij women (16.28). But the age group in which highest percentage of marriages took place differs across the tribes. In Bathudi community, the highest percentage of marriages found to have taken place in the age group 16-17 (34.62%), in Sabar community the highest percentage is found (25.71%) both in the age groups of 14-15 and 16-17, whereas in Bhumij community the corresponding age group is 14-15 and the percentage is 25.58%. Out of the three communities early marriage is seen in Bhumij community. Table 3.12 shows Mean age at 1st marriage among women of Bhumij is 15.65 yrs, of Bathudi is 17.87 yrs and of Sabara is 16.83 yrs. The mean age at marriage in Jammu and Kashmir is the highest i.e. 23.6 years, in Delhi it is 22.4 years, in Punjab and Kerala it is 22.1 and 22.7 years respectively (WHO and Ministry of Health and Family Welfare in India,2011). It is found that in the present tribal communities marriage occurs earlier than other states of India.

The measures of fertility ratios and rates help us in understanding the relation between the general conditions of the people and level of fertility .The general fertility rate(GFR), as it takes into account the age and sex composition of population, is an improvement over and more refined than the crude birth rate. The marital fertility rate considers those females who are actually exposed to the risk of child bearing. The GMFR is expressed as the number of live births per thousand married women in the reproductive age groups 15 – 49. The Crude birth rate (CBR) is another important measure of fertility that is sometimes referred simply as birth rate, and is the simplest and commonest measure of fertility. Table 3.15 shows general fertility rate, general marital fertility rate and crude birth rate of Bhumij, Sabara and Bathudi community. The crude birth rate of Bathudi is 23.31, general fertility rate is 272.72 & general marital fertility rate is 132.35.The crude birth rate of Bhumij is 40.48, general fertility rate is 169.49 and general marital fertility rate is 243.90 but in case of Sabara is 54.26,181.81 & 291.66 respectively .It shows general marital fertility rate of Sabara is better than Bathudi and Bhumij community. But crude birth rate of Bathudi is lower than Sabara and Bhumij community. According to 2011 census CBR of Odisha and India is 20.1 and 21.8 respectively. The GFR of Odisha and India is 81.2, where as GMFR in Odisha is and India is 132. The fertility rate is higher among the tribes in the present study than state and national average.

The menopause is a critical biological phase in women’s life, during which ovulation and menstruation are arrested and consequently the reproductive function ceases The mean age at menopause of most population for which measurements exists falls between ages 40 and 50, but the age of menopause of individual women ranges from less than 40 to near 60. The mean age at menopause ranges from 44-50 years in developing countries. From Table 3.14, it was observed that the age at menopause for Punjabi Khatri females from Chandigarh is 49.5 years (Talwar and Pandey 2004), for Gujjars of Delhi it is 44 years, (Dabral and Malik 2004), for rural (urban) Punjabi Brahmin females it is 48.22yrs(49.30yrs) (Kaur and Talwar, 2009), for urban women of Pune, Maharastra it is 45.8 years(Kaulagekar,2011). Similarly, Table 3.13 shows, the mean age at menopause among Bhumij females is 50.20 yrs, Bathudi females it is 42.94yrs, and Sabara females it is 39.0yrs. The difference observed among them is found statistically significant. It is important to note that even though living in the same ecological habitat they have different age of onset of menopause. Further when Bathudi and Sabar females are found to have begun attaining menopause early, between the age of 35yrs to 40yrs, the Bhumij females begin attaining menopause between the age of 46 yrs to 50 yrs. The instance of late menopause that is after the age of 51 is observed only among Bhumij females and are also having early menarche.

Mortality deals with the effects of death on population. The study of mortality is useful for analyzing current health status and demographic condition as well as for determining the prospects of potential changes in mortality conditions of the future. In the present study an attempt has been made to asses mortality of Bhumij, Sabara and Bathudi community Crude death rate (CDR) is the most common and widely used measure of mortality, describing the frequency with which death occurs in a population at a specified time/period. In the present study the crude death rate has been found among three different communities (Bhumij, Bathudi and Sabara) living in the same ecological habitat. Table 3.15 shows that the crude death rate in Bhumij community is 36.43, 2.59 in Bathudi community and 10.9 in Sabara community. According to 2011 census CDR of Mayurbhanj is 9.7, Odisha is 8.5 and India is 7.1. Thus the CDR is highest among the Bhumij community and much higher than the district, state and national figures. It has been observed that malaria, fever, tuberculosis, cardiovascular problems, alcohol consumption are the main causes of death. It is also reported that the infant mortality rate in Mayurbhanj is 42.3 and in Shamakhunta block it is 82.0, which is much higher than the State and National values (Acharya and Das, 2012).

4 Conclusion

In the present study an attempt is made to throw light upon the health status of Bhumij, Bathudi and Sabara women of Shymakhunta Block, Mayurbhaj, Odisha. In all three communities, it is found that the sex ratio is higher than several state averages and national average. This suggests that the females in the tribal society are not unwelcome as found in the mainstream caste societies. There is no preference for male child. However, the population pyramids of all three communities show a bulging base, middle and tapering top which is also a typical feature of developing nations with high mortality with low life expectancy. High incidence of early age marriage, especially among females, seen in these tribal communities, is much higher than the national average and the state average, which respectively is 42% and 33.3% according to Census 2011. In the studied population the predominant occupation is found to be agricultural daily labour, and the majority of women are non-literate. The mean menarchial age of women in the study area is 13.11 years. But, when the age at menarche is compared across these three tribal communities, it is found to be lowest among the Bhumija i.e. 10 years. This study supports the hypothesis of late age at menopause for females having early menarche. The crude birth rate (CBR) and general fertility rate (GFR) of Bhumij, Bathudi and Sabara are higher than state and national averages. Similarly, the crude death rate (CDR) among these communities exhibits higher values than the state and national average. However, it was reported that introduction of National Rural Health Mission (NRHM) and Reproductive Child Health Care (RCH) programme improved the health care practices for women especially in the present tribal areas of Mayurbhanj (Acharya and Das, 2012). From the present study it is concluded that micro demographic study of the tribal populations living in similar ecological habitat reveals tribal women needs special health care strategies to reduce health disparities observed among them.

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