Reproductive health care status of the displaced tribal women in India: An analysis using Nussbaum Central human capabilities

Abstract

Scheduled Tribes (STs) of India are characterized by distinct cultures and a close relationship with the land they inhabit. Tribal people make up to 5% of the world’s population but 15% of such people are living in poverty. They face deprivations caused by social, economic, and political exclusion. In India displacement due to development projects is pushing the tribals out of their habitat dispossessing them of their traditional forest resources. Women and children in displacement suffer more than the male counterpart especially in the process of moving to a new setup. The objective of the author is to study the reproductive healthcare status of displaced tribal women in India. In this paper, the author underlines the capabilities of tribal women in post displacement settings. The study was conducted in three wildlife sanctuaries in the Indian States of Odisha and Chhattisgarh namely Simlipal, Chandaka-Dampara, and Achankamar. Sequential explanatory study design was employed for collecting the data. A total of 194 displaced tribal women within the reproductive age group of 15–49 years were surveyed and Focus Group Discussion was conducted among the displaced women. Women who had given birth in the last five years were selected using a purposive sampling method. Key findings of the study suggest that women lack awareness of child spacing capabilities (57%) and the unmet need for family planning is comparatively higher. More than half of the women face domestic violence that curtails their capabilities to avail reproductive healthcare services. It also reduces the immediate wellbeing of their children. Women in this study lack control over the decision on reproductive healthcare. Due to this, women lack social and political freedom. The Government of India has taken fewer initiatives to promote effective reproductive healthcare services. Also, there is limited awareness in the rehabilitation colonies on protection from domestic violence.

Acknowledgments

We wish to acknowledge the cooperation and valuable time of the respondents, without whom this research would not have been possible. Thanks to local NGO staff and workers, particularly for assisting to the field for data collection.

Disclosure statement

The authors declare that they have no competing interest.

Ethical approval and consent to participate

Not applicable

Table 1. Capabilities variables used in the study.

Notes

1 Being able to live to the end of a human life of normal length; not dying prematurely or before one’s life is so reduced as to be not worth living.

2 Being able to have good health, including reproductive health; to be adequately nourished; to have adequate shelter.

3 Being able to move freely from place-to-place; to be secure against violent assault, including sexual assault and domestic violence; having opportunities for sexual satisfaction and for choice in matters of reproduction.

4 Being able to use the senses, to imagine, think, and reason — and to do these things in a ‘truly human’ way, a way informed and cultivated by an adequate education, including, but by no means limited to, literacy and basic mathematical and scientific training. Being able to use imagination and thought in connection with experiencing and producing works and events of one’s own choice, religious, literary, musical, and so forth. Being able to use one’s mind in ways protected by guarantees of freedom of expression with respect to both political and artistic speech, and freedom of religious exercise. Being able to have pleasurable experiences, and to avoid non-necessary pain.

5 Being able to have attachments to things and people outside ourselves; to love those who love and care for us, to grieve at their absence; in general, to love, to grieve, to experience longing, gratitude, and justified anger. Not having one’s emotional development blighted by fear and anxiety. (Supporting this capability means supporting forms of human association that can be shown to be crucial in their development).

6 Being able to form a conception of the good and to engage in critical reflection about the planning of one’s life. (This entails protection for the liberty of conscience).

7 (A) Being able to live with and toward others, to recognize and show concern for other human beings, to engage in various forms of social interaction; to be able to imagine the situation of another and to have compassion for that situation; to have the capability for both justice and friendship. (Protecting this capability means protecting institutions that constitute and nourish such forms of affiliation, and also protecting the freedom of assembly and political speech).

(B) Having the social bases of self-respect and non-humiliation; being able to be treated as a dignified being whose worth is equal to that of others. This entails protections against discrimination on the basis of race, sex, sexual orientation, religion, caste, ethnicity, or national origin.

8 Being able to live with concern for and in relation to animals, plants, and the world of nature.

9 (A) Political. Being able to participate effectively in political choices that govern one’s life; having the right of political participation, protections of free speech and association.

(B) Material. Being able to hold property (both land and movable goods); having the right to seek employment on an equal basis with others; having the freedom from unwarranted search and seizure. In work, being able to work as a human being, exercising practical reason and entering into meaningful relationships of mutual recognition with other workers.

10 Particularly Vulnerable Tribal Groups (PVTGs) are the tribal population notified by Government of India those having preagriculture level of technology, stagnant or declining population, extremely low literacy and having subsistence level of economy.

11 Sequential explanatory is characterized by collection and analysis of quantitative data followed by a collection and analysis of qualitative data. To use qualitative results to assist in explaining and interpreting the findings of a quantitative study.

12 Village Health Nutrition Day (VHND) is to be organized once every month (preferably on Wednesdays, and for those villages that have been left out, on any other day of the same month) at the AWC in the village. This will ensure uniformity in organizing the VHND. The AWC is identified as the hub for service provision in the RCH-II, NHM, and also as a platform for inter-sectoral convergence. VHND is also to be seen as a platform for interfacing between the community and the health system. On the appointed day, ASHAs, AWWs, and other mobilize the villagers, especially women and children, to assemble at the nearest AWC. The ANM and other health personnel are required to be present on time.

13 Anganadi Worker (AWW) means a woman employed to provide additional and supplementary healthcare and nutritional services to children and pregnant women under the Integrated Child Development Services Scheme (ICDS Scheme) in the villages.

14 An accredited social health activist (ASHA) is a community health worker appointed by the Government of India’s Ministry of Health and Family Welfare (MoHFW) as a part of the National Rural Health Mission (NRHM). The mission began in 2005; full implementation was targeted for 2012.

15 Auxiliary nurse midwife (ANM) is a village-level female health worker in who is known as the first contact person for the people in need of health care services. ANMs are regarded as the grass-roots workers. Their services are considered important to provide safe and effective care to village communities.

16 Sterilization is a permanent method of birth control.

17 Cash benefit under JSY: In Low performing state (LPS) cash benefit for institutional delivery in rural areas- Mother-INR1400, ASHA-INR600. In urban areas- Mother-INR 1000, ASHA-INR 400 (Available to all women regardless of age and number of children for delivery in government/private accredited health facilities). In High performing state (HPS) cash benefit for institutional delivery in rural areas- Mother-INR 700, ASHA-INR 600. In urban areas- Mother-INR 600, ASHA-INR 400 (Available only to BPL/SC/ST women regardless of age and number of children for delivery in government/private accredited health facilities). Cash benefit for home delivery in LPS and HPS-Mother get benefit of INR500 in both rural and urban areas (Available only to BPL women who prefer to deliver at home regardless of age and number of children).

18 The cashless benefits under JSSK for pregnant women: Free and cashless delivery, Free C-Section, Free drugs and consumables, Free diagnostics, Free diet during stay in the health institutions, Free provision of blood, Exemption from user charges, Free transport from home to health institutions, Free transport between facilities in case of referral and Free drop back from Institutions to home after 48 h stay. Benefits under JSSK for Sick new borns till 1 year after birth: Free treatment, Free drugs, and consumables, Free diagnostics, Free provision of blood, Exemption from user charges, Free Transport from Home to Health Institutions, Free Transport between facilities in case of referral and Free drop Back from Institutions to home.