Tribal status is strongly related to poor nutritional outcomes. The combination of being from a tribal and high out-migration area like Pratapgarh and Udaipur in South Rajasthan, potentially adds to the vulnerabilities faced by families, further compromising the nutrition and growth of their children. Amid the emerging health complexities, tribal societies remain one of the most vulnerable segments of the population. Tribal women bear the greatest brunt of poor nutrition indicators due to inherent gender bias. According to the National Family Health Survey (NFHS-5), only 55% of women in Rajasthan get four or more antenatal care visits; the percentage stands even lower for tribal-dominating districts. The reasons for this are manifold and include inadequate access to quality healthcare services, poor literacy status, limited knowledge about healthcare and nutritional practices, and poor dietary diversity.
Major Impediments In The Nutrition For Tribal Communities
On a recent field visit to Pratapgarh and Udaipur, one of the striking observations was the misconception regarding the consumption of bananas and milk during pregnancy. Many community members firmly believed that consumption of these food items could result in white scars on babies. This misguided belief reflects these regions’ limited access to accurate health information.
As per a recent report by UNICEF, “Malnutrition in women is rooted in poor care practices at the individual, household, community and societal levels”. Women’s nutrition deserves more attention to tackle malnutrition at all ages and break its intergenerational cycle. The absence of trained healthcare professionals exacerbates the problem, leaving tribal women vulnerable to health complications and nutritional deficiencies. The arid climate and low agricultural productivity also make it difficult for tribal communities to have a diverse and nutritious diet.
Additionally, Anganwadi centres are located very far from the village’s core, making it difficult for children to access services. Children from migrant households are even less likely to have benefited from the Anganwadis because of administrative issues, which reduce the capacity of the family to access and benefit from government schemes. The prevailing social norms, beliefs, cultural practices, geographical isolation, and forest dependency push the tribal population to seek traditional methods.
Gender And Nutrition
Malnutrition is a grave public health crisis. According to UN Women, women face more food insecurity than men, in nearly two-thirds of all countries. In a study published in the Economic and Political Weekly, the authors found that tribal women have worse health and nutritional outcomes than the general population, and this is because of the limited reach of critical welfare schemes such as the public distribution system (PDS) and the integrated child development scheme (ICDS).
Women eat last and the least, which perpetuates the vicious cycle of malnutrition. The roots of poor nutrition lie in intra-household power dynamics. Pregnant and lactating women (PLW) do not consider it appropriate to eat more food than others at meals because it challenges their notion of an ideal wife or daughter-in-law and, more importantly, that they can’t have ownership of resources. Discrimination and cultural norms limit women’s decision-making power on household food choices, affecting their and their children’s nutrition.
Interventions To Transform Nutritional Outcomes Of Tribal Communities
In Salumber, Rajasthan, project Phulwari, (the Hindi word for a garden of flowers), is working in nine villages to provide supplementary nutrition, and education for early child development and monthly health check-ups to tribal children who are undernourished and wasted. Further, Rajasthan’s VAAGDHARA program, supported by NABARD, is working, to reclaim and regenerate the forest’s untapped fruits and vegetables for use in the household hearth to improve dietary diversity.
Front-line workers (FLWs) have also joined hands with POSHAN champions (Nutrition champions) trained under RajPusht program to impart specific counselling to every pregnant and lactating woman (PLW) in Rajasthan. A layered approach has been adopted wherein messages are being imparted to the PLW through multiple channels at multiple levels – an Anganwadi worker counselling at Anganwadi centres, ASHA during community-level meetings, ANM (Auxiliary Nurse and Midwife) on the MCHN (Maternal, Child, Health, and Nutrition) days and the POSHAN champions supplementing the counselling effort by the Anganwadi workers and ASHA (Accredited Social Health Activist) during the home visits. Intensive interpersonal communication (IPC) by the FLWs has increased awareness amongst PLWs and has also motivated family members to support them.
Way Ahead: Integrative Policy-Making Process
There is an imperative need to recognise the differential health and nutritional issues of tribal communities, prioritise reliable data, and evidence-based nutritional policies to fight the uncertainties in the health and nutrition of the tribal community. This can be done through a more decentralised local programming approach to end the hidden epidemic of malnutrition.
Integrating traditional medicine into India’s primary healthcare is imperative to provide universal access to equitable, affordable, and quality healthcare for people, including the marginalised section, as envisaged in the National Health Mission. India should develop a tribal health policy emphasising promoting and integrating traditional medicine into modern healthcare to resolve the human resource crunch and strengthen the long tradition of indigenous medicine knowledge that will reach everyone.
Tribal Development Report, 2022, has mentioned in its report, “There are many tribal communities that prefer isolation and silence. They are shy and are not going to reach out to the outside world on their own. Policymakers and leaders of the country need to understand this trait and then work towards the welfare of tribals so that they connect with them in a better way.” Consequently, promoting culture-friendly and context-specific tribal healthcare in public health programs significantly reduces healthcare disparities among tribal communities. By respecting their cultural identity, integrating traditional knowledge, and actively involving the community, we can foster more inclusive and effective healthcare interventions that lead to better health outcomes for tribal populations.
(This article has been authored by Ishika Chaudhary, Analyst with the Social and Economic Empowerment team at IPE Global and Raghwesh Ranjan, Senior Director, Social and Economic Empowerment, IPE Global Ltd.)
Disclaimer: These are the personal opinions of authors.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF)status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.