This document discusses factors influencing maternal health indicators among tribal populations in Maharashtra, India, with a focus on five high priority districts. It finds that the key determinants include socioeconomic conditions, the physical environment, individual behaviors, culture and traditions. Challenges include poor infrastructure and budgeting for health, low education and land ownership for women, migration, food insecurity, genetics, and shortages of health facilities and personnel. While some indicators have improved over time, recommendations emphasize addressing social determinants of health through strengthened systems and intersectoral approaches, as well as culturally appropriate community-based programs.

1. FACTORS INFLUENCING MATERNAL
HEALTH INDICATORS AMONG TRIBAL
POPULATION IN MAHARASHTRA WITH
SPECIAL FOCUS ON FIVE HIGH
PRIORITY DISTRICTS
Ajeesh Sebastian & Shahina Begum
Dept. of Biostatistics
National Institute for Research in Reproductive Health (ICMR),
Mumbai, Maharashtra

2. INTRODUCTION
 Health - a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity. (WHO. 1948)
 Main determinants of health include
The social and economic environment,
 the physical environment, and,
The person's individual characteristics and behaviors.
(WHO, 2008)
 The inequities in how society is organized mean that the freedom to lead a
flourishing life and to enjoy good health is unequally distributed between and
within societies. (WHO commission on social Determinants of Health, 2008)

3. Conceptual Framework – WHO 2008
http://whqlibdoc.who.int/publications/2010/9789241500852_eng.pdf

4. KEY SOCIAL SECTOR EXPENDITURE: MAHARASHTRA

5.  Much of the tribal budget goes towards infrastructure development, but there is
barely enough budget for the maintenance of those assets, or for human
development. (Krishna, S. 2016)
 Poor planning and implementation Eg: The Dr APJ Abdul Kalam Amrut Ahar
Yojna. (DNA report,2016)
 Poor utilization by the target population. Eg: JSY evaluation(PP Doke, UH
Gawande, SR Deshpande. 2015)
SCHEMES FOR SCHEDULED TRIBE

6.  Early age marriages. (SS Nerkar et al. 2016)
 Dependency of tribal people upon spiritual security they receive from their
traditional healers.
 Practises for normal delivery by making changes in food consumption
(CJ Sonowal. 2010, Jungari and B Paswan.2016, Dilnaz Boga. 2015)
 Child feeding practises. (Neonatal Disease Surveillance Study - 2006-07)
 Spacing between deliveries. (Niswade A et al. 2011)
 All the household level hard work continues even during pregnancy. (SS
Nerkar et al. 2016)
CULTURE

7.  Poor spending on health.
 Trend towards self-treating themselves through herbal medicines or allopathic
medicines bought from a pharmacy also reported.
 Embarrassment to discuss reproductive problems
(A Shukla. 2012).
HEALTH SEEKING BEHAVIOUR

8. PROFILE OF 5 HPD DISTRICTS
 Dhule, Gadchiroli, Jalgaon,
Nanded, and Nadurbar
 Issues related with equitable health
care and poor performance in health
outcomes. (PIB. 2015)
 listed in the Backward Regions
Grant Fund Programme under
Ministry of Panchayati Raj
(PIB.2012)
 These districts are characterized by
agrarian economy and majority of its
population lives in rural areas.
(Census. 2011; NRHM PIPs. 2008-
14)

9. The Major ST groups in the 5 HPDs (Census 2011)
District Major tribal groups in rural area (>1000 population)
Nandurbar Bhil, Kokna, Gamit, Koli Mahadev, Dhanka, Koli Dhor
Dhule Bhil, Kokna, Koli Dhor, Gamit, Pardhi, Koli Mahadev, Thakur
Jalgaon Bhil, Koli Dhor, Koli Mahadev, Pardhi, Dhanka, Thakur, Naikda,
Koli Malhar, Korku
Gadchiroli Gond, Pardhan, Halba, Kawar, Oraon
Nanded Andh, Koli Mahadev, Kolam, Gond, Bhil, Pardhan, Naikda,
Pardhi, Thakur
Growth rate of tribal population in five HPD districts
between 2001 and 2011
Dhule -4.59%, Gadchiroli - 1.17%, Jalgaon - 3.86%, Nanded - 1.1%, Nandurbar -
3.28%

10. THE SOCIO ECONOMIC PROFILE OF THE THE TRIBAL
POPULATION – SECC 2011

11. GENDER (CENSUS 2011 & SECC 2011)
Gender specific indicators Maha
rashtr
a
Rural
Women owning a house and/or
land (alone or jointly with others)
(%)
33.3
Women having a bank or savings
account that they themselves use
(%)
38.7
The tribal land holdings are characterized
by men ownership. The share of women
who hold land is critically low. (Alkira S.
et al. 2012)

12. Education status of Women (7-80+) in five HPDs
(Census 2011)

13. MIGRATION
 Chief Minister of Maharashtra: Lack of nourishment coupled
with sustained earning that often lead to migration was a cause of serious
concern in tribal areas of Maharashtra. (Khapre. 2014)
 Migration to other parts of the state as well as to neighbouring states in
search of seasonal jobs under contractors. (CJ Sonowal. 2010)
 Tough to track pregnant women. (D Kulkarni. 2015)

14. FOOD AND FOOD SECURITY
A report of enquiry based on the Starvation, Malnutrition and Malnutrition
Related Deaths of Children in 15 Tribal Districts of Maharashtra points out:
 Unstable cereal production
 20 to 50 percent landless labour households who consume less than 2300
calorie value of food
 Production of jawar & bajra is coming down and is substituted by the
production of cash crops.
 huge deficit between the recommended norm and what is available for
consumption in respect of cereals, sugar, pulses, vegetables, fruits, oil/fat,
milk, meat and fish.
 The existing PDS does not distribute coarse cereals such as jawar, bajra and
ragi for which members of tribal households have a preference.
 PDS caters to only 50 percent of the requirements of a family .

15. GENETICS
 The prevalence of sickle cell hemoglobin (HbS), beta-thalassemia trait and G6PD
among some important Gond related endogamous tribes in Maharashtra, India.
The HbS gene frequency varies from 0.0530 to 0.1805, the beta-thal gene from 0
to 0.0283 and Gd- gene from 0.0189 to 0.1120. (Rao VR and Gorakshakar AC.
1990)
 Glucose-6-phosphate-dehydrogenase (G6PD) deficiency was observed in the
Gamits (31.4%), and Bhils (16.3%) in Maharashtra. Deficiency of this enzyme is
highly polymorphic in those areas where malaria is/has been endemic.
(Mukherjee MB et al. 2015)

16. Sr. No Tribal Group District Sickle Cell Carriers (%)
1 Otkar Gadchiroli 35
2 Pardhan Nanded 33.7
3 Pawara Dhule, Jalgaon 25.18
4 Madia, Gond Gadchiroli 20.8
5 Bhil Nandurbar 20.6
6 Halbi Gadchiroli 13.93
8 Rajgond Gadchiroli 10.88
10 Tandvi Jalgaon 8.33
14 Kokana Dhule 3.50
15 Andha Nanded 1.97
% of sickle cell carriers in different tribal groups in five HPD
districts

17. AVAILABILITY OF HEALTH FACILITIES
*Tiers of Health Care Infrastructure and the Applicable Population Norms
Centre Hilly/Tribal/Difficult
Area (as per norms)
Situation in Tribal Areas
of Maharashtra including
5 HPDs (in reality)
Sub-Centre 3000 4378.258
Primary Health Centre 20000 28590.72
Community
Health Centre
80000 134419.1
*Ministry of Tribal Affairs, Statistical Profile of Scheduled Tribes in India 2013
Number of Sub Centres, PHCs & CHCs in Tribal Areas
(as on 31st March 2015)
State/ UT
Tribal
Population
Sub Centres PHCs CHCs
Required Shortfall Required Shortfall Required Shortfall
Maharashtra 9006077 3002 945 450 135 112 45

18. Building Position for Sub Centres, PHCs, and CHCs in Tribal Areas (as on 31st March 2015)Maharashtra
Maharashtra
Total Number of
Sub Centres
functioning
Buildings
required to be
constructed
Total
Number of
PHCs
functioning
Buildings
required to
be
constructed
Total
Number of
CHCs
functioning
Buildings
required to
be
constructed
2057 220 315 26 67 7
Human Resource Required In position Shortfall
Health Worker [F] / ANM at Sub Centre & PHC 2372 6833 0
Health Worker [M] at Sub Centre 2057 1375 682
Health Assistants [Male] at PHCs 315 700 0
Health Assistants [Female] / LHV at PHCs 315 739 0
Total Specialist at Community Health Centres 268 83 185
Obstetricians & Gynaecologists at CHC 67 29 38
Surgeon at CHCs 67 16 51
Physicians at CHCs 67 15 52
Nursing Staff at PHCs & CHCs 784 646 138
Lab Technicians at PHCs & CHCs 382 400 0

19. CHANGES IN THE STATUS OF HDI

20. HMIS COMPOSITE INDEX OF 5 HPDS DURING 2012-15
(NRHM)
Districts
Composite Index
Overall Index Pregnancy care
Postnatal
maternal & new
born care
Reproductive age
group
2014-
15
2013-
14
2012-
13
2014-
15
2013-
14
2012-
13
2014-
15
2013-
14
2012-
13
2014-
15
2013-
14
2012-
13
Dhule
0.4058
0.3599
0.3545
0.3157
0.3204
0.341
0.5713
0.336
0.3985
0.2909
0.395
0.2755
Gadchiroli
0.532
0.6119
0.5766
0.6579
0.7675
0.7612
0.5199
0.5666
0.5354
0.4391
0.58
0.4831
Jalgaon
0.4821
0.5309
0.4985
0.5063
0.5275
0.4408
0.5172
0.591
0.6388
0.2717
0.3833
0.2926
Nanded
0.4889
0.5298
0.5246
0.5901
0.6327
0.6175
0.6229
0.6592
0.6056
0.0596
0.0461
0.0828
Nandurbar
0.3843
0.4576
0.3909
0.4524
0.5686
0.5083
0.4945
0.5397
0.5365
0.2242
0.2832
0.1609

22. CONCLUSION AND RECOMMENDATIONS
 Necessity of tailored programmes with a focus on the social determinants of
health influencing the maternal health indicators.
 Need to encourage context-specific and culturally and socially acceptable
provisioning of care.
 Addressing the social determinants of health through health system
strengthening and inter-sectoral convergence.
 Improved community participation.
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