Field Report and Insights,
Feb 17 2024.
Overview
Figure 1: At Kotada, Poshina village, Sabarkantha.
Sabarkantha district in northeastern Gujarat borders Rajasthan and is flanked by Gujarat’s Banaskantha, Mehsana, and Gandhinagar districts. Its varied terrain includes flat plains and hilly areas, with Himmatnagar serving as the administrative centre. The 2011 census reported a population of 2,428,589, which grew to an estimated 3,424,311 by 2024 (India Growing). The district showcases a diverse demographic with a sex ratio of 951 females per 1000 males and significant ST and SC populations, highlighting its agrarian economy focused on agriculture and dairy farming. Sabarkantha’s inclusion in the Backward Regions Grant Fund Programme underlines its developmental challenges.
During a recent CHDO/CDMO review meeting on February 3, 2024, it was noted that despite the diligent efforts from the service side, there are still significant instances of home deliveries in certain pockets of the district. Poshina had been identified as one of the villages experiencing a notable number of home deliveries. In response to this concern, a GHBIL, Social Action and Policy (SAP) Lab and UNICEF team visited the selected Poshina Taluka in Sabarkantha on February 7, 2024. The team was accompanied by CDHO Dr. Raj Suthar, Mr. Jayesh Pandya (DIECO) and Mr. Rohit Panchal (DSBCC).
Poshina, a village within Sabarkantha, has seen its population grow from 3,261 in 2011 to an estimated 4,109 in 2024, reflecting a steady increase. The literacy rate has improved, with 2,204 residents being literate. The workforce primarily engages in agri culture. The village is home to various indigenous communities like Rabaris, Bhils, and Garasias, enriching its cultural heritage and customs.
Objectives
To investigate the community’s norms, customs, and beliefs regarding pregnancy and delivery, including social norms and cultural influences.
To examine the community’s perception of available healthcare facilities and schemes, focusing on critical factors influencing the decision on the delivery location.
To explore stakeholders’ beliefs and perceptions towards home-based versus institutional deliveries.
To identify and list the messaging/actions by healthcare providers aimed at encouraging more institutional deliveries among the community.
Problem Statement
High rates of Home-Deliveries among families and its critical impact on child health and survival.
Approach
A qualitative methodology was chosen to achieve the outlined objectives, utilising ethnographic investigation, Focus Group Discussions (FGDs), and semi-structured interviews. This approach allows for an in-depth exploration of the community’s norms, customs, and beliefs regarding pregnancy and delivery. Ethnographic investigation offers context and depth by observing behaviours in their natural settings. FGDs facilitate understanding collective attitudes, while semi-structured interviews afford personal insights into individual experiences and perceptions. This rationale underscores the importance of a nuanced, multifaceted approach to understanding complex social issues.
Field Site
The SAP Lab and UNICEF team conducted Focus Group Discussions (FGDs - 12 Females, 7 males and 4 ASHA workers) at Kotada village in Poshina. Kotada is near the Rajasthan border and has a significant migrant tribal population. The population is dispersed across approximately 1200 houses, with distances of 1-2 kilometers between each house. The nearest service road is 3 kilometers away, and the closest Primary Health Center (PHC) - PHC Demti - is 15 kilometers away.
An interesting observation is the tradition of live-in relationships in the village. Couples often live together and have children without formal marriage. Many choose not to marry and thus lack marriage certificates, creating administrative challenges when they need documents to access important schemes for which they are eligible.
Despite these challenges, respondents expressed a positive outlook on health and education. They are well aware of the roles and responsibilities of ASHA workers and the immunization sessions conducted at Anganwadi centers.
Insights
Service side
Electricity and Sanitation : Kotada village faces severe electricity access and sanitation challenges. Most residents practice open defecation due to a lack of proper sanitation facilities. The absence of electricity exacerbates these issues, critically affecting daily life and health hygiene practices.
Water and Nutrition : The village suffers from a shortage of clean drinking water, affecting health and limiting dietary diversity. The scarcity of water resources further contributes to nutritional deficits and health complications among residents. Most residents consume daal and roti daily. They do not strictly adhere to IFA tablets. An ANC mother was awailing Matrushakti packets in Kasturba Poshan Sahay Yojana.
Electricity and Sanitation : Kotada village faces severe electricity access and sanitation challenges. Most residents practice open defecation due to a lack of proper sanitation facilities. The absence of electricity exacerbates these issues, critically affecting daily life and health hygiene practices.
Healthcare Access : Access to healthcare is significantly hindered by the village’s remote location, poor transportation infrastructure, and distance from medical facilities. This situation forces villagers to rely on limited local healthcare options or need help in reaching timely medical assistance.
"Jholi karke leke jaate hai, aur raaste mai hi baccha ho jaata hai"
Houses in the village are nearly 3 kilometers away from the main road, so when a pregnant woman goes into labor, 5-6 men carry her to the road. Unfortunately, due to the long distance and lack of available stretchers or vehicles, many deliveries occur on the way. This situation highlights the urgent need for better transportation and healthcare facilities in the area.
Ambulance Service : The ambulance service is unreliable, sometimes misrouting calls to another state, Rajasthan. When they dial 108, the call gets connected to Rajasthan dashboard of 108. Even if an ambulance is available, an ANC or ASHA worker must reassure the driver that the call is not bogus. This inefficiency creates critical delays in emergencies, further complicating access to necessary medical care.
Government Schemes and Identification : As the Migrated populations are from Rajasthan, they face challenges in transferring identification documents to Gujarat, especially Aadhar card addresses, which affects their access to government schemes. This bureaucratic hurdle contributes to the difficulties in obtaining essential services and support. Health workers do help them in opening bank accounts to get benefits to various schemes. Treatment is given and the data is entered in HMIS and not in Techo App.
Demand side
Cultural Practices and Health : Cultural norms such as son preference, early marriages, and early pregnancies pose additional health risks. These practices are deeply ingrained and influence health outcomes and the community’s social well-being.
Home Deliveries : Home deliveries are typical, with many births occurring en route to hospitals due to transportation challenges. The preference for home deliveries reflects the interplay of accessibility, cultural beliefs, and mistrust of formal healthcare services.
Health Workers and Awareness : ASHA workers need more awareness about government health schemes and incentives. This knowledge gap affects their ability to provide essential health services and guidance to villagers, impacting overall health outcomes.
Men as Influencers : There is the reluctance of young men to engage in conversations about pregnancy or sexual health. Despite their pivotal role as influencers, many young men prefer sharing stories and customs related to marriage, avoiding direct discussions on topics critical to the health and well-being of families. This gap in communication and education presents a challenge in promoting comprehensive health awareness and responsible behaviours.
Figure 2: During Focussed Group Discussion among men and women at kotada, Poshina.
Suggested Action Plan
Based on the above insights, the Social Action and Policy (SAP) Lab team can provide technical support in implementing an SBC-driven strategy for increasing institutional deliveries. SAP Lab can support in suggesting an action plan and a list of activities, con ducting capacity building of relevant stakeholders and providing communication packages for driving intensive community engagement within the community. Below are some of the activities suggested based on preliminary data.
Stakeholder Mobilization and Engagement
Engage key community influencers, including men and healthcare providers, to promote discussions on pregnancy and sexual health. Utilise local customs and storytelling to address sensitive topics, fostering a supportive environment for health education.
SAP Lab can support the district health department in organising meetings with local industry associations, SHGs, and panchayats to disseminate SBC communication materials and promote institutional deliveries.
Leveraging existing community platforms
Mahila Aarogya Samiti members can be mobilised by the health department to conduct awareness sessions with the communities and counselling on institutional deliveries. SAP Lab and GHBIL can support the provision of communication materials to the Samiti members.
CDHO can be supported in disseminating SBC-driven IEC materials to the ASHA and ANM catering to these specific pockets.
References
• India Growing. “Sabarkantha Population 2023/2024, District Talukas List, Gujarat.” India, https://www.indiagrowing.com/Gujarat/Sabarkantha.
• India stat districts. “DistrictsOfIndia- Socio-economic statistical data of Sabar Kantha District, Gujarat.” Districts of India, https://www.indiastatdistricts.com/gujarat/%20sabarkantha-district
Comentários