While it is heartening to know that over the past three decades, the Maternal Mortality Rate (MMR) and Under-5 Mortality Rate (U5MR) have significantly decreased in India, from 556 in 1990 to 113 in 2016-18 for MMR; and from 113 in 1990 to 36 in 2018 for U5MR, this data does not tell the whole story.
There is a lack of equal access to healthcare, especially the utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services in Low- and Middle-income countries including India.
Scheduled Tribes (ST) are one of the most marginalised communities in India, with poorer access to RMNCH services when compared to the remaining population of the country. ST women often face multiple barriers that hinder their access to quality health services, leading to higher pregnancy-related mortality and morbidity in the community. Limited availability of healthcare facilities, inadequate infrastructure, geographical remoteness, cultural and language barriers, and socio-economic disparities contribute to this issue. The Scheduled Tribes constitute 8.6 percent of India’s population, accounting for 104 million tribal people. Despite numerous interventions designed to improve healthcare access for them, significant inequalities persist within this population. The intersection of social status, wealth, and education exacerbates these disparities, often leaving the poorest and least educated tribal individuals most deprived of RMNCH care.
In this study, the authors Ms. Rekha S., Ms. Varshini Neethi Mohan, Dr. Girija Vaidyanathan, Prof. Umakant Dash, and Prof. V. R. Muraleedharan from the Department of Humanities and Social Sciences (DoHSS), Indian Institute of Technology (IIT) Madras, Chennai, India (Prof. Umakant Dash is also the Director of Institute of Rural Management Anand (IRMA), Anand, India), have studied the ST communities in RMNCH coverage in the states of Odisha and Jharkhand. Odisha and Jharkhand have been chosen because of their substantial representation of Scheduled Tribes in the country.
The major causes of inequality among the ST population have been attributed to the intersection of their social status, wealth, and education level.
In this study, the two latest rounds of the National Family Health Survey (NFHS): NFHS-4 (2015-16); and NFHS-5 (2019-21) have been analysed.
To measure the inequalities in the access to RMNCH services, two summary measures which were introduced to monitor the progress in reduction of maternal and infant mortalities, namely – the Composite Coverage Index (CCI) and the Co-coverage Indicator have been utilised.
This study evaluated the wealth- and education-related inequalities in access to RMNCH services within ST communities in Odisha and Jharkhand.
The following were the findings from this study:
- Women with better education, and belonging to richer households had better access to RMNCH services.
- Inequalities in the utilisation of RMNCH services between rich and poor ST households widened in Odisha between 2016 and 2021, while they narrowed in Jharkhand.
- In Odisha, in both the rounds of NFHS, the proportion of children who received vaccination was higher among the richer wealth quintile in Odisha. Whereas, in 2019-21 in Jharkhand, the poor received more vaccinations when compared to the rich.
- The utilisation of antenatal care services was very poor among women who belonged to Jharkhand in both the NFHS rounds, which requires attention.
- The service utilisation has improved among the ST population in both Odisha and Jharkhand in 2019-21 when compared to 2015-16.
This study concludes that addressing the socio-economic determinants of health, such as poverty, education, and social exclusion, is vital for achieving equitable healthcare access for ST communities.
It is suggested that policies should uplift marginalised populations by providing targeted social support, educational opportunities, and economic empowerment initiatives.
Dr. Lalitha Vadrevu, who is a consultant for World Bank, gave her analysis of the work done by the authors and appreciated their work with the following comments: “This research on the inequities in the utilization of RMNCH services among the tribal populations is a much needed addition to the literature on health of the schedule tribes. It uses a more comprehensive metric to understand the variation in utilization of health services. It also explores the intersectionality between education, wealth and other social attributes that affect health care utilization. I congratulate the authors for their work and look forward to more interdisciplinary work in this area.”
Article by Akshay Anantharaman
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