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Using Three Delay Model to Understand the Social Factors Responsible for Neonatal Deaths Among Displaced Tribal Communities in India

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A Correction to this article was published on 15 April 2020

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Abstract

In the tribal region, risk of death among neonates is influenced to a great extent by factors related to the mother such as situation of the mother prior to and post pregnancy, care received before, during and after pregnancy, birth order, and care received by the child during the first few years of his/her life. There is paucity of basic epidemiological data on reproductive health outcomes of displaced people (Hynes et al. in JAMA 288(5):595–603, 2002). Therefore, this study aims to examine the social factors responsible for neonatal deaths among displaced tribal communities in India. Sequential exploratory study design was used to collect data from displaced tribal communities in the state of Odisha and Chhattisgarh during 2016–2017. A purposive sampling method was used to select the sample from the definite population. Results indicate that in total 115 (59.3%) women had experienced at least one child deaths. Analysis of neonatal deaths suggests that about 39.2% women experienced at least one or more neonatal death during the last 5 years. Women who chose to deliver at home experience higher neonatal deaths (47.1%) in comparison to the women who delivered at the health facility (26.0%). The logistic regression analysis indicate that mothers education, place of delivery, utilization of the services, possession of Below Poverty Line (BPL) card and Particularly Vulnerable Tribal Group (PVTG) status are significant predictors of neonatal mortality. The probability of occurrence of neonatal mortality is 60% lower for literate women as compared to the illiterate women. Findings of the study identified three phases of delay that affect displaced tribal women in accessing and receiving health care services. Displaced tribal women are late in recognizing health problems of neonates and delay in seeking medical care due to rooted cultural barriers. Women who participated in this study had low levels of risk perception about delivering children at home and visiting traditional healer for the treatment. This is mainly due to their personal experiences of uneventful deliveries conducted by mothers-in-law or Traditional Birth Attendants (TBA) and sociocultural beliefs. There is need for provision of culturally sensitive instruction to service providers. This would further motivate service providers to sensitize the displaced tribal communities on various free healthcare services available to them.

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Notes

  1. Scheduled Tribes are various officially designated groups of historically disadvantaged people in India.

  2. Earlier known as Primitive tribal group, this is a Government of India classification created with the purpose of enabling improvement in conditions of certain communities with particularly low development indices.

  3. Anganwadi workers (AWW) ensure antenatal and postnatal care for pregnant women and immediate diagnosis and care for new born children and nursing mothers. They administer immunisation to all children below the age of 6 years.

  4. Auxiliary Nurse Midwifery (ANM), is a village-level female health worker in India who is the first contact person between the community and the health services.

  5. Accredited Social Health Activists (ASHAs) are health activist(s) in the community who create awareness on health and its social determinants and mobilize the community towards local health planning as well as increased utilization and accountability of the existing health services.

  6. Anganwadi is a type of rural mother and child care centre in India. They were started by the Indian government in 1975 as part of the Integrated Child Development Services program to combat child hunger and malnutrition. Anganwadi means "courtyard shelter" in Indian languages.

  7. Sequential Explanatory is characterised by collection and analysis of quantitative data followed by a collection and analysis of qualitative data (Ivankov, 2006).

  8. The Village Health Nutrition Day (VHND) manded 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 others mobilize the villagers, especially women and children, to assemble at the nearest AWC. The ANM and other health personnel should be present on time.

  9. Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Health Mission being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among poor pregnant women.

  10. Janani Shishu Surakhsha Karyakram (JSSK) It is an initiative taken by Government of India to ensure better facilities for women and child health services. It is a initiative to provide completely free and cashless services to pregnant women including normal deliveries and c-sections and sick new borns upto 30 days after birth in Government health institutions in both rural and urban areas.

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Acknowledgements

The author would like to thanks the respondents, field investigators, health service providers and local organizations for contributing in the study.

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Authors and Affiliations

  1. Vellore Institute of Technology University, School of Business, Andhra Pradesh, Amaravati, Guntur, Vijayawada, Andhra Pradesh, 522237, India

    Madhulika Sahoo

  2. National Institute of Technology, Department of Humanities and Social Sciences, Rourkela, Sector 2, Rourkela, Odisha, 769008, India

    Jalandhar Pradhan

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The original concept and design for this work was conceived by MS. MS and JP drafted the article. JP critically reviewed the final version of the manuscript.

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Correspondence to Madhulika Sahoo.

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Sahoo, M., Pradhan, J. Using Three Delay Model to Understand the Social Factors Responsible for Neonatal Deaths Among Displaced Tribal Communities in India. J Immigrant Minority Health 23, 265–277 (2021). https://doi.org/10.1007/s10903-020-00990-y

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