Attappadi, Kerala’s only tribal block, has been a blot on the state’s story of inclusive development with recurring infant deaths, mainly attributed to malnutrition and health problems of mothers.
Data from the state integrated tribal development project (ITDP) shows that since 2012, as many as 137 tribal infant deaths have occurred. In addition, there have been around 300 abortions, 90 intrauterine deaths and 21 stillbirths during the period. As a result, the tribal population in the region has been falling alarmingly.
But the state government has now started a new initiative that aims to arrest this slide. Last month, the health department launched a comprehensive healthcare programme for all newly-wed tribal couples in Attappadi. The move aims at improving the health of tribal women and thus prevent neonatal deaths and children born with genetic disorders.
The comprehensive health programme for tribals covers all eligible couples, particularly newly-wed. Under the programme, couples will go through a health screening to diagnose diseases or genetic disorders before they start planning a baby. The screening involves tests for thyroid stimulating hormone, sickle cell disorder, Rh factor, complete blood count, Hepatitis B surface Antigen, Hepatitis C Virus, Diabetic Mellitus, BP and BMI. Based on the health data of each couple, the state will provide specific interventions. Further, the health parameters of the couples will be constantly monitored. Besides medicines, such couples will be given educational sessions on reproductive and child health, drug abuse and family planning.
The pilot scheme was launched in the Sholayur panchayat, which is part of the Attappadi block.
Ponnuswamy and Kalpana, who have been married for three years and expecting a baby now, are one of the first beneficiaries. The couple is undergoing pre-pregnancy health screening, which was quite rare in Sholayur.
At the two such health camps held in Sholayur public health centre, several tribal couples were screened and it was revealed that nine of them were anaemic, three had thyroid deficiency, 10 suffered from sickle cell disorder and nine were infertile.
Based on the test results, the health department has charted out interventions and constant monitoring of various parameters of all the couples concerned. Folic acid tablets are being distributed to women even before pregnancy is planned.
Palakkad’s District Medical Officer (DMO) K P Reetha underscored how necessary this intervention was for the tribal population. “Only healthy couples can give birth to healthy babies. We have to understand their health conditions and genetic disorders, if any, before they start planning a child. Besides, maternal underweight is a major issue, which is going to be addressed through this screening,’’ she said.
The DMO said in the absence of this scheme, couples would turn up before the clinics only after they had already become pregnant, sometimes not even then. In many such cases, effective intervention to improve the mothers’ health was not possible because the pregnancy was already in an advanced stage.
“We want to focus more on all eligible couples to address the issue of infant deaths. In the next stage, we would take this health screening down to the level of adolescent tribals,” the DMO said.
A particular problem is that often tribal couples are reluctant to seek timely medical advice.
“We have not legally registered our marriage or conducted any rituals. Hence, we have been reluctant to approach ASHA workers. In our colony, some women are still reluctant to disclose even when they are pregnant. It is only by the size of a woman’s belly that others come to know about it,’’ said a couple, who has been living together for the last three months and had turned up for the screening camp at the Gonchiyoor health sub-centre.
The reason for this reluctance, according to health workers, is that many tribals believe that if their pregnancy is revealed, somebody would perform witchcraft and harm their child.
Dr Dhanya Raman, a gynaecologist at a government tribal speciality hospital in Attappadi, says many women don’t come forward during the first trimester of their pregnancy due to this belief and this delay is often quite damaging.
“The ideal period for taking folic acid tablets is before conceiving or during the first trimester. If the couples are reluctant, it limits effective intervention. When genetic disorders or other issues remain undetected, treatment becomes risky at an advanced stage of pregnancy,” Dr Raman said.