Family Planning and Child Care in Rural Tribals of Chotanagpur

On a sample of 498 females in two tribal rural blocks of Ranchi district data on information, attitudes and behaviour in relation to family planning, child care and breast feeding was collected through personal interviews. The data reveal that there was widespread ignorance and misconception about these issues. Health-population education, using audio-visual aids, has been suggested as a remedial measure.

Tribal Socializaiton: Image and Ignorance

Many non-tribals believe, often with a streak of ridicule and contempt, that ignorance and superstition are all-pervasive in the tribal communities. What they are not aware of is their own ignorance and misconceptions about them. The most prevalent, or the only mental image, held by the non-tribals of the tribal mother and the child is that the child is tied on the back of its mother. Beyond this mental image there is hardly anything else that the non-tribals know about tribal socialization. There is also little appreciation of the fact that by tying the child on her back, the tribal mother, who is, almost without exception, a working woman, keeps her two hands free to engage in work. The same practice is also prevalent among the Japanese; but because of their economic and technological progress, what is considered a reflection of backwardness in the Indian tribal community is admired as work-efficiency of the Japanese culture.

The myth of the healthy tribal

As in the case of tribal socialization, so also in the case of tribal health, there is widespread misconception and ignorance. In a recent survey of the health status in two rural tribal blocks of Ranchi district, "the myth of the healthy tribal" has been exploded (Singh et. Al. 1987).

Percentage of families found ill on survey	29%
Percentage of children suffering from malnutrition	75%
Percentage of children with severe malnutrition	44%
Mean age at marriage of Tribal women	15 years
Fertility Rate	6
Percentage  using birth control methods	7%
Percentage of children immunized	<8%

 The mean age at marriage of tribal women was 15 years, two years lower than the national average for rural women. The tribal women also had a higher fertility rate of six children against the national average of four. Scientific information, attitudes and behaviour in relation to health and disease, diet and nutrition, family planning and child care was almost negligible (less than 4%). 

In another study the health status of the tribals of Chotanagpur and Santhal Parganas in Bihar was found to be inferior to that of the Hindus and the Muslims. A further analysis of the data of this research, taking only the women cases, showed that they were aware of the governmental health programs, but they did not benefit from them. Their preference for traditional delivery systems continued; 82% deliveries occurred in the family and 51% preferred it. There is paucity of empirical data on tribal health and family planning. There has also been a lack of appreciation of ‘Socio-Cultural Dimensions of Tribal Health’.

"The massive volume of KAP studies (Knowledge-Awareness-Practice), have failed to unravel the fundamentals of fertility behaviour. This is attributable to the fact that fertility is not treated as an aspect of culture, not is it understood in its wider social context. This implies an understandings of economy, politics, religion, and the domestic life of villagers subtle and complex phenomenon and detailed studies at the micro-level are necessary to gain some understanding of it’. (Chaudhuri 1986b p. 386).

The study based on the data of ICMR(Indian Council of Medical Research) 'Health Modernity Education Project' conducted at the Post-graduate Dept. of Psychology, Ranchi University covered seven dimensions, namely, physical health, mental health, diet and nutrition, family planning, child care, breast feeding and health habits. The concept of health modernity has been defined as "scientifically correct information, attitudes and behavior in relation to physical and child care, personal hygiene and environmental sanitation and such other issues which are essential pre-requisites for healthy living, and therefore, for human and social development (Singh et al, 1987, p. 12). The paper is concerned with the data in relation to family planning, child care and breast feeding.

The sample was drawn from two rural blocks of Ranchi, namely, Namkum and Kanke, including both males and females, in four age-groups, i.e. 15-24, 25-34, 35-44, and 45+. A total number of 498 males and 493 females were taken .

The sample was overwhelmingly illiterate (67% male and 95% female) and poor, 58% having a monthly income of Rs. 200 or less .

Family Planning, Child Care and Breast-Feeding Scales

Three separate scales were constructed to measure information, attitudes and behaviors in relation to family planning, child care and breast feeding. All the three scales were constructed in a way that they had an identical range of scores from 0-50. 

MAIN FINDINGS: OVERALL PICTURE

The sample, males as well as females, had overall extremely un-modern and traditional knowledge, attitudes and behavior on the three issues of family planning, child care and breast feeding.. The percentage of modern scores, that is, those who had scientifically correct information, attitudes and habits ranged from 0 to 4%. This trend is also reflected in the mean scores of all the four age-groups in relation to the calls, as indicated earlier, was 0 to 50, 25 being the mid-point. The mean scores of both males and females, in relation of FP and CC were below the mid-point while the scores of both, males and females, on BF were above the mid-point, even though only a little above it .

Family Planning

Though a majority of them (64%) wanted to prevent childbirth after having the desired number of children, almost all of them (99%) wanted to leave it to chance. None of them wanted to abstain from sexual relations, a higher percentage of men, compared with the women, wanted the women to be sterilized and to take preventive measures. However almost double the number of women (41%) wanted sterilization compared with men (20%). Only 7% of the sample were in fact using any birth-control measure.

Child Care

Their knowledge of immunization, weight of the child at different ages, milestones of development and signs of dehydration was also inadequate. The correct knowledge of the age of immunization of BCG, DPT and Polio varied from 0 to 7%. Only 8% knew about the correct weight of the child at birth. This percentage was even lower (3%) for the child of one year. The percentage of persons having correct knowledge of age at various milestones of development varied from 8% for training over to 40% for standing without help. Less than half of the sample had correct information about the signs of dehydration.

Influence of Age and Sex on family planning, child care and breast feeding.

The tests of statistical significance (t-test) between the four different age-groups for the three scales have been computed separately for the male and female samples as well as for the total sample. The t-test comparisons indicate that the younger age-groups have more modern, i.e. scientifically correct information, attitudes and behavior about family planning, child care and breast feeding. The females, understandably, have obtained significantly more modern scores than men in child care and breast feeding. In FP though the males have significantly more modern scores than females in the total sample, it is only in the youngest age-group of 15-24 years that the t-value is statistically significant.

Areas of Ignorance

Family Planning

In each of the three scales there were about 10 items. The items in which more than 50% of the sample had unscientific and incorrect information and attitudes. There is a strong son-preference because most (84%) of them felt that a son was a necessity for the continuation of the lineage of the family; 82% believed that she should not get a tubectomy done after two children if they were girls. A majority of them (65%) did not know that the sex determination of the child depended entirely on the father and that the mother did not have any role in it. A vast majority of 93% believed that the use of condoms and other contraceptives destroyed sexual pleasure. Similarly again, 93% believed that vasectomy made a man impotent.

Child Care

In addition to the already reported ignorance about the age of immunization, minimum weight at different ages, milestones of development and signs of dehydration, a majority of the sample revealed ignorance about basic facts of child development, for example, 94% believed that a child was only a lump of flesh and bones at the time of birth and the brain developed only afterwards. Eighty one percent did not know about the relationship between weight and health of the child. Almost half of the sample believed that a pregnant woman should not be given any injection.

Breast Feeding

There was widespread misconception and ignorance regarding various aspects of breast feeding. A majority of them (72%) considered first breast milk after child birth harmful to the baby; 69% believed that the mother should not breast-feed her child during illness as it may cause harm to the child; 62% did not know that breast feeding may delay conception. An overwhelming 94% did not know about the necessity of supplementary food to the child after 4-5 months and believed that the child can be healthy only with breast feeding till one or one-and-a-half years.

Conclusions

The data reported in this paper points towards the following:

(1) There is widespread ignorance and misconceptions about family planning, child care and breast feeding in the tribal population. 

(2) Because of widespread illiteracy among tribals, particularly in the women, the importance of health education using audio-visual materials as a remedial measure cannot be over-emphasized.

*Post-graduate Department of Psychology, Ranchi University, RANCHI-834001

**Population Education Resource Centre, Ranchi University, RANCHI-834001

***Council for Social Development, 53 Lodi Estate, NEW DELHI-110003

[1]Professor Amar Kumar Singh is the Principal Investigator of the ICMR Health Modernity Education Project, Drs. S.K. Sinha, S.N. Singh and Meera Jayaswal are Co-investigators, and Dr. M.K. Jabbi is Research Associate. Professors D. Sinha (Allahabad), G.G. Prabhu (Bangalore), S.D. sharma and J.S. Yadav (New Delhi) and Dr.L. Ramachandran (Dindigul, Tamil Nadu) are Consultans. Professor Usha K. Luthra, Senior Deputy Director-General and Drs. Rashmee Parhee and Narendra Kumar of the ICMR are associated with the formulation of the over-all prespective and mointoring of the Project.