|
World Food Programme - India the food aid arm of the United Nations |
|
Home About Us Policies Events Media Publications Vacancies Other Websites All Documents |
|
Adolescent Girls in Tribal Integrated Child Development Services A Pilot Project Funded by USAID Foreword If genuine human development is to be achieved, much more has to be done for women. They should be given priority. Development statistics for women show glaring inequalities with those of men. Although we know that education and good health among women can significantly foster human development, in India, even today, large numbers of women have not been to school, have inadequate access to health ca and food, are overburdened and discriminated against. Development programmes often pay attention to women when it is already too late, after years of chronic undernourishment, after early marriage, when the have given birth to high risk babies at great risk to their health and even their own lives. WFP has worked on an innovative project to reach women earlier and is providing some missed opportunities to girls in their adolescence. Through this project, the young girls receive training on aspects of self care, age at marriage and care of infants. Besides, their self confidence is enhanced through their participation in the village centres of the Integrated Child Development Services. WFP is increasingly focusing its attention towards women's development in the most deprived parts of the country. The "adolescent girls scheme" was tested in the tribal district of Jhabua in Madhya Pradesh. The project is now ready for replication. Our positive experience encourages us to expand this idea to other tribal districts as well. This has of course been a joint effort. The active support of the Government of India and the enthusiastic cooperation of the Government of Madhya Pradesh have been crucial to its success. We are hopeful that the scheme will be introduced in many more districts. WFP is particularly thankful to USAID for the financial support offered for the project. Finally, I would like to express my appreciation of the work of Dr. Minnie Mathew of the Women & Child Development Unit of the WFP India office. Dr. Mathew designed this project and saw it through the first successful phase of its implementation. Michael Ellis, Country
Director March 1994
Abbreviations
Glossary of Terms
Introduction Over the past forty years, life expectancy has improved more than during the entire previous span of human history. Infant mortality has come down; preventable diseases are on the decline, yet disparities exist between developed and developing countries. Absolute levels of mortality in developing countries remain unacceptably high; child mortality rates being ten times higher than those in the established market economies. What people do with their lives and those of their children affect their health far more than anything that governments do. But what they can do is determined to a great extent, by their income and knowledge. In every society, the capabilities, income and status of women exert a powerful influence on health (World Development Report 1993). Focusing on women's development, India does not have much to be proud of, whether it be their health, nutrition, education or participation in the workforce. In fact, gender imbalances get clearly reflected in mortality differentials between sexes. Urban-rural differences are striking, with a larger number of female infant deaths in rural areas. Age-specific death rates clearly indicate higher rates for female children and women upto 35 years of age. The contributory factors to the high mortality rate in the reproductive years of women are mainly anemia and complications in pregnancy and child birth. It is estimated that in India 10 to 15 percent of all births, around 25 million in a year, involve teenage mothers. More than a third of these have had prenatal malnourishment and have low birth weight (LBW) less than 2.5 kilograms. Needless to mention, LBW babies are more susceptible to infection and disease than those having normal birth weight. Also, mortality is three to five times higher in LBW babies, accounting for half to two thirds of all infant deaths. In fact, LBW is the foremost problem in child health, India continues to face today (Rohde 1987). Undernourished teenage mothers, often over-worked during pregnancy, medically signify a high-risk group. Hogberg and Wall (1986) have shown that women younger than 20 years have a maternal death probability two to six times higher than those who belong to the optimum age group. Further, girls who marry before attaining the age of 18 years are likely to end up with a large family. Not only do they face higher risks in their first pregnancy but also compounded risks and related ill-health over their life time. Despite Child Marriage Restraint Act, early marriage and teenage pregnancy are common in India. The 1981 Census showed that around 8 percent of girls in the age group of 10 to 14 and 43 percent in the age group of 15 to 19 were married. As is well known, adolescence begins at about the age of 10 years in girls and 12 in boys. However, the growth achieved and the growth velocity in relation to age are influenced by socio-cultural and economic living conditions. Gopalan (1989) traces disparities in growth to socioeconomic living conditions. Between 14 and 18 years, girls of poor rural communities gain over 5 cm in height and nearly 6.8 kg in body weight as against 2.3 cm in height and 3.5 kg in body weight by girls from affluent sections of population. This is because menarche and consequent growth spurt are delayed by almost one year in the case of poor rural girls. Between 14 and 18 years, there is a significant degree of catch-up of the growth levels of poor rural girls with those of the affluent girls. Thus the growth process continues over a longer time in the poorer group than in the well-to-do. For this reason, it is even more important that conception is delayed till about the 18th year among the poor rural girls. An unfavourable social milieu affects girls' and women's nutrition and health adversely. Their poor status compromises maternal health in many ways compared with boys. Girls often get less education, less food and less health care. Ironically enough, some sections of the society continue to be deprived of the most basic requirements for good health. The 1991 Census reveals that 61 percent of girls are illiterate as compared to 36 percent of boys. This fact confirms the unstated fear that the race for equal opportunity is skewed right from the early stages (Census of India 1991). Educated and trained on proper lines, girls and women become an asset in ensuring social change in a desired direction. Social returns from, female literacy are even higher in terms of reduced fertility, reduced infant mortality, lower school drop-out rates, improved family nutrition and lower population growth, (UNDP 1 990). The positive effects of literacy on important nutrition and health indicators can be seen mostly in the long run. There should be an appreciation of the need to create awareness among the people who need it most. Many of the preventable diseases and deaths caused by inadequate nutritional intake or inadequate health care could be avoided if people were aware of the right choices they should be making. The World Food Programme (WFP) tested an innovative approach whereby adolescent girls were oriented towards leading a healthy life and preparing them for safe motherhood. It was felt that they could be approached through the Integrated Child Development Services (ICDS) scheme which has a wide network of village centres called the Anganwadi Centres (AWCs). The ICDS is no doubt one of the largest and well designed intervention programmes of the Government of India with an emphasis on providing promotion and developmental services to children below 6 years and expectant and nursing mothers living below the poverty line. Apart from being mere beneficiaries they could also be -supporters of the grass roots staff called the Anganwadi Workers (AWWs). In the tribal district of Jhabua, Madhya Pradesh, the project had three main objectives: (a) to improve the quality of ICDS services; (b) to improve the knowledge, attitude and practices (KAP) in respect of nutrition, health and hygiene among adolescent girls who would be trained as ICDS assistants and (c) to attempt an improvement in the KAP among family groups and the community covered by the ICDS. Based on a formal agreement signed between the Government of India (GOI) and the WFP in 1989 a systematic project design emerged. The sheet anchor in this was 'People's Participation'. A considerable amount of time was spent listening to people about their problems and priorities and on their opinions of the project. Community meetings were organized in the villages. Meetings were also held with local school teachers, volunteers of the Adult Literacy Programme, AWWS, their supervisors etc. Their viewpoints provided a broad framework for the project. Also, a baseline study was done to (a) understand the KAP among the adolescent girls and their parents besides their socioeconomic background, motivation and aspiration levels. The problems identified through this indepth study were addressed through a training package for volunteer girls and (b) observations of the functioning of AWCs and interviews with the AWWs helped in the identification of the adolescent girls' role as Anganwadi Assistants and in designing training for them.
Findings
Here, most of the families were observed to be nuclear (52 percent), with an average size of about 6 members. In a way, the population in Jhabua is young, proportion of children below 14 years being 45 percent while those aged above 50 merely 9 percent. The sex-ratio was unfavourable to women (968 females for 1000 males), though the ratio was a shade better than the state average of 932 and national average of 929.
Medicare facilities are limited to 42 hospitals, 286 Primary-Health Centres (PHCS) and sub-health centres. These are supported by 44 Ayurvedic hospitals. This apart, tribals continue to resort to folk medicine and, even to witch-craft. Taken together, 1360 villages scattered all over the district have inadequate health facilities. Operational constraints of the existing health infrastructure often cited by authorities are: difficult terrain, lack of transport and communication facilities, scattered population and unwillingness of health functionaries to serve in PHCs located in deep tribal areas.
Jhabua has a low literacy level of 14.17 percent with a deplorably low female literacy rate of 8.55 percent. Among the rural women, it is still lower, a negligible figure of 3.16 percent. As would be expected and as made out from official data, agriculture is a major occupation, in the district. In spite of being the main occupation, agriculture does not offer a satisfactory livelihood to most tribals. A commonly observed fact is that agriculture as an occupation hardly meets even the primary needs of the tribals. Daily wage earners find work for not more than 192 days in a year. This hardly speaks well of tribal development programmes going on in the district for the last four decades. As per estimates prepared in 1988, 36 percent of the population in Madhya Pradesh was below the poverty-line as against the all India average of 29 percent. Among other developmental efforts, ICDS needs to be mentioned. It was launched in Jhabua in 1976. At present all the developmental blocks have ICDS services. There are 1088 ICDS AWCs under 12 ICDS blocks. On an average, the programme benefits about 74,000 children and 18,000 expectant and nursing mothers everyday. For Meghnagar block, ICDS was sanctioned in 1985 and it became fully operational by 1988. The block has 112 AWCs covering a beneficiary population of 5568 out of which 2119 are children below 3 years in age , 2368 children in the group of 3 to 6 years and 1081 expectant and nursing mothers.
Wide variations were observed in respect of their educational level. While 25 percent were educated below Standard V, 5 percent were Graduates, the modal educational level being Standard VIII. The majority had been working since the inception of ICDS in the block, while the rest were inducted during the course of time with opening of new AWCs in the block. Except for 3, all had
received orientation training and 78 had received either 1 or 2 refresher
courses. As stated by AWWs the topic invariably covered by refresher
courses was pre-school education. Health, hygiene, growth-monitoring,
other nutrition related aspects, management and communication skills were the
others.
Surprisingly, 17.5 percent of AWWs failed to mention even a single@ activity related to supplementary nutrition and only 2.5 percent could mention all important activities related to this component. Records were, however, well maintained in most AWCS. While most of the workers mentioned nutrition and health education as a job responsibility, 7.5 percent of AWWs could not mention a single activity related to nutrition and health education. To many of them growth-monitoring did not seem to be important. About 20 percent of them did not include it in their job responsibilities. Similarly a third described only weighing as their growth-monitoring responsibility. The lack of awareness about the importance of growth-monitoring was evident from the fact that weighing, plotting and counseling of mothers were mentioned by only 7.5 percent of the AWWS. Even the responsibility of record keeping, was not mentioned by 55 percent of AWWS. According to most AWWs (60 percent), their health related
responsibility was limited to informing beneficiaries on immunization
days. Linkages with, other departments were not considered as a duty by
most AWWs (82.5 percent). A large proportion of those who perceived
this aspect as their job responsibility were those with educational levels
higher than matriculation.
Interestingly, a large majority of AWWs (85 percent) were of the view that there was no job responsibility for which they did not find time. But a few reported that, given time, they would have taken children out for pleasure trips, kept children clean and formed women's groups. To take up and fulfill these responsibilities, most of them suggested additional help or enhancement of their own emoluments. Helping children to cultivate habits of cleanliness, lining up for immunization, monitoring growth of children and motivating people to plan their families were difficult tasks according to three fourths of AWWS. But what were the difficulties? Most mentioned: difficult terrain, distances, transport--these adversely affected punctuality and regularity both of AWWs and beneficiaries. They also mentioned low community participation. In this regard, a few AWWs also stressed their own lack of knowledge and skill in the areas of growth-monitoring, village surveys and record-keeping. A few AWWs also included paucity of equipment and lack of cooperation from their superiors and from functionaries in sister departments. Besides, AWWs had quite a few suggestions to resolve their functional problems and improve their quality of work. These included awareness generation in the community on ICDS, additional training especially in growth-monitoring, guidance from superiors and improved coordination with functionaries of the health department. Next, the study project paid attention to beneficiaries,
their background and their involvement in ICDS. A majority of the
beneficiaries (87 percent) interviewed were illiterate. Others who were
literate had very low levels of literacy. They largely depended on
agriculture for their livelihood. Most belonged to nuclear families and
their household sizes ranged between 4 to 10 members.
Almost all pregnant women interviewed were enlisted for ICDS services from the very first month of pregnancy. Most beneficiaries conformed to formal eligibility criteria. The majority felt that they were included in the programme to receive additional food, nutrition and health information and health check-ups. Approximately half the beneficiaries felt that their special needs were being met through ICDS. Others mentioned that facilities were too far away to avail and the supplementary food provided was inadequate. Beneficiaries had also their preferences. Preferred benefits included supplementary food, health check-ups and growth-monitoring. Services looked for by a few included immunization, referral services, vitamin and mineral supplementation and nutrition and health advice. The other side of the picture may also be kept in view. According to the AWWS, almost all beneficiaries had to be persuaded or even brought to the AWC for availing of services. They reported that very few recognized the importance of immunization and still fewer willingly brought their children for immunization. Immunization records were maintained only in 27 out of the 40 AWCS. Only in 10 AWCs all registered children below 1 year received BCG and 3 doses of DPT and Polio. In 6 AWCs all children below 3 years had received booster doses of DPT and Polio. Measles vaccination was given to all children below 1 year only in 2 AWCS. In 12 AWCs all registered expectant mothers received 1 dose of Tetanus Toxoide (TT). Regular participation in ICDS services was reported by just half of the beneficiaries. Others could not recall the period for which their wards participated in the programme. A few mothers also provided some insight into the reasons for irregular participation of their children in ICDS. One mother reported that her child accompanied her to the work-site and 2 mothers complained that there was no one in the family to accompany the child to the AWC. While a majority of the beneficiaries (91 percent) felt that health checkups were necessary, half of them were just not aware of the need for such check-ups. Their awareness of different types of check-ups was equally low. Among 32 expectant mothers interviewed, 22 had been referred for different health problems to the PHC by the AWW. Out of 40 AWCS, Anganwadi records indicated that 15 AWWs distributed folifer tablets and in 4 AWCs all expectant mothers had received folifer tablets for 100 days. Only in 1 AWC were children in the age group of 1 to 5 years given folifer tablets. This was hardly inspiring as far as the distribution of folifer tablets was concerned. In this regard, a few administrative problems came to light. Supply of folifer tablets was the responsibility of the health department. Only 3 AWCs had received adequate stocks of folifer tablets. The viewpoint of the beneficiaries on the issue was also ascertained. Only 1 but of 6 of them reported receiving folifer tablets though the quantity was inadequate. Distribution of vitamin A was equally erratic. In a few AWCS, children below 3 years had received vitamin A during the 6 month period preceding data collection. A few AWWs were mindful about promoting personal cleanliness among children. Hygienic practices at meal-times were observed to be poor in most AWCS: children did not wash hands and the premises were not cleaned. While most AWWs were conscious about sanitation of the AWCS, they were not conscious of cleanliness among children. Nearly two-thirds of AWWs reported having started growth-monitoring of infants beginning their third month. Children below 3 years of age, accounting for 55 percent, were weighed every month, the rest being weighed only once in a quarter. Children 3 to 6 years were weighed every 3 months according to 68 percent of AWWS, every month according to 15 percent and without any fixed periodicity according to 5 percent. However, Anganwadi records revealed that only in 3 AWCs all children below 3 years were weighed during the preceding quarter. No weighing was done at all in the majority of the AWCS. All children 3 to 6 years were weighed during a six-month period preceding observations. Few AWWs recorded the weights on growth charts and marked the growth trend immediately after weighing children, a process meant to facilitate discussions with mothers. Growth cards were not maintained properly in three-fourths of the AWCs studied. Literacy level being low in Jhabua (14.7 percent) and disturbingly low in rural areas (8.5 percent), non-formal pre-school education assumes great importance. Mothers of pre-school children considered pre-school education an important component, their main expectation from this component was that their children would learn to read and write. In a fourth of the AWCS, reading and writing were taught in spite of the emphasis on non-formal methods of teaching. Children were taught numbers and alphabets with the help of songs and rhymes in half of the AWCS. Participation of children was negligibly low. Concepts of size, shape, colour, texture, time, seasons, animals, birds, plants and human beings were all taught in most AWCS. But the method of teaching was not stimulating. There were hardly any discussions with children on the concepts taught. Recitation of poems and rhymes on various themes was quite popular. They were recited one after another with children parroting the AWW. On the other hand, physical activities were not very popular in AWCS. Outdoor space was not utilised for games and the like. But, activities which required no movement of the limbs and limited movement of hands were somewhat popular. Play with mud, clay, activities like drawing, cutting and painting were observed in very few AWCS. What was the profile of the adolescent girls selected to assist in the AWCS? Most of the girls selected for the project belonged to single but large family groups, sometimes with as many as 8 members. The girls were in the age group of 10 to 13 years. Most had never been to school. Others had certainly been to school, but only for a year or 2 before dropping out. The majority of their family members were also illiterate. Parents reported that their daughters were not in school due to the need to work back at home. The girls themselves had similar feelings. As would be expected, most of them belonged to families earning below Rs. 500 a month. Parents had no objection to their daughters undertaking jobs outside their home, especially agriculture related jobs. It was encouraging to note that they were also inclined towards training their daughters in such pursuits as social work, agriculture and other income-generating activities and even household work.
Indeed most of the girls had varied family backgrounds, for example most of their mothers did not know of family planning methods when they were married. However, at present half of them had heard of such methods, yet they seldom practiced them. Likewise three-fourths of them did not view pregnancy as a period requiring any special care. During their last pregnancy only 4 percent had increased their dietary intake, while 21 percent reported no change and 15 percent reported restricted intake. A few had met doctors/health functionaries during pregnancy and still fewer had consumed folifer tablets and only 1 was immunized. The majority of them (81 percent) had their last child-birth at home and were attended to by untrained female or even male dais (traditional birth attendants) or family members. After child-birth, 70 percent reported to having taken rest for brief periods. Very few (6 percent) reported increased dietary intakes. Only 15 percent were examined by health functionaries, but only a half of those who were examined, received comprehensive advice on post-natal care.
Just 20 percent of the girls' mothers initiated breast-feeding within 3 to 4 hours after child-birth, thereby providing colostrum, rich in immunoglobulin. But most of them waited for 3 days before initiating breast-feeding. Instead, they provided prelacteal feeds to their babies in the form of goat's milk, water sweetened with jaggery (molasses) etc. which can be harmful to infants. Breast-feeding was continued up to 2 years; but, almost universally, complementary food was introduced after the sixth month. The type of food mentioned by them reportedly included liquid, semi-solid and solid and the frequency of feeding was usually 3 times a day. On these and related issues, the adolescent girls followed the very same lines and did not largely vary with those reported by their mothers. Child-rearing practices of the mothers of the adolescent girls were further probed. That they did not monitor growth of children was not surprising. What, however, was surprising was that the usefulness of growth-monitoring was not clear to the adolescent girls as well. Only around 68 percent of mothers interviewed got their children immunized, in spite of UIP efforts. BCG shots were received by 65 percent and 3 doses of DPT by only 37 percent and Polio by 47 percent, during the first year. It was, however, gratifying to note that a good majority of the adolescent girls knew that immunization could prevent diseases. But they were not able to connect different immunizations with specific diseases. Throughout the country, especially in tribal areas, the availability of safe drinking water is a critical factor. In the study area, tap water facilities were available to only 6 percent of the households. Hand-pump was the most common source of drinking water (59 percent). However, more than a third of the households had little choice but to depend on other sources such as open wells, rivers and ponds; and almost a half of them did nothing to make the water safe--so much for the large investments under the Technology Missions on Safe Drinking Water. In view of indifferent nutrition, hygiene and health care and unsafe drinking water, widespread and recurring ailments among people, especially among children, were ubiquitous. Common illnesses among children included fever, vomiting, diarrhoea, stomach problems, measles, upper respiratory infections and malaria. Most mothers took their children to hospitals or dispensaries for treatment. Not surprisingly a few living in remote areas resorted to traditional treatment or even 'black-magic'. While only a negligible number of adolescent girls realised the value of nutrition in illness, very many of them considered medical care as important. Though a few adolescent girls and their mothers knew how to prepare Oral Rehydration Solution (ORS) none knew how frequently ORS should be given to children with diarrhoea. They also prepare home made fluids like tea and rice water when children had diarrhoea. However, a few restricted water and fluid intake in conditions of diarrhoea contrary to the requirement. Quite a few of them sought medical consultation when their children suffered from diarrhoea. On the other hand, there were a few who delayed consultation by as much as 1 week or until the child was dehydrated. Almost all the respondents were aware of the locations of concerned (PHCs)/sub-centres. In fact, more than two-thirds of them had visited these health centres, sometime or the other, in spite of the poor accessibility. Health functionaries did visit the centres, but their visits were less frequent than those of respondents. Functionaries were reported to have visited them for preventive as well as for curative purposes. Only diets of 35 percent of the families provided adequate calories. There were a few families (3 percent) surviving on calorie intakes less than 25 percent of the normal requirement. On the day of this survey contact, 40 percent of the households (N=113) had not consumed any pulses. Vegetable consumption was quite low. Meat, fish or eggs simply did not figure on the menu (though the tribals did raise some poultry and cattle stock). Milk and milk products were used by less than a half of them. The use of fat and oils in the diet was very low. A half of the family used no visible fat at all. The family inadequacy was clearly reflected in the diets of the adolescent girls. Only 12 percent of the girls' diet had adequate calories. However, protein intake was adequate for 76 percent. Almost all had inadequate intake of vitamin A and iron intake was alarmingly low for 94 percent. In these circumstances the idea of providing carry-home commodities to the adolescent girls appeared to be a viable one.
Mothers' priority for their daughters included clothes and jewelry. Obviously, the crucial inputs to growth and development did not form part of their felt-needs. Even self-care was not considered all that important. Mothers had not spoken to their daughters on menarche and marriage. Daughters were also not in the habit of seeking advice from their mothers, when they started menstruating. Half of the menstruating girls mentioned using clean old materials, while the others were not particular. As a matter of tradition, they abstained from cooking and other household work while menstruating. They were also segregated from others. Personal hygiene was not necessarily a priority to them. Only 22 percent had a daily bath. Others had their bath twice or once a week or even once in 2 weeks. Adolescent girls and their mothers had active roles in household work and care of infants. They were also busy in the farm when there was farm work or in tending the animals. Less than a third of them were busy for 7 to 9 hours and others for fewer hours. It was difficult for them to specify the number of leisure hours and what they did during leisure hours. They had nothing concrete to do. They either did nothing, wandered around, played, chatted with friends, took rest, or adorned themselves. Furthermore, information gathered through discussions with adolescent girls and families was used in the selection of messages for preparing a training package for them. Understandably, not all problems could be addressed through training packages. Only crucial aspects such as (i) significance of adolescence (ii) personal hygiene and environmental sanitation (iii) feeding of babies (iv) diarrhoea management (v) growthmonitoring (vi) immunization (vii) prevention of anaemia (viii) care in pregnancy (ix) pre-school activities and games for children were selected. The consideration that went into this selective approach was the limitation of time, finance and the girls' own capacity to learn. Similarly, adolescent girls could not be expected to undertake tasks which the AWWs themselves found difficult. They could, however, play a complementary role, thereby strengthening the hands of the AWW. Apparently the training would have a meaningful influence on their own lives. Some of the activities identified for them included: (i) organizing preschool activities including games (ii) ensuring personal hygiene among beneficiaries and environmental sanitation in and around the Anganwadis (iii) reminding beneficiaries about participation in the ICDS services, and (iv) assisting in organizing women's groups for nutrition and health education. Selection of the girls was based on two criteria (a) their own willingness and enthusiasm to participate in the programme and (b) their age. The preferred age group was 11 to 13, the pre-adolescent group who will benefit by the programme inputs. Three girls were attached to the AWC and they worked for 2 days a week in turns. This schedule was flexible to suit their own convenience. They would continue for a period of 2 years. Subsequently, this batch would be replaced by a fresh batch who will be trained and placed at the AWCS. In this way a large number of girls would benefit. For every day of service at the AWC, each girl receives 500grams of Soya Fortified Bulgar Wheat (SFBW) and 125grams of vegetable oil. They are also entitled everyday to a cooked supplementary meal providing 600 K calories and 22grams of protein. This would make up for the calorie gap in their daily diets. Besides, they would also receive folifer tablets for 100 days. Who could be the best trainers for these tribal girls? Certainly it calls for familiarity with their local language and life style and persons who could have constant interaction with them while on their job. These were the main parameters in selecting the ICDS Supervisors and some motivated AWWs to be inducted as trainers for the programme. The training package was used in two stages: first on trainers (numbering 12) and then on AWWs (112) and adolescent girls (336). Training was conducted at the village level in small batches with a good trainer/ trainee ratio. Each batch received training over a 9-day period; the learning process was participatory and discussions dwelt on their knowledge and experiences. The girls learnt by doing, singing and listening. Interesting stories and songs in their own tribal dialect Bhili based on their own cultural practices were included in the training package. To a great extent, this made learning an interesting experience. Pre-recorded cassettes were also used to good effect. Additionally, puppetry and tribal dances added colour and excitement to the programme. Presumably this approach managed to break the literacy barrier. Thus, it can be seen that the findings of the present study shed light on the state of nutrition, hygiene and health in the tribal area. Besides, it provided an understanding of the organization and working of ICDS in Meghnagar block. Put together, these two data angles have gone into developing a training package for the adolescent girls which, from the initial feed-back, appears to be effective.
Recommendations During the course of the baseline study and numerous follow-up visits, considerable insight was gained into the tribal way of life, the working of ICDS and the hopes and aspirations of adolescent girls. Based on this, a few suggestions may be offered which could be helpful in honing up change strategies and development programmes for tribal areas, especially Jhabua. Children in the tribal district of Jhabua either do not enrol in schools or drop out within a few years. This is especially common among girls who have to shoulder household responsibilities when their parents go out to work. Since it is well established that education has a positive influence on family size, birth-spacing, child-bearing and child-rearing practices, there is a strong case for giving a boost to primary and nonformal education in the tribal area. Concerted attention needs in be paid to expanding opportunities for employment and income-generation. By any standard, tribals have low incomes which spawn umpteen problems. Besides, studies have shown that mothers who are agricultural labourers or daily-wage earners lag behind in nutrition and health education. This calls for the provision of alternative employment opportunities within their homes or very near their homes, so that, among other things, they could take care of infants and children. In fact, this may also prevent children from dropping out of school. That in Jhabua forests are fast shrinking is a common observation. It is, therefore, imperative that forestry programmes be expanded not only from the point of environmental protection, but also for providing job opportunities to the tribals at their door-step. Community forestry programmes are likely to be a boon, particularly to tribal women, who often walk several kilometres to gather fire-wood. All this becomes still more important in view of the phenomenon of migration as it obtains among Bhils in Jhabua. To them, agriculture provides inadequate sustenance. It is thus hardly surprising that many among them, after sowing a crop, leave their village/district or even state for daily-wage work in industrial towns, only to return at harvest time. The need to increase job opportunities is pressing in Jhabua. Indeed, schemes do exist for cottage and small scale industries but they need to be further encouraged. Similarly, entrepreneurs should be made aware of the subsidies and tax-concessions for setting up industries in this backward area. Even a cursory look at the topography of this district brings out the perennial shortage of water. Centuries of deforestation has affected rainfall, as also the sub-soil water. In turn, it has adversely affected agriculture. Furthermore, the problem of drinking water has surfaced in a terrifying way. Several water borne diseases (eg. diarrhoea, dysentery, cholera, guinea-worm etc.) have become almost routine. In this direction, much has been achieved through National Technology Mission on Safe Drinking Water; but much remains to be done and must be done, on a priority basis. Apparently, nutrition level in this tribal region is low. This is still more disturbing in relation to adolescent girls: their dietary or calorie gap is large and micro-nutrient deficiencies are noticeable. These nutritional deficiencies hardly equip them for child-bearing and child-rearing. With this in view, they need to be supplied with vitamin A and folifer tablets, either through the PHC or AWC network. Jhabua does have a network of health services, though far from adequate. Several tribal settlements are far away from PHCs or subcentres which have unfilled positions. All this has had serious repercussions on the health practices among the tribals. This necessitates the revamping of the medical network. Besides, the viability of organising mobile clinics needs to be earnestly examined. It is a sad commentary on the planning of health services that even to this day child-births take place at home attended by untrained dais, using crude equipment to cut the umbilical cord. This becomes an important cause for infant mortality. Such deaths are not reflected in official records as they do not take place in hospitals. In this context, there can be no gain saying the importance of training village dais on a priority basis. In view of the low knowledge, attitude and practices (KAP) among the tribals on basic nutrition, health and hygiene, it is important to organise nutrition and health awareness programmes. While doing so, content and format for nutrition and health education programmes should be evolved based on a proper understanding of local problems, culture and practices. It should be recalled that ICDS has been in operation in Jhabua for quite some time. Through a network of ICDS blocks and AWCS, it has provided development services to children and women. If any region needs these services, it is this tribal district. Over the years, ICDS has made its presence felt. But it could be further strengthened and streamlined, perhaps on the following lines. Indeed, AWCs make for the cutting-edge of the ICDS programme. If their Organisation and working are not up to the mark, the possibility of disenchantment and indifference among tribals would be difficult to rule out. In this connection punctuality in their opening and closing time assumes a definite significance. But, many AWWs do not appear to be mindful and much of this irregularity could be traced to inadequate supervision and monitoring. Many AWCs have just not been visited by supervisory staff for months together. Several AWWs are hardly aware of the gamut of their job responsibilities. When asked, few are able to mention main ICDS components. This is well reflected in the manner beneficiaries are selected, growth of children monitored, supplementary nutrition provided and the manner of conducting home visits. In fact, none of them were able to mention all the ICDS components. Clearly, procedures involved in the selection and training of AWWs have much scope for improvement. It follows that AWW training needs to be more job-oriented. This could be easily achieved through a careful selection of the training-content, and of methodology duly anchored to training needs of the participants. Class-room work, practical visits--all of them should be related to the field reality. This may circumvent the difficulties functionaries face in translating their training experience to situation. In the delivery of the elementary health services, AWCs have the potential of making some difference, given the necessary support. The example may be cited of distribution of foiifer tablets. At present, the distribution is woefully irregular. This situation could be improved, if the distribution is made through the ICDS infrastructure which has a wider reach than the health infrastructure. In AWCS, growth-monitoring is indifferent, if not neglected. One way of bridging this gap would be to intensify inputs. AWWs need to be trained in all aspects of growth-monitoring including weighing, plotting and counselling of mothers. They should be further encouraged to link growth-monitoring with nutrition and health education. The weakest link, however, is the nutrition health education. The need to improve awareness among beneficiaries on hygiene, family size, birth-spacing and the like is urgent. It is suggested that AWWs along with Supervisors organise community meetings at least once a month in a village on nutrition and health using audio cassettes, puppets or other aids. Attention should also be paid to the pre-school component of ICDS. The AWWS, no doubt, have learnt a number of pre-school activities, songs, rhymes, games, stories, and the like. Unfortunately, these activities are seldom conducted in AWCS meaningfully and purposefully. On the other hand, children in a TRIBAL AREA LIKE Jhabua badly need them. Assuredly, there is a need for improving the quality of preschool education. Perhaps, ICDS supervisory staff could do much in this direction. The AWWs are often tied to the AWC routine and rarely do they Tiave time for home-visits, field counselling, outings or group meetings in villages. Should some spirited villagers come forward, activities of an AWC are bound to receive an impetus. Moreover, some innovative approaches could be tried to step-up the involvement of volunteers. Few AWWs have adequate communication skills. The best they often do is to haltingly request beneficiaries to visit AWCs without convincing them of the need for doing so. It is not enough to provide AWWs with communication materials, they should also be imparted the necessary skills for using them. It hardly augurs well for ICDS that it remains merely a government sponsored programme. Only with adequate people's participation is it likely to fulfill its quantitative and qualitative objectives. This assumes special relevance in the social scene of Jhabua. Tribal dwellings or settlements are often dispersed over a large area. Quite a few AWCs are difficult to reach. As a consequence, when an AWW is late in arriving or remains absent, the helper only prepares the supplementary meal and distributes it. What is more, few AWWs are subject to supervision or monitoring worth the name. This brings up a possibility. Should the pre-existing local committees not be entrusted also with the supervision responsibility? There is no denying that development programmes for women are important for two specific reasons: first these cater to women's specific development needs and second these are regenerative in their effect This is explains the need for focusing attention on adolescent girls in Jhabua. Adolescence is an important stage in life which offers one more promise in life for growth and development. Do adolescents in Jhabua have adequate opportunities to grow and develop to their fullest" potential? The present study brings out that the nutritional intake of the tribal girls is abysmally low and equally low is their KAP of nutrition, hygiene and health. For these inadequacies, not only will they pay, but also they are likely to pass it on to the next generation. Should they be left to fend for themselves? Or else, can some innovative approaches be evolved to get over the problem? Could they be oriented or trained as has been done in the present case, in AWC work ? It is strongly felt that girls in Jhabua as in other tribal areas could be encouraged to gainfully participate in development programmes. This is likely to benefit them and future generations. Furthermore, this would be a visible symbol of people's participation in change and development. While doing so, orientation or training programmes must be rooted in the tribal realities. Most tribal girls are illiterate, ignorant and even superstitious. In view of this, the training package evolved should be simple, transparent, down-to-earth and interesting. The thrust of the training should strive to respond to local aspirations. Nutritional and health education programmes for adolescent girls, especially for those with limited exposure to education and media, are very important to help them adopt appropriate nutrition and health practices, and to equip them for adulthood. Since literacy was found to have a strong positive influence on family size, child spacing and a definite influence on the adolescent girls' KAP, it is very important to invest in education, both non-formal and formal, especially in areas where literacy levels are very low. The dietary calorie gap, identified through the 24-hour recall method needs to be bridged through dietary supplementation, nutrition and health education and ultimately by providing family food security. This will greatly help them to attain optimum body-build. The micro-nutrient deficiencies in the diet of adolescent girls, especially those of iron and vitamin A, need to be addressed through prophylactic and therapeutic measures. These steps will also go a long way in reducing future maternal and infant mortality risks. Delaying the age of marriage for especially the undernourished girls Is very important to permit them adequate time for achieving optimum physical development. Lastly, it may be observed that the people in the tribal district of Jhabua have been subject to indifference and even neglect, for centuries. For quite some time, planned efforts have been made to better their quality of life. Health, nutrition and child development programmes could readily be mentioned in this regard. Nevertheless, their impact has hardly been commensurate to efforts. Perhaps, they have been planned from above or else, they have been inadequately aligned with tribal realities. For a balanced development , these inadequacies need to be taken care of, as this is critically important for bringing girls into the development mainstream.
|
|
World Food Programme 2 Poorvi Marg, Vasant Vihar, New Delhi - 110057, India Tel:91-11-26150000, Fax:91-11-26150019
Contact:
|