Several Schemes, But Bastar’s Adivasi Women Still Remain Highly Anaemic
The acute anaemia crisis in the state is missing from the poll agenda of Chhattisgarh’s political parties
Anaemia among women is a critical health issue in tribal-dominated Bastar, which goes to polls on November 7, along with other parts of Chhattisgarh in a two-phase assembly election.
Upt 80% of people in the Bastar division suffer from anaemia, said the then health minister of Chhattisgarh, T Singhdev. Among the most vulnerable are pregnant women and newborn children who are worst-affected by the condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.
Up to 61% of women aged between 15-49 in Chhattisgarh are anaemic according to the latest National Family Health Survey-5 data. At least 27% are mildly anaemic (10.0-10.9 g/dl), 31% (7.0-9.9 g/dl) moderately and 2.6% severely anaemic (<7.0 g/dl) in the state. Among children, 67% of those between 6-59 months are anaemic, 29% of them mildly, 37% moderately and 2% severely. The overall prevalence of anaemia in children increased from 42% in NFHS-4 to 67% in NFHS-5. The highest prevalence of anaemia is in the age group of 15-49 months and among them, 31.5% have moderate and 2.5% have severe anaemia.
Women in many districts that fall within the Bastar division have higher levels of anaemia than the average in Chhattisgarh– the highest being Kondagaon where 80% women and 77% children are anaemic. In Bastar district, 77% women and 81% children and in Dantewada, 76% women and 90% children are anaemic, show data from the NFHS-5. At least 39.3% Scheduled Tribe women have anaemia compared to 25% from general castes.
Concerned by the high levels of prevalence of anaemia in the Bastar region, which comprises of seven districts, the government of Chhattisgarh started the “Suposhit Dantewada Abhiyan” on June 24, 2019, in the tribal-dominated Dantewada district. This was then extended to the rest of the state under the Chief Minister’s Nutrition Campaign. The aim of the campaign was to make the state anaemia free by 2023.
Despite this health crisis, women’s health is missing from the election manifestos of political parties including the incumbent Indian National Congress. Chhattisgarh ranks third in the Modi government’s ambitious Anaemia Mukt Bharat scheme whose primary strategy is the distribution of iron and folic acid supplements to vulnerable populations. The state is preceded only by Andhra Pradesh and Maharashtra. But the issue continues to be a significant challenge for women in the region.
Chhattisgarh’s tribal population is particularly prone to sickle cell anaemia, a genetic haemoglobin disorder that requires lifelong management and contributes to infant, childhood as well as adult morbidity and mortality. Of the state’s 7.5-million strong indigenous tribal population, at least 20%, especially among the Gond tribe, has the disease.
There is no permanent cure for the disease but with good management of the disease, its severity and complications can be curtailed to improve the quality of life and life span of patients. This is the focus of the National Sickle Cell Anaemia Elimination Mission – to emphasise an integrated approach for both screening and management of SCD with a special focus on prevention and control. But it was introduced very recently – during the 2023 Union budget.
From Mother To Child
Behanbox visited the district hospital in Dantewada, in southern Bastar, which has one of the highest numbers of patients with anaemia. It is here that women come from near and far to get treated. We found women with acute, chronic anaemia, many of them pregnant or postpartum. At least 47% of pregnant women in the state are anaemic, 30.6% moderately and 2.6% severely, per the NFHS-5 data.
Meena Poddami, 30, an Adivasi woman from Katenar block, lies in a bed in the post-labour ward of the hospital, gazing at her newborn. She is frail, her cheeks are sunken and she is on an intravenous drip with glucose.
Meena gave birth at home because the ambulance did not reach her home in time – she is from Katekalyan, a block that is 45 km from the Dantewada district office. “I was experiencing labour pains so we dialled 108, but before it could reach I delivered. We brought my daughter to the hospital and the doctors told us that she was born with severe anaemia,” she said.
According to the doctors, when Meena was brought in she had less than five grams of haemoglobin and was severely anaemic. Even though 84% of women in Chhattisgarh delivered in an institutional facility, only 77% of women from Scheduled Tribes had access to institutional delivery in the state.
This is Meena’s fourth child, she is already mother to two daughters and a son. Post- birth she said she is suffering from acute exhaustion. Fatigue, weakness, dizziness and shortness of breath are typical symptoms of anaemia. Data from NFHS show that 68% of anaemic children were born as second or third in the birth order, 69% between fourth and fifth as compared to 66% born as the first child in the state.
It has been established that anaemia is intergenerational, and this study concludes that the children of anaemic mothers in India have 26 percentage points higher probability of being anaemic. It is thus highly likely that Meena’s youngest daughter is impacted by her mother’s low haemoglobin levels. In Chattisgarh, NFHS data show that 75% of children who had any form of anaemia had mothers who were themselves anaemic, 45% of them had mothers who were moderately or severely anaemic. Anaemia during pregnancy impacts maternal health and birth outcomes, including premature birth, low birth weight and maternal mortality.
No Access To Nutrition, Medical Help
Anaemia is caused by poor nutrition or the inadequate absorption of nutrients, infections such as malaria, parasitic infections, tuberculosis, and HIV, inflammation, chronic diseases, gynaecological and obstetric conditions, and inherited red blood cell disorder. It leaves young children, women in the menstruating age bracket and pregnant and postpartum women particularly vulnerable.
In India, anaemia is the biggest cause of maternal deaths (50%) and the associate cause in 20% of maternal deaths, according to a 2014 study published in Nutrition reported by IndiaSpend. Last year, India reported anaemia among 45% of its pregnant women–the highest in the world–even though there has been a fall of 12% in the last ten years, as IndiaSpend reported in September 2016.
Meena said the hospital staff has been requesting her family to arrange for blood for transfusion because the hospital had none. “My husband is trying but to no avail. If this doesn’t work out, I am thinking I will just have to leave and go home,” she said. The family had been at the hospital for five days when we met her.
She has visited her public health centre all through her pregnancy and was prescribed medicines and a diet that includes fruits. “We live in a remote village where all these things are not easily available. The doctor had asked me to eat pomegranate and apple but they were not available near the village so how could I eat them?” she said.
At the Dantewada District Hospital, we were told that everyday about 150 anaemia patients seek treatment at the out-patient department and about 50-60 are admitted. Among these are at least 10-12 pregnant women.
Many of the patients who have come to the hospital, especially the women, have travelled long distances for treatment. Kumari Vatti is one of them. She is accompanied by her daughter, and her husband’s Aadhaar identification card shows her to be 29 years of age and a mother of three who recently miscarried her fourth pregnancy.
Kumari and her husband are farmers. The paddy harvest is on and the family spends long hours on the field. When she was four-months pregnant and she was working, Vatti suffered a miscarriage.
“I have three daughters, and we wanted a son Which is why we planned another child,” she said. This study indicates a link between abnormal haemoglobin levels and miscarriage though most researchers argue that anaemia has other indirect impacts.
When asked about her diet, she said that the family could not afford any milk or fruits for her during her pregnancy. At the hospital both Vatti and her husband are arranging for blood, with her husband being accompanied by a potential donor.
Rice Gruel And Nothing More
Public health specialist Raman Kataria, in an interview to Behanbox, spoke about the underlying reasons for the anaemia crisis in Bastar. “One of the causal factors is sickle cell and the second, food consumption practices. In addition to this the region suffers from economic disparity adding to the crisis,” he said.
Only 54.5% women in Chhattisgarh consume pulses daily and 38% weekly; 1.4% women eat eggs and less than 1% eat fish or any other form of meat; 75% women eat green leafy vegetables, according to NFHS-5 data. Only 16% of women have milk/curd.
Priyanka Saxena is a resident doctor who deals primarily with anaemia cases at the Dantewada District Hospital. She confirms these diet issues in her patients, most of whom are women. “A major reason for this is the socio economic condition of the people of Bastar. It’s surrounded by hills and forests and access for resources is an issue. The diet of most adivasis lacks critical nutritious inputs. My patients tell me that they mostly eat maad chawal (rice gruel) and only few said they eat any vegetables.”
Frail and drained of energy, Bhatrin Yadav, 40, from Geedam block in Dantewada, was one of Saxena’s patients. Bhatrin was being given blood transfusion at the hospital where she came accompanied by her daughter and her brother-in-law. Her daughter told Behanbox that Bhatrin had developed a fever and complained of exhaustion and swelling in her hands and feet. When she came into the hospital the doctors found out that only 4 gm of blood was remaining in her body.
Blood loss, leading to low levels of iron in the blood and thus anaemia, can be caused by multiple factors. The hospital data accessed by Behanbox showed that the hospital had 2521 patients coming in with anaemia-related concerns in the month of September 2023 alone and of them 176, i.e. 7% were severely anaemic. For January-August, 2023, the number of severely anaemic patients was 1588.
Saxena said that most patients opt for home remedies till a crisis sets in. “Pregnant women refuse to take the iron-calcium medicines given to them,” she said. Community health specialists point out that this reluctance is often due to nausea, a side-effect of iron pills. Alcoholism and lack of awareness are other factors that cause poor health outcomes in the area, she added. Alcoholics are often diagnosed with anaemia, per this study; malaria, common in the region, is another reason.
A nurse at the Dantewada hospital spoke of the frequent emergencies the medical staff faced when women with severe blood deficiencies went into labour. “We mostly ask relatives to arrange for blood and store it at the hospital when pregnant women come in with anaemia. It is a big challenge. One of our concerns is that such a woman could go into shock due to the lack of blood during delivery,” she said.
‘Schemes Not Working’
Among the multiple anaemia-focussed schemes is one called the Mukhyamantri Suposhan Yojana which was launched on October 2, 2019. This scheme, under the Ministry of Women and Child Development and the ‘Suposhit Dantewada’ campaign was first initiated in 2019 to combat rising malnutrition and anaemia among the children and women of Bastar.
But the scheme has not succeeded much, say local activists. “This is a widespread problem among tribal women,” said Soni Sori, a tribal activist and social worker. “Many times our tribal sisters need blood and the hospitals do not provide it, we have had to fight at hospitals so many times. No matter how many health services the government claims, the truth is that tribals are struggling.”
The anaemia eradication campaigns need to address multiple issues,” said public health specialist Raman Kataria. “For an Anaemia Mukt Bharat (anaemia free India), we need more than just the distribution of iron and phosphorus tablets. We have to look at the overall health of people,” he said. “Government food programmes have focused primarily on distribution of rice, grams and pulses but these are often sub quality and polished which takes away their nutritious value.”
Ashwini, a public health associate based in Chhattisgarh, echoed this view. “I feel that the iron tablets alone will not help much, what a woman needs is a nutritious meal and a balanced diet. The impact of the POSHAN Abhiyan, a mission to provide hot, cooked meals for pregnant and lactating mothers and adolescent girls, has fizzled out over time. For example, a lot of pregnant women do not have access to hot cooked meals. The same is true for adolescent girls,” she said.
Sangeeta Sahu, from the Right to Food campaign in Chhattisgarh, said that in Bastar specifically, Suposhan Kendras were created at the Panchayat level where pregnant and lactating women, and children aged between 6 months to 3 years could access nutritious food. “The kendras are underperforming, but meals are provided through the Anganwadi centres; eggs are also being given here. Of course, behavioural and consumption practices take time to change and then, there are questions – how accessible are the kendras for their beneficiaries, is the food suitable. Budgetary issues have also affected the scheme,” said Sahu.
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