The excluded people

The continuing tale of malnutrition and alarmingly high infant mortality rates in Maharashtra's tribal districts is also a tale of abject poverty, denial of basic facilities and exploitation.

DIONNE BUNSHA in Nandurbar district

EIGHT-MONTH-OLD Gomi was at the age when she should have been able to crawl. But when we met Gomi and her mother Jatribai Bila Padvi in Kua village, Nandurbar district, the infant could barely raise her hand. Extremely weak and undernourished, she had been falling ill repeatedly. "She always has fever or diarrhoea. It's difficult to keep taking her to hospital. It's too far (11 km) and the doctor's medicines don't seem to work," said Jatribai. Besides, Jatribai had two other children to look after and had to work every day unloading sand from trucks. Her husband had gone to Gujarat in search of work. The local anganwadi (child care centre), which is supposed to provide food for the infants every day, has failed to do so. "They don't give the children anything. What's the point of taking them there?" Jatribai asked. Five days after this correspondent met Jatribai, her daughter died.

"Every hour in Maharashtra, there is an avoidable death of one tribal infant," says Dr. Abhay Shukla, a researcher from the Centre for Enquiry in Health and Allied Themes (CEHAT). "There would be 9,717 fewer deaths of tribal infants every year if the infant mortality rate among tribal children in Maharashtra was to improve and become the same as that among children in the high standard of living index population," he added. According to the National Sample Survey Organisation (1997), more than half the families in Maharashtra do not get enough to eat.

A survey carried out this year by the Maharashtra State Tribal Research Institute highlights the alarming levels of hunger and deprivation in the State. It found that three out of four infants in the predominantly tribal district of Nandurbar were malnourished. The survey also exposed the State's failure to record 57 per cent of the malnutrition-related infant deaths in Nandurbar's tribal hamlets. The findings of the Tribal Research Institute study are confirmed by a two-year survey conducted by the organisation SEARCH, which found that around 70 per cent of infant deaths in Maharashtra go unrecorded. These findings expose the state of public health services. But, more important, they reveal the extent of poverty and deprivation that exist in what is considered one of India's most developed and prosperous States.

"The massive contrasts and the number of avoidable child deaths taking place among the tribal population are obvious," says Dr. Shukla. The tribal areas, which account for 9.25 per cent of the State's population, have alarmingly high infant mortality rates. He points out that the mortality rate for children under five years of age in the tribal areas is 92.3 (for 1,000), which is much higher than the Maharashtra average of 69.9. That means more than nine out of 100 tribal children die.

The high death rate in the tribal areas reflects the lack of availability of health services. Health centres are far from the remote hamlets. Where they do exist, most primary health centres (PHCs) are not properly equipped with either medicines or trained personnel. For example, the remote Horaphali primary health centre in Nandurbar is operated from the government doctor's house itself. "There are no proper facilities for deliveries here. There is neither a bed nor a delivery table and there are no sterilisation facilities," says a local worker. Each village is supposed to have an auxiliary nurse mid-wife (ANM) to help in deliveries and dispense basic medication, but very few ANMs live in these remote areas. The posts of 4,000 multi-purpose health workers, who are meant to form the base of the public health system, are lying vacant, says Dr. Shukla.

The decline in government health budgets as a consequence of the implementation of structural adjustment programmes is also a reason for the pathetic state of health services. "Health expenditure in Maharashtra fell from 1 per cent of state domestic product (SDP) in the 1980s to 0.6 per cent in 1998-99. As a proportion of total government spending it dropped from 6 per cent during the 1980s to 4.5 per cent in 1998-99. As a result, expenses have tripled for inpatient care and increased by 50 per cent for outpatient care during the period from 1986-87 to 1995-96," says Ravi Duggal from CEHAT.

Getting to the PHCs is itself difficult, owing to the rough terrain and the lack of transport facilities. Ronkabai Vasave's two-year-old daughter died on March 30, while they were on the way to the government hospital in Akalkua from their village Kua in Nandurbar. "She was very weak and had a severe stomach ache and was vomiting. We left at 7 a.m. and reached Khapar at 2 p.m. The people in the dispensary there told us to take her to the hospital. She died while on the way," says Ronkabai. Many of the sick have to be carried across rocky and hilly terrain to local health centres or hospitals. On the road, this correspondent came across two men carrying their sick brother across 30 km to a dispensary. They had left their village at 5 p.m. and still had miles to go when one met them the next morning.

Besides health services, preventive child care is inadequate, although government infrastructure for anganwadis exists. Many mothers find no benefit in sending their children to the anganwadis because food is not distributed properly there. Says Dr. Shukla: "Around 35 per cent of children eligible for food under the Integrated Child Development Scheme (ICDS) are not receiving food, according to government estimates. The actual percentage, especially in tribal areas, is likely to be higher."

Records at the anganwadis, where the nutritional status of infants is supposed to be monitored, are far from complete. This is where under-reporting of the extent of malnutrition and infant deaths begins. At Kua village, two-year-old Bharat Singh Ramsingh Padvi's weight recorded in the anganwadi was 7.8 kg, and he was classified as Grade 2 indicating moderate malnutrition. However, when weighed 10 days later in the presence of this correspondent, he was 6.2 kg - which is just short of Grade 4, indicating severe malnutrition. Under-reporting has concealed the severity of the situation. The government survey found that in the 143 families surveyed 158 children had died, but only around half of these deaths had been recorded.

The tale of malnutrition and child deaths is also one of abject poverty and exploitation in Maharashtra's tribal districts. Forests, the main source of livelihood for adivasis, have been denuded. Most tribal people are still considered encroachers in the jungle, thanks to outdated forest laws. Says Ranshod Shera Tadvi from Ambabari village: "Here in Nandurbar, our forest was wiped out by logging contractors around 40 years back. Forest guards watched as huge trees were hacked. The Satpura hills are bare now." He continues: "Yet we are not allowed to cultivate anything even on this vacant land. Forest officials keep harassing us for bribes. In some places they have planted trees where people used to grow crops."

Unemployment is so severe that most families migrate to Gujarat to work in the sugar industry and at construction sites for around six months in a year. Essentially constituting landless or small tenants, most families are food-deficit here. Of the 143 families surveyed by the government, 86 per cent were food-deficient, and 78 per cent did not have enough food for six months or more in a year. A fourth of the families surveyed were landless and 72 per cent were landless or owned less than three acres (1.2 hectares) of land. "The highly exploitative rent for tenanted land (50 per cent of the produce) is an indication of the absence of employment opportunities," says the Tribal Research Institute survey.

Many of the landless people who have been farming on degraded forest land are now demanding title to this land, citing a 1995 Supreme Court judgment that gives tribal people tilling denuded forest title to the land. "The government will only give us land if we are criminals," intones Ranshod Shera Tadvi, ridiculing the government rule that will only give title to those who can produce receipts for fines paid to forest officials between the years 1972 and 1976 as proof that they have been farming the land. "They will do anything to deny us land," says Ranshod. Even those who survive by gathering forest produce are finding it harder to obtain. "Since there's hardly any forest left, it's difficult to find as many tendu leaves as we once used to," says Hatibai Kirti Padvi, who picks and sells tendu leaves, used to make beedis. Women collect firewood also to earn a daily wage. But the trek is getting longer and tougher. "We walk more than 6 km uphill and back again to collect wood. Then, at 2-30 a.m. we leave for the market, carrying bundles of 10-20 kg of wood. We return around 8 a.m., cook and leave by 10 a.m. for the jungle again," says Mandu Sonilal Tadvi, narrating her routine. At the end of the day, she earns between Rs.15 and Rs.30, depending on how much wood she has collected and how much the traders in the market would pay.

The Employment Guarantee Scheme (EGS), meant to provide work to the rural unemployed on public infrastructure projects, provides no benefit here. "EGS works exist only on paper. Either contractors don't execute the work or they get the roads built by machine and manipulate the paperwork," says activist Sanjay Mahajan. A government survey in Nandurbar found that EGS works that exist in government records are neither close to tribal settlements nor do they provide work for long enough periods. Says the survey report: "That the EGS is not answering the needs of the tribals is evident from the fact that they continue to migrate to Gujarat to work under harsh conditions. They place themselves at the mercy of contractors, have to work for 14 to 18 hours a day, live in grass shelters, migrate away from their homes, in preference to accepting the employment offered by the government."

Not only are people in these remote regions deprived of access to land and employment, but they are denied their right to basic education. Schools in these parts exist mainly on paper. "Look at the school here. The master visits once a month. There isn't a roof," says Pesribai Padvi from Kua village.

For most tribal people, there seems to be no way out of this cycle of deprivation and exploitation, in the forest and also when they migrate. Yet, government officials use old prejudices to attribute their poor health to their 'tribal lifestyle'. "They are not educated, marry very young, have so many children and don't bother with hygiene," said a health worker. Later, the true reason for her misconceptions was revealed. "We don't understand their language. It's difficult to understand what the patients are saying," she said. As Pesribai Padvi puts it, "They blame us to cover up their own failings. Many of the women who lose their children are over 30 years old. How can they say our children die because we marry young?"

Adivasis in these hamlets have to deal with more than just prejudices. Systemic exploitation continues to work against them, not only depriving them of what is rightfully theirs but snatching away the lives of their children. Until their rights are enforced, it is likely that their lives, as well as the forests, will continue to be wiped out.

Malnutrition in Maharashtra

1993: Pneumonia and other ailments kill about 316 malnourished children, aged up to six, between July and November in the Melghat area of Amravati district. A majority of the malnourished children belong to the Korku tribe in the backward Melghat area. A number of the children admitted in health centres are found to have been prematurely taken out by their guardians. However, on closer inspection of the circumstances, their actions are found to be understandable. The primary health centres did little to win the confidence of the tribal people. Their personnel were apathetic and the medicines were often out of stock. The tribal people therefore preferred to trust their padyals (tribal medicine men).

In the Chikhaldara taluk, food prepared from cereals and pulses procured locally, through an Integrated Child Development Scheme (ICDS) network of village-level anganwadi (child care centre) workers is distributed. In Dharni taluk, on the other hand, a wheat-based supplement known as sukdi, prepared by the Maharashtra State Cooperative Marketing Federation (Markfed) is distributed under the ICDS. This helps sustain children up to the age of six, pregnant women and nursing mothers. However, in October-November the distribution is abruptly stopped. According to Markfed, the government refused to pay the higher price the federation sought for the sukdi as the prices of wheat had risen. This sudden deprivation of an important source of nutrition contributes to malnutrition, infant deaths and still births.

- see Frontline, November 19, 1993.

1995: As the 11.5 lakh adivasis in Dhule district depend on a single annual crop for their nutrition, protein deficiency widespread in the tribal pockets of the region. The crop is poor and any failure of the public distribution system would have caused a substantial death toll. However, the distribution of sukdi to children up to the age of six, pregnant women and nursing mothers under the ICDS prevents that eventuality. Unfortunately, sukdi, which was supposed to be only a food supplement, becomes a complete meal in itself. Moreover, the success of the anganwadis depends on their accessibility and the earnestness of their workers. They do not work well in Khadki and other regions in the remote interior areas of the State.

- see Frontline, June 16, 1995.

1996: According to newspaper reports, 740 quintals of wheat are supplied to Chikhaldara taluk for distribution in June, but only 140 quintals are lifted. Likewise, though 370 quintals of rice is supplied to the area, only 67 quintals is lifted. In other words, even if the food is locally available, the villagers are not able to afford it. Malnutrition rates in Chikhaldara are alarmingly high. According to sources in the State Health Department, until the end of July an estimated 34,000 children have been affected by malnutrition of different grades. Of these, 242 suffer from Grade 4 malnutrition, which is the most serious.

- see Frontline, October 4, 1996.Compiled by Shonali Miriam Muthalaly.