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− Most women in the surveyed households were thin, anaemic and ate once or at best twice a day. Given that the drought situation was rather severe in some of the areas, especially Karnataka and AP, food was limited to rice/wheat with salt and some chillies. Children too were fed the same food, with the mother’s share being the least. Many women reported that they were given iron/folic (IFA) tablets by the locally appointed auxiliary nurse and midwife (ANM). However, given the very low awareness about the benefit of taking IFA tablets, most of them were irregular in consuming them. Further, very few had taken pre-delivery tetanus toxoid injection, especially in Uttar Pradesh 6 . − Perhaps the most disturbing finding of the study relates to the low level of awareness about health including antenatal care, immunisation and nutrition during pregnancy. Despite the presence of the aanganwadi worker (AWW) and monthly visits by the ANM – nutrition and health education activities are practically non-existent, at least vis-à-vis the poorest women in the surveyed villages and urban slums. While general awareness levels were certainly higher in urban slums, there was little difference in practice. Focus group discussions usually revealed that the monthly visit of the ANM is limited to one specific area in the village and that she rarely moves around, especially to distant settlements mostly inhabited by SC or ST groups. Similarly in urban areas, recent migrants (especially those to the slums at the periphery) are often bypassed by service providers. Respondents admitted that only census enumerators and others doing surveys (like our team) visit them! − The combination of low awareness and poverty of individual households contributes to both poor health of mothers and low birth weight of babies. We could not ascertain the birth- weight as most of the children in the surveyed households were born at home (no records); however, the children looked small and obviously malnourished. Our investigations confirm the macro finding that one-third of all babies in India are born with low birth weight (as compared to Bangladesh where the proportion is 50% and sub-Sahara Africa where it is one- sixth. ‘Low birth weight indicates that the infant was malnourished in the womb and / or the mother was malnourished during her own infancy, childhood, adolescence and pregnancy…Girls and women in South Asia seem to be generally less well cared for by their 6 NFHS-2 (1998-99) reveals that only 52.89 rural and 76.34 urban women were given iron folic acid tablets during pregnancy. If we are to look at Uttar Pradesh, only 32.91 per cent women received IFA tablets! Educational Resource Unit Page 32 April 2003
families… The incidence of low birth weight is one clear marker in this process. Another is the level of anaemia. About 40% of women in sub-Sahara Africa suffer from iron deficiency anaemia, as opposed to approximately 60% of women in South Asia, a proportion that rises to 75% in pregnancy (a staggering 83% in India)’ (Ramalingaswami et al, 1996) Table 13: Key reproductive health indicators, in selected households UP, Karnataka & AP Uttar Pradesh Karnataka Andhra Pradesh Number of mothers profiled 18 18 18 Average age of marriage 13.1 15.1 14.8 Average age of first conception 17.2 16.3 18.8 Average number of pregnancies per woman 6.2 5.4 4.3 Average number of successful deliveries per woman 5.9 5.3 4.1 Successful deliveries 89 out of 114 pregnancies 89 out of 92 pregnancies 65 out of 76 pregnancies Abortions / miscarriages 3 out of 114 pregnancies 3 miscarriages reported 4 out of 76 pregnancies % Children died under 5 years of live born 20.8% 10.9% 14.9% Average number of children per woman 4.7 4.5 3.5 Deliveries at home / assisted by dai (TBA) or relatives 109 out of 110 83 out of 89 68 out of 76 Deliveries in hospital Source: Household survey data 1 only 6 out of 89 8 out of 76 While the age of marriage in the state as a whole is 19 (Uttar Pradesh), 20 (Karnataka) and 18 (Andhra Pradesh), the mean age of marriage in the profiled households is much lower at 13, 15 and 15 respectively. Clearly, very poor households in all the three states record a much lower age of marriage than the state average. Unsurprisingly, the workload of women in the poor households was fairly high, more so in the case of those engaged in daily wage labour and there was no respite evident for pregnant women either. Many women also feared loosing children due to several illnesses that could easily be prevented by vaccinations. Regarding birth control, very few women used Mala D (contraceptive pill) and the dominant measure was female sterilisation. Table 11 is clearly indicative of the overall reproductive health of mothers and their newborn children. Contextualising the findings of this study with larger representative sample surveys Educational Resource Unit Page 33 April 2003
Page 1 and 2: Publication released by World Bank
Page 3 and 4: Acknowledgements My first and heart
Page 5 and 6: LIST OF TABLES Table 1: ICD Concept
Page 7 and 8: GLOSSARY Ab iska kahan fayada hota
Page 9 and 10: Taluka Administrative unit - often
Page 11 and 12: concentric domains that span proxim
Page 13 and 14: Taking its cue from the above frame
Page 15 and 16: The rising cost of healthcare can h
Page 17 and 18: This emerging phenomenon of ‘hier
Page 19 and 20: day workshop in Hyderabad in late A
Page 21 and 22: Profile of the study area: Key indi
Page 23 and 24: stable, Uttar Pradesh continues to
Page 25 and 26: Village Village 1 UP Village 2 UP V
Page 27 and 28: SECTION TWO: THROUGH THE LIFE CYCLE
Page 29 and 30: implicated, wholly or partially, in
Page 31: women. Since, most children began t
Page 35 and 36: Box 4: Devdasi woman of Karnataka K
Page 37 and 38: odies. Running noses, skin rashes a
Page 39 and 40: low, as is knowledge about the link
Page 41 and 42: Box 7: Glimpse of healthcare facili
Page 43 and 44: years, in our sample, suffer from e
Page 45 and 46: Measurements taken in the course of
Page 47 and 48: The problem of irregular food suppl
Page 49 and 50: Box 10: The Aanganwadi worker of th
Page 51 and 52: other services (looking after the c
Page 53 and 54: women who are pregnant and those wh
Page 55 and 56: completed primary education, 13 nev
Page 57 and 58: The same issue was reiterated as we
Page 59 and 60: instance, let us take the example o
Page 61 and 62: gradually becoming more common. Wha
Page 63 and 64: desired. In Uttar Pradesh free text
Page 65 and 66: fuzzy. Learning outcomes are integr
Page 67 and 68: discussed earlier, dry rations seem
Page 69 and 70: mixed village pointing to the need
Page 71 and 72: and further fragment the experience
Page 73 and 74: poverty line. The households survey
Page 75 and 76: databases in recent years on the is
Page 77 and 78: and are able to cross the initial b
Page 79 and 80: contrary to current received wisdom
Page 81 and 82: - Height and weight for age an impo
Page 83 and 84:
eliable and regular immunisation, m
Page 85 and 86:
Table 27: Utilisation of health rel
Page 87 and 88:
Aanganwadi worker irregular +++ +++
Page 89 and 90:
impedes retention in school is the
Page 91 and 92:
for both. Enhancing access without
Page 93 and 94:
SECTION FOUR: POLICY IMPLICATIONS A
Page 95 and 96:
o While in-service teacher training
Page 97 and 98:
Balwadis of Pratham (Mumbai, Delhi
Page 99 and 100:
and monitoring, poor cold chain mai
Page 101 and 102:
BIBLIOGRAPHY AND REFRENCES 1. Aggar
Page 103:
47. Sundaram, K. 2001. ‘Employmen
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