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Institutional Interventions & Safe Motherhood in Odisha: Evidence from NFHS-5

According to NFHS-5, 20.5% of the women aged 20-24 years were married before the age of 18 years in Odisha.

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Teenage pregnancies and child birth are perhaps two important issues related to gender, which has been widely discussed and debated in Odisha. This particular piece is an attempt to understand the interventions in this area by the state. Using the recent data released for the fifth round (2019-21) of the National Family Health Survey (NFHS-5), we look closely at the institutional capacity of the state to align the strategies in line with achieving Safe Motherhood Goals in Odisha.

Child marriage is the direct outcome of the societal pressure on women’s sexual autonomy. The most serious impact of an early marriage is early pregnancy.

According to NFHS-5, 20.5% of the women aged 20-24 years were married before the age of 18 years in Odisha.

The district with the highest proportion of women in this category is in Nabarangpur with 39.4% where as Sambalpur had the lowest percentage with 7.4%.

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The percentage of child marriage in the districts like Dhenkanal, Anugul, Baudh, Baleswar, Gajapati, Kendujhar, Mayurbhanj, Malkangiri, Rayagada, Koraput, Nayagarh and Nabarangpur is more than the national average of 23.3%. It is to note that low age at marriage is an important factor which has adverse consequences on maternal and child well-being. As per NFHS-5, women aged 15-19 years who were already mothers or pregnant at the time of the survey in Odisha were 7.6% (no change from the previous round, i.e. NFHS-4 (2015-16). This issue is more prevalent in rural areas (7.9%) than in urban areas (6.1%). The districts like Mayurbhanj, Baudh, Kendujhar, Anugul, Malkangiri, Ganjam, Nayagarh, Dhenkanal, Rayagada, Debagarh, Koraput, Nabarangpur, Baleswar and Jajapur had a higher percentage than the state. In NFHS-5, the district with the highest number of women in this category is Mayurbhanj with 17.2%, whereas Sambalpur had the lowest percentage with 0.9%.

In the present day too, less than one percent of the women have begun child bearing at the age of 15 years, which sharply rose to 10.7% in the age category of 18 and further doubled at the age of 19 years, i.e. within an age gap of one year.

Going by Social category, it is seen more among the Scheduled Tribe women (9.3%), closely followed by Scheduled Caste (7.9%), Other Backward Castes (7.1%) and Others (5.2%). Religion wise, the incidence is high among Christians (9.7%), followed by Hindus (7.6%) and Muslims (2.7%). One should keep in mind that in a patriarchal context, the society visualises the sexuality of a teenage girl as problematic and hence the incidence of child-marriage and teenage pregnancy especially in rural context

Policy Initiatives That Help

Many initiatives have been initiated to achieve safe motherhood goal in Odisha. There exist several note-worthy interventions - the foremost being the creation of Department of Women and Child Development (DWCD) - the wider mandate of which is to facilitate comprehensive development of women and children through effective institutional interventions. Such interventions include introduction of exclusive policy on girls and women in 2014, establishment of District Child Protection Units in all districts, conduct of workshops and training programmes that focus on gender sensitisation, creation of awareness through leaflets in Odia language on Prohibition of Child Marriage Act and initiation of mass pledge on “No to Child Marriage” to mention a few.

However, we have a long way to go in achieving desired results since the proportion of women (aged 20-24) who were married before the age of 18 years declined by less than 1% between NFHS-4 and NFHS-5. They still account for a little more than one-fifth of women in this cohort. This has resulted in early pregnancies, abortions, early age deliveries, neonatal mortality, post-neonatal mortality and infant mortality, for which women are often not physically or mentally prepared. NFHS-5 reveals that when the mother’s age is below 20 years at the time of birth, the neonatal mortality is 31% and 27% with the mother’s age 20-29 years, at birth. Post-neonatal mortality is 10.3% with mother’s age at birth less than 20 years compared with 9.7% with mother’s age at birth 20-29 years. Infant mortality is 41.3%, with the mother’s age being less than 20 years compared to 36.7% of the mother’s age at birth 20-29 years. In efforts to completely wipe out child marriages in Odisha by 2030, a Strategic Action Plan (2019-2024) was initiated by DWCD and the Mission Shakti. The District Collectors while preparing the Gram Panchayat Development Plans are directed to include an exclusive plan for campaign against child marriage. There are budgetary provisions available under the Pancahayati Raj institutions to undertake wide-scale awareness programmes at village level.

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Contraceptive Burden

However knowledge about family planning methods has a direct bearing on pregnancy/ motherhood, which is the primary deciding indicator of the health and wellbeing of a woman. As per NFHS-5, only 48.8% of the currently married women aged 15-49 years are using any modern method of family planning. There is a 3.4% increase in such usage compared to the levels under NFHS-4. The sterilisation method has emerged as one of the leading and popular family planning techniques, but it is mainly performed on the woman from the husband-wife cohort. This is backed up by the data on male sterilisation, which is zero in the districts like Anugul, Bargarh, Bhadrak, Debagarh, Ganjam, Jagatsinghpur, Jajapur, Kendujhar, Nabarangapur, Puri and Subarnapur. Even the lowest share of female sterilisation stood at 19.2% (Kandhamal district). Thus, the need of the hour is to strengthen the awareness regarding the benefits and impact of sterilisation process irrespective of gender so that more men would also participate in this process. In Odisha, it can be observed that the presence of a son determines the usage of the contraceptive method (any modern method) - it is 61.1% among women aged 15-49 years with at least one son (among two kids) compared to 44.6% of women with two daughters.

A close correlation exists between the level of education and teenage pregnancy. NFHS-5 reveals a higher incidence of women age 15-19 who have begun childbearing (23.5%) with no schooling than those with less than five years of complete schooling (21.8%). There is a sharp decline from 21.8% to 7.9% of women with 5-9 years of completed schooling whereas only 5% of women reported childbearing with 10-11years of completed schooling. In other words, 10-11 years of complete school education reduces the childbearing risk by more than four times compared with no education. The pertinent question here is: Can educating the girl

for additional number of years will remove the problem or how does one negotiate with patriarchal norms in allowing the girl child to continue education?

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The latter requires change in mindset and pre-conceived notions about the role of women in society which are often skewed, unequal and discriminatory. Despite ingenious and substantive efforts by the governments and various stakeholders (community and civil society organisations), the aforementioned factors accompanied by the deep-rooted patriarchal mindsets emerge as major hindrances to the upliftment of women with the freedom to educate themselves, eradication of child marriages and information and access to healthy reproductive choices. An immediate requirement is a multi-pronged approach involving all the stakeholders and government towards sensitisation and awareness on the benefits of educating a girl.

(Sujit Kumar Mishra is a Professor of Council for Social Development, and Sanjaya Kumar Mishra is Lecturer, KV College, Kantamanji, Odisha)

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Policy Interventions That Have Helped 

Many initiatives have been initiated to achieve safe motherhood goal in Odisha. There exist several note-worthy interventions - the foremost being the creation of Department of Women and Child Development (DWCD) - the wider mandate of which is to facilitate comprehensive development of women and children through effective institutional interventions. Such interventions include introduction of exclusive policy on girls and women in 2014, establishment of District Child Protection Units in all districts, conduct of workshops and training programmes that focus on gender sensitisation, creation of awareness through leaflets in Odia language on Prohibition of Child Marriage Act and initiation of mass pledge on “No to Child Marriage” to mention a few.

However, we have a long way to go in achieving desired results since the proportion of women (aged 20-24) who were married before the age of 18 years declined by less than 1% between NFHS-4 and NFHS-5. They still account for a little more than one-fifth of women in this cohort. This has resulted in early pregnancies, abortions, early age deliveries, neonatal mortality, post-neonatal mortality and infant mortality, for which women are often not physically or mentally prepared. NFHS-5 reveals that when the mother’s age is below 20 years at the time of birth, the neonatal mortality is 31% and 27% with the mother’s age 20-29 years, at birth. Post-neonatal mortality is 10.3% with mother’s age at birth less than 20 years compared with 9.7% with mother’s age at birth 20-29 years. Infant mortality is 41.3%, with the mother’s age being less than 20 years compared to 36.7% of the mother’s age at birth 20-29 years. In efforts to completely wipe out child marriages in Odisha by 2030, a Strategic Action Plan (2019-2024) was initiated by DWCD and the Mission Shakti. The District Collectors while preparing the Gram Panchayat Development Plans are directed to include an exclusive plan for campaign against child marriage. There are budgetary provisions available under the Pancahayati Raj institutions to undertake wide-scale awareness programmes at village level.

ADVERTISEMENTREMOVE AD

Contraceptive Burden

However knowledge about family planning methods has a direct bearing on pregnancy/ motherhood, which is the primary deciding indicator of the health and wellbeing of a woman. As per NFHS-5, only 48.8% of the currently married women aged 15-49 years are using any modern method of family planning. There is a 3.4% increase in such usage compared to the levels under NFHS-4. The sterilisation method has emerged as one of the leading and popular family planning techniques, but it is mainly performed on the woman from the husband-wife cohort. This is backed up by the data on male sterilisation, which is zero in the districts like Anugul, Bargarh, Bhadrak, Debagarh, Ganjam, Jagatsinghpur, Jajapur, Kendujhar, Nabarangapur, Puri and Subarnapur. Even the lowest share of female sterilisation stood at 19.2% (Kandhamal district). Thus, the need of the hour is to strengthen the awareness regarding the benefits and impact of sterilisation process irrespective of gender so that more men would also participate in this process. In Odisha, it can be observed that the presence of a son determines the usage of the contraceptive method (any modern method) - it is 61.1% among women aged 15-49 years with at least one son (among two kids) compared to 44.6% of women with two daughters.

A close correlation exists between the level of education and teenage pregnancy. NFHS-5 reveals a higher incidence of women age 15-19 who have begun childbearing (23.5%) with no schooling than those with less than five years of complete schooling (21.8%). There is a sharp decline from 21.8% to 7.9% of women with 5-9 years of completed schooling whereas only 5% of women reported childbearing with 10-11years of completed schooling. In other words, 10-11 years of complete school education reduces the childbearing risk by more than four times compared with no education. The pertinent question here is: Can educating the girl for additional number of years will remove the problem or how does one negotiate with patriarchal norms in allowing the girl child to continue education?

The latter requires change in mindset and pre-conceived notions about the role of women in society which are often skewed, unequal and discriminatory. Despite ingenious and substantive efforts by the governments and various stakeholders (community and civil society organisations), the aforementioned factors accompanied by the deep-rooted patriarchal mindsets emerge as major hindrances to the upliftment of women with the freedom to educate themselves, eradication of child marriages and information and access to healthy reproductive choices. An immediate requirement is a multi-pronged approach involving all the stakeholders and government towards sensitisation and awareness on the benefits of educating a girl.

(Sujit Kumar Mishra is Professor, Council for Social Development Hyderabad, and Sanjaya Kumar Mishra is Lecturer, KV College, Kantamanji, Odisha)

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