Maternal and Child Health Practices of Indigenous Women in Northeast India: Implications for Social Work Practice

Background: Despite progress on maternal and child health (MCH) related Millennium Development Goals, MCH disparities remain not only across countries but also regions and sub-regions within countries. Local-level knowledge on MCH-related risk and protective factors (e.g., post-partum practices, health-seeking behaviors, access to MCH services) can inform development of relevant policies/programs and improve social work practice. We explored the MCH-related practices of and use of health services by indigenous women in Arunachal Pradesh, a remote mountainous state of Northeast India, surrounded by Bhutan, Tibet, and Myanmar. 

Method: In June 2013, we, in collaboration with India-based colleagues and community leaders conducted an exploratory study using purposive sampling to accomplish our objectives. Kleinman's Explanatory Model of illness formed our framework and semi-structured focus group guides were developed to facilitate data collection in six focus groups with indigenous women (N=42). Focus group questions were translated into Hindi language and focus groups were conducted in Hindi and Idu Mishmi language which does not have a script. Focus groups were audio-recorded with informed consent of all participants and were transcribed directly from Hindi and Idu Mishmi to English. Grounded Theory served as the guiding framework for a content analysis of the transcribed data.

Results: The average age of women was 33 years, and 30% of them were married before 18 years. On average, women had 2.12 children; a majority had at least one institutional delivery. Findings from the analysis of our focus group transcriptions highlight: 1)) MCH-related practices vary by tribe and include dietary restrictions (e.g., avoidance of sour food to facilitate healing of wounds, avoidance of chicken and meat and meat of wild animals), use of herbs and oils (e.g., oil massage of the back with wild banana leaf), rest period, and restrictions on certain household activities (e.g., cutting of plants/trees is not allowed); 2) In case of their own or their children’s illness, women resort to both western medicine and local medicines, and also faith healing practices. Simultaneous use of western and local medicines is generally avoided to reduce the risk of adverse interactions; 4) Women rarely go for routine medical checkups; for many, the last visit to a hospital was when they gave birth; 4) Transportation to a hospital is difficult during rainy season, number of physicians is limited (there is only one gynecologist and obstetrician in the town and its surrounding areas), and women travel long distances to other states for specialized care.

Conclusions: Our study provides contextual knowledge about MCH practices and use of health services by indigenous women. It also identifies contextual challenges to improving MCH conditions of indigenous women in Arunachal Pradesh and similar settings. Such knowledge can help in the development of relevant MCH programs and contribute to social work and other health professionals' cultural competence in working with indigenous groups.