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Mukesh Ranjan, Laxmi Kant Dwivedi, Rahul Mishra, et al.

to the 2011 census, STs accounted for more than 20% of the population in the Central and Eastern
states of Madhya Pradesh, Odisha, Jharkhand, and Chhattisgarh. These four states are highly focused
on because most of their indicators related to maternal and child health are poor (Annual Health
Survey [AHS], 2011).
The tribes of Central and Eastern India have a traditional style of living, and their way of life
is completely devoid of modern health facilities. The majority of the tribal population is generally
poor and concentrated in rural India. Due to this, awareness about population dynamics, health and
nutrition among different tribal groups in India is limited yet important (Deb, Basu, Balgir et al.,
2001). Because of striking differences in socio-economic status and cultural practices between tribes
and non-tribes, the maternal and child health status of tribal populations is different from that of
non-tribal populations. For example, the average Indian child had 25% lower likelihood of dying
under the age of five years compared with adivasi (tribal) children born in 2001–2005 (Das, Kapoor,
and Nikitin, 2010). According to the third round of the National Family Health Survey (NFHS,
2005–2006), in rural areas where a majority of adivasi children live, adivasi contributed about 11%
of all births and almost one-fourth of all deaths under the age of five years. Children born to women
from scheduled castes (SCs) and scheduled tribes have higher mortality rates than children born to
women from other backward classes and other classes (i.e., general/advanced classes). Children born
to women from non-backward classes and non-tribes have by far the lowest rates of infant and child
mortality (NFHS, 1998–1999). A nationally representative study of India based on the 1981 census
also indicated that under-five mortality in the lower STs and SCs was significantly higher than that
among the non-tribal population (Das, Hall, Kapoor et al., 2014). Previous studies also showed that
mother’s education, household head’s religion, caste/tribe membership, and economic level of the
household (indicated by ownership of consumer goods) had a substantial effect on infant mortality
(e.g., Murthi, Guio, and Dreze, 1995).
The 2005–2006 NFHS data for Odisha showed a significant disparity in neonatal, infant, and un-
der-five mortality rates by tribal, wealth, and education status (Sharma, Sarangi, Kanungo et al.,
2009). Infant mortality rates (IMRs) are higher among the STs and they are mainly determined by
poverty, low levels of education, and poor access/utilization of health services (World Bank, 2007).
A longitudinal survey in the tribal dominated Bolangir district in Odisha found that the villagers took
a young child to the hospital only when his or her condition was critical (van Dillen, 2006). The STs
in Jharkhand are mostly located in rural and remote areas where access to maternal and child
health-related services is very limited and the use is further restricted by their own traditional beliefs
and taboos (Singh and Ram, 2006). About three-fourths of the infant deaths among tribes occurred
during the neonatal period in Madhya Pradesh (Pandey, 1988; Pandey and Tiwari, 2001). Tribes
lag behind the general population in Madhya Pradesh on key health indicators by about three dec-
ades (Pandey, 1988). Antenatal care is not a common practice among primitive tribes (Pandey and
Tiwari, 2001) and tribal women usually do not utilize public health services. Studies have even
shown that there is a cyclicality of neonatal deaths among Tribes (Shah and Dwivedi, 2011). Women
from villages near the health centers utilize primary health centers only in case of emergency (Mar-
war and Jain, 1997). One study demonstrated that the utilization of maternal and child healthcare
services is very limited among the tribes of Madhya Pradesh (Sharma, 2010).
The poverty rate is high among STs in Madhya Pradesh and Chhattisgarh (NSSO, NSO, and
MOSPI, 2011). The Central region also demonstrates high IMRs among ST populations and the situ-
ation is worse among the primitive tribal groups such as Birhor, Korwa, Abhujmaria, Kamar and
Baiga in Chhattisgarh (Dhar, 2013). Higher birth order could be one of the reasons for higher infant
deaths among the ST community. In a recent study, Sahu et al. (2015) found that birth order
and birth interval were significantly associated with infant and child mortality among STs in rural
India during 1992–2006 (Sahu, Nair, Singh et al., 2015). They found that the risk of infant mortality
was higher in first order births. For the period of 1992–1993, babies with birth order four or more

International Journal of Population Studies | 2016, Volume 2, Issue 2 27