Creating awareness through street plays and one-to-one counseling, trained transgender women leverage cultural practices to educate tribal women with poor health indicators, the importance of seeking health care
“Please don’t come close to me and do not sit on my verandah, it will harm my child,” Jinita Sabar told a visitor. The child she referred to, is her third child, an infant son, who was unwell. She was following the advice of a local shaman, generally referred to as gunia, and distancing herself from others.
Jinita Sabar, a Soura tribal woman, got married before she turned 18, as per the prevalent social norm. Her husband works as a laborer in Bengaluru. She resides with her three kids in Pada Sahi village of Gunupur administrative block in Rayagada district.
Though she lives close to her community, she is isolated, which is the cure the shaman suggested. The tribal villagers seek the help of these practitioners for all kinds of remedies and exigencies, that sometimes cost lives. To fight such taboos, transgender women create awareness on the importance of maternal and child care.
Misguided villagers
According to Rohini Sabar, the accredited social health activist (ASHA), Jinita Sabar had all her antenatal check-ups at the anganwadi center as per schedule and had a normal delivery at home. Her son weighed 2.5 kg at birth. But everything changed when the baby turned four months old and had severe convulsions that left him unconscious for a few minutes.
Jinita Sabar took the child to the shaman. The shaman told her that she and the child should stay in isolation, rice and salt should be her only diet and she should stop breastfeeding the child. Her husband strictly told her to follow the shaman’s instructions. The ASHA and her neighbors could not convince her to go to the hospital or a nutrition rehabilitation center.
The child became weak since Jinita Sabar stopped breastfeeding him. “Her child had fallen into the red zone as per our weighing register, and in the severely underweight category,” Susila Khura, the anganwadi worker, told VillageSquare.in.
Poor health indicators
Rayagada district, with a predominant tribal population, has a literacy rate of 56% among men and 29% among women. 43.5% children are stunted and 42% are underweight. Anemia, early marriage and blind beliefs make it worse on health and nutrition status as per National Family Health Survey (NFHS) 4, 2015-16.
56% deaths of children below age 5 occur in the first four weeks after birth, up from 50% in NFHS-3. The percentage is rising, and hence there is a need for concerted efforts in the maternal and new born care, especially in rural areas.
Only 57.7% of women had at least four antenatal visits. Institutional delivery stands at 68.8%. Infants under six months exclusively breastfed are at 71.8% and children age 6-59 months who are anemic are 51.5%. Almost half the pregnant women between 15 and 49 years are anemic. In the forest fringe villages, these indicators are even more severe.
Project Nua Maa
Nua Maa, meaning new mother, is a transgender catalyst program done in two administrative blocks of Rayagada district as part of Odisha Multi-sector Nutrition Action plan led by the Government of Odisha, supported by Azim Premji Philanthropic Initiatives.
The Nua Maa project is being implemented by Sakha, a community based organization, that works for the wellbeing and entitlements of transgenders , with technical support of Kalinga Institute of Social Sciences, based at Bhubaneswar.
In India, the practice of transgender groups visiting homes of pregnant women and new mothers to give blessings is a distinct culture. The Nua Maa project has tapped into this culture and roped in transgender people to act as transformational catalysts.
Sixty trained transgender women, in groups of five, deliver messages on maternal and child nutrition, and on related themes through a local theater performance. The performance is followed by interactions with pregnant and lactating mothers in every village. The villagers address the transgender women as nua maa, based on the project.
Nua Maa intervention
It was during a visit to Jinita Sabar’s village thatPapun Sahu, a Nua Maa catalyst, noticed how unwell the young child was. Local taboos and social norms are so deep rooted among the tribal communities that it is difficult to convince them. After repeated visits, Sahu and Rohini Sabar convinced Jinita Sabar to go to the hospital, though she was afraid of defying the shaman’s instructions.
Papun Sahu and the ASHA counseled her husband over phone. On the intervention of nua maa Sahu, Jinita Sabar’s parents-in-law started visiting her. They took care of the household and the other two children, so that the mother and the child could go to the hospital for treatment.
Jinita Sabar now visits the anganwadi center regularly. Her son weighs 5.7 kg in his eighth month and has moved to the yellow zone. “I enjoy interacting with nua maa and I meet her whenever she comes to our village. She has become a big support for all of us,”Jinita Sabar told VillageSquare.in.
Behavioral challenges
The household survey done in 50 villages under this project revealed that some key behavioral indicators such as availability and usage of toilets, safe disposal of children’s feces, treatment of drinking water and hand washing, exclusive breastfeeding, uptake of Iron and folic acid tablet are big concerns.
Existing cultural & religious practices, local taboos and misconceptions lead to such poor behavioral practices. “I observe such behavioral problems based on traditions in almost each of the 50 villages we work in,” Sahu told VillageSquare.in.
Rayagada and many southern districts of Odisha which have predominant tribal populations, have high levels of stunting, wasting and anemia. The state stunting rate and underweight rate for children under 5 years stand at 34 as per NFHS 4.
Transgender catalysts are paving the way by bringing a strong acceptance among these communities and are playing a significant role as influencers. Papun Sahu and her team’s ability and skill to convince the husband and mother-in-law in their own attire and style is unique to this social and behavior change program.
Successful intervention
“Through various schemes, services, maternity benefit programs, etc. providers make valiant efforts, but it’s difficult to get through social beliefs, misconceptions and taboos that prevail in the society,” said Waheda Begum, the District Social Welfare Officer of Rayagada district.
“Such taboos ultimately morph into deeply rooted norms,” Begum told VillageSquare.in. “But nua maas have found strong acceptance and the villagers listen to them.” The cultural practice of transgender women blessing mothers and newborns has been effectively utilized in the program.
The strategy has worked successfully. But there is a mismatch in the number of empowered transgender women and tribal people steeped in taboos and social norms. There is a need for more strong influencers who can break these barriers and improve the health indicators.
Sanghamitra Ray is the deputy director (social projects) at Kalinga Institute of Social Sciences. She is the technical advisor for Nua Maa project. Views are personal.
