Do tribal lives matter? Life expectancy, health indicators stay poor in Madhya Pradesh

Madhya Pradesh has the highest number of Scheduled Tribe (ST) population in India but the lowest life expectancy among nine Indian states that make up half of the country’s population, according to a study.

Several health and nutritional indicators are among the reasons behind the shorter life span among the STs in the state, the Union Ministry of Tribal Affairs said in a 2019 statement. 

Jetli (70), a resident of Chhapri village in Madhya Pradesh’s Jhabua district, is a great-grandmother of two. She has witnessed three generations in her life, which, she said, is not as many as it used to be when she was a child. “When I was five-six years old, at least five generations of my family used to live together,” she said. 

Jetli believes that people of her community — the Bhil tribe that is a majority in the district — are not living as long as they used to some decades ago. 

A few kilometres away in Golabadi village, 34-year old Narangi Prem has five children and no grandchildren. Jitri Bai, a local of the same village in her mid-50s, has four children and no grandchildren. 

While the latter is an extreme case, this is not an indication of a decreasing lifespan but that of awareness. 

The local population has been getting married at slightly later ages — from 14 years a few decades ago to 19-21 years now — due to interventions by local non-profits. They also have fewer children — down to two from five. 

“Because of this, they feel like they are living shorter lives because they are seeing fewer generations but their life expectancy has actually increased over the years,” said Dr Pratibha Pandey, senior specialist, health at ChildFund India — a non-profit working on malnutrition in children in MP since the 1980s — to DTE. 

However, the life expectancy of India’s tribal communities has always been lower than the national average. The current life expectancy of STs is 63.9 years, lower than the 67 years for the general population, according to the ministry of tribal affairs.

If you look at it in isolation, the life expectancy of STs has been increasing but it consistently remains the poorest among all social groups. 

An April 2022 study published in the Population and Development Review estimated life expectancy based on data from the National Family Health Surveys (NFHS) and the Sample Registration Surveys between 1997-2000 and 2013-2016. It found that “Scheduled Castes (SC) and Scheduled Tribes have drastically and persistently lower life expectancies than high caste individuals.”

In 1997-2000, the life expectancy at birth of ST women was 57 years, lower than women in other social groups — SCs (58 years), other backward classes (OBC; 60.7), Muslims (62.2) and high caste people (64.3). 

In 2013-2016, the life expectancy at birth of ST women increased to 68, marginally better than that of SC women (67.8), but consistently worse than Muslims and OBCs (69.4 each) and high caste individuals (72.2). 

A similar trend is recorded when looking at life expectancy at birth for men, which was at 54.5 years in 1997-2000 for STs. It was, again, lowest among men in all social groups — SCs (58.3), OBCs (60.2), Muslim (62.6) and high caste people (62.9). 

In 2013-2016, all five groups recorded an increase but the trend remains constant. The life expectancy at birth for ST men improved to 62.4 years, lowest still than SC (63.3), OBC (66), Muslim en (66.8) and high caste (69.4). 

How poor, then, is the life expectancy of tribals in MP — the state with the highest ST population in absolute figures (15 million), according to the 2011 Census?

At 57.4 years for men and 60.1 years for women, Madhya Pradesh recorded the lowest ST life expectancy among nine states —Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand, a March 2022 study showed published in the Proceedings of the National Academy of Sciences (PNAS) showed.

The estimates were made based on data from India’s Annual Health Survey, 2010-2011.

However, this isn’t the only cause of concern.

Kalia Dutiya (70), a resident of Golabadi village in Jhabua, believes a lot has changed in the last two decades. “We had no machinery back then to aid us with our farm labour. So we used to do a lot of physical work,” he said. 

Even the ghee and milk they get from their cows or crops don’t smell the same anymore, he said, adding:

Our crops and dairy aren't as nutritious as they used to be due to chemicals. Earlier, we used to grow what was naturally occurring, and consuming that gave us a lot of strength. 

There is a consensus among the residents of Jhabua and Alirajpur about how their strength and stamina has reduced over time. 

Both the districts have recorded high levels of malnutrition. As much as 49.3 per cent of children under five in Jhabua are stunted, 17.9 per cent are wasted while 41.7 per cent are underweight, according to the National Family Health Survey (2019-2021).

The indicators are slightly better in Alirajpur — 34.6 per cent are stunted, 15.4 per cent are wasted and 31.6 per cent are underweight. 

Of the six Nutrition Rehabilitation Centres (NRC) in Alirajpur —  70 total beds — all are always occupied either at capacity or beyond, according to chief medical health officer Dr Prakash Dhoke. The figures are similar in the four NRCs — 50 total beds — in Jhabua. 

“Malnutrition in the tribal population is 1.5 times higher than the national average. For severely malnourished children, we need hospitalisation. But their health-seeking behaviour is very poor,” Dr Pandey said. 

Surya Punia Maida, a resident of Umradara village in Jhabua district, was not even five years old when she died of pulmonary tuberculosis (TB) on 28 January 2021. But that wasn't the real cause of death. Weighing barely 8 kilograms at the time, close to half of what a girl her age should typically weigh, she was extremely malnourished and highly anaemic. 

Months before she was diagnosed with TB in December 2020, her father had already been suffering from it. While his treatment is currently underway, Dr Pandey believes it's likely he’s the source of infection. However, Surya’s persisting malnourished state since birth weakened her immune system and, therefore, her chances of survival. 

According to a 2018 health ministry report titled ‘Tribal Health in India’, under-five mortality rate among ST dropped 58 per cent — from 135 in 1988 to 57 in 2014. However, percentage of excess under-five mortality in ST has more than doubled, up from 21 per cent to 48 per cent in the same time period. 

Infant mortality has also been on a consistent decline, down to 44.4 in 2014 (NFHS 4) to from 90.5 per 1,000 births in 1988 (NFHS 1) . However, there is a caveat. 

The 2018 tribal health report added:

When compared to other populations, it was observed that though the absolute level of IMR in tribal population in India has nearly halved over a quarter century, the gap with the favourable social groups has widened from 10 per cent to 38 per cent.

The prevalence of stunting, wasting and underweight in ST population improved only marginally between 1998-1999 and 2007-2008, according to a 2009 report by the National Nutrition Monitoring Bureau (NNMB). 

The prevalence of stunting reduced to 56 per cent from 58 per cent, wasting came down to 22 per cent from 23 per cent while underweight came down to 52 per cent from 57 in the same time period. 

By 2013-2014, according to the Rapid Survey on Children, these figures improved some more — 42.3 per cent of tribal children under five were stunted, 18.7 per cent were wasted and 36.7 per cent were underweight.

Prevalence of obesity and overweight in adults doubled, up to 7 per cent from 3.6 per cent for men, and to 8 per cent from 4 per cent for women between 1998-1999 and 2008-2008, the NNMB report showed. These two health conditions are also considered forms of malnutrition by the World Health Organization (WHO). 

However, even these figures give only a partial understanding of what the true health condition of India’s tribal community is. Most surveys take STs as one identifier but many communities self-identify as Adivasis, even if they are not listed in the list of STs. These populations are typically forest-associated communities in central and southern India. 

There are also urban and rural ST communities which form a large proportion of the ST category in states like Karnataka. 

Health indicator disparities exist between forest-associated and the relatively rural / urban ST groups, with the former being grossly marginalised, Prashanth N Srinivas, a researcher working on tribal health inequities at the Institute of Public Health in Bengaluru, told DTE.

“The ST indicators in national surveys is an average of both,” he added. Indicators will be even worse if disaggregated by tribes which we don't have in India, the expert said.

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