The term tribe is derived from the Latin word 'tribes' meaning the 'poor or the masses'. In English language the word 'tribe' appeared in the sixteenth century and denoted a community of persons claiming descent from a common ancestor. India is a vast, ethnically diverse country and the people inhabiting it are as diverse as the land itself. The large Indian population is multi-ethnic and divided into subgroups. As many as over 4635 different ethnic groups form the panoramic cultural mosaic of the country.

A majority of populations are from the Indo-Aryan stock (72%) followed by Dravidian (25%) and Mongoloid and other 3 per cent. People living in specific geographical isolation with distinct language, territorial distribution and cultural practices may be termed ‘indigenous’. The other term used to identify them is ‘tribal’ or ‘adivasi’. As per the Census of India, 2001, there are about 635 biological isolates (tribes and sub-tribes) that constituted 8.08 per cent (about 84.3 million) of the total population of India who are considered the original inhabitants of this ancient country. They fall under the category of Scheduled Tribes and constitute the largest tribal populace in the world.

The tribal population in India is 84.51 million, which constitutes 8.14% of tribal population. There are about 449 tribes and sub tribes in different parts of India. Half of India’s tribal people live in the forests and forest fringes and their economy is linked with the forests. Tamilnadu has 6,51,321 tribal population as per 2001 census which constitutes 1.02% of the total population. There are 36 tribes and sub tribes in Tamilnadu. Literacy rate of the population is 27.9%. Most of the tribals in Tamilnadu are cultivators, agriculture labourers or dependent on forests for their livelihood. There are six primitive tribes in Tamilnadu. The tribal groups in Tamilnadu are distributed in almost all the districts and they have contributed significantly in the management of the forests.

Most of the tribal areas are hilly, inaccessible undulating plateau lands in the forest areas of the country resulting in the bypassing of general developmental programmes. Due to this, infrastructure and development facilities in tribal areas for education, roads, healthcare, communication, drinking water, sanitation etc. lagged behind compared to other areas which has resulted in further widening the gaps of development between the tribals and the general population for a long time. Indian tribals are a heterogeneous group; most of them remain at the lowest stratum of the society due to various factors like geographical and cultural isolation, low levels of literacy, primitive occupations, and extreme levels of poverty.

Tribal communities in general and primitive tribal groups in particular are highly disease prone. Also they do not have required access to basic health facilities. They are most exploited, neglected, and highly vulnerable to diseases with high degree of malnutrition, morbidity and mortality (Balgir, 2004). Their misery is compounded by poverty, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water and blind beliefs, etc. Some of the preventable diseases such as tuberculosis, malaria, gastroenteritis, filariasis, measles, tetanus, whooping cough, skin diseases (scabies), etc. are also high among the tribals. Some of the diseases of genetic origin reported to be occurring in the Indian tribal population are sickle cell anemia, alpha- and betathalassemia, glucose-6-phosphate dehydrogenase (GPD) deficiency, etc. (Balgir, 2004). Night blindness, sexually transmitted diseases are well known public health problems of tribals in India.

Health care is one of the most important of all human endeavors to improve the quality of life especially of the tribal people (Balgir, 1997; 2000). Health must meet the need of the people, as they perceive them. Health cannot be imposed from outside against people’s will. It cannot be dispensed to the tribal people.

The need of the hour for Tribal Development is to reduce the gap between the Tribal and non-tribal population with respect to economic, educational and social status, the objective is to integrate the Tribals into the main stream of economic and social development. Out of the 36 Scheduled Tribe communities in the state, 6 Tribal Communities (ie) Toda, Kota, Kurumbas, Irulur, Paniyan and Kattunayakan have been identified as Primitive Tribal. The area where the population of Scheduled Tribes exceeds 50% of the total population is declared as Integrated Tribal Development Programme area.

STATEMENT OF THE PROBLEM:

The fact that more than 100,000 women in India are estimated to die every year from pregnancy- and childbirth-related causes reinforces the importance of ensuring that all pregnant women receive adequate antenatal care during pregnancy and that deliveries take place under the supervision of trained medical personnel in a hygienic environment (IIPS 1995). The tribal communities live inside the Reserved Forests, in the vicinity in fringes and outside and are also called ‘forest dwellers’. Their socio-cultural life is centered on nature. The tribal population is identified as the aboriginal inhabitants of our country. They are seen in almost every State of India. In our country, known for the extreme poverty of the masses, the tribals constitute the core of the poor. Poverty, poor health and sanitation, illiteracy and other social problems among the tribals are exerting a dragging effect on the Indian economy. The health status of the Indian women is extremely low; this is all the more ironic since the primary caregivers of a household’s health are women. It may be mentioned that health related studies among the tribal population are found to be limited, most of the available studies being fragmentary in nature without an adequate sample size and standard methodology. There is paucity of studies on many issues affecting the health status of tribal women. Tribal women in India have specific problems, some of these are built-in problems of these tribal communities and some are imposed upon them, which jeopardize their overall development and progress inclusive of their health. In order to improve the health status of the tribal women, the health care delivery system should be designed for each specific needs and problems by ensuring their personal involvement. Pregnancy-related under nutrition in developing countries can be attributed to various socio-economical reasons. Poor awareness of basic nutritional requirements during pregnancy, practical and economical ways to meet these requirements further contributes to the problem. Poor maternal nutritional status and substandard antenatal care, which result in increased women's risk, low birth weight and stillbirth, afflict many countries with weak or emerging economies even today. This study seeks to find out the effect of socioeconomics characteristics to nutritional knowledge, attitude and practices among tribal pregnant women.

There is a need for proper understanding of the different maternal health care aspects of tribal women and their nutritional health status so that relevant health measures can be prepared and implemented. More particularly, there is a need for undertaking a region-specific study of the levels nutritional awareness of tribal women during pregnancy, which will make planning for their welfare more successful. In the above context, this study investigates the socio economic profile and maternity care practices among the tribal women in Western Ghats of Nilgiris and Anaimali Hills province with reference to the following objectives.

OBJECTIVES OF THE STUDY:

1. To draw the socio economic profile of the tribal women in Western Ghats of Nilgiris and Anaimali Hills province

2. To understand the Reasons for Non-Utilisation of HealthCare Facility Methodology of the study

The study is based on the sample survey. Multi stage random and purposive sampling has been followed. Information on ever married pregnant women’s demographic, socio-economic data, nutritional status and maternal care was collected through structured interview scheduled. A survey was carried out in all villages of tribes scattered throughout in the Nilgiris and Anaimali Hills blocks. Villages have been selected through Probability Proportion to Size (PPS) sampling procedure. Over all 150 tribal households have been surveyed in these villages. The secondary data was collected through various published and unpublished records, Government offices, Government Hospitals and primary health centers. The nutrition awareness scale and maternity care variables have been developed with the help of doctors in nutrition and dietetics department and the Gynecologist in Kovi Medical Centre and Hospital, Coimbatore.

REVIEW OF LITERATURE:

Basu and Kshatriya (1992) studied the fertility and mortality trends among the Dudh Kharia of Sunderagarh district Orissa. They reported that the estimated total fertility, crude birth rate, crude death rate and infant mortality rate were 5.39, 38.5, 11.80 and 102.4 respectively. All these demographic figures showed higher values than the Indian national population level according to the 1981 census. These were similar to those of the other Indian tribal populations.

Basu, (1994) there is a general agreement that the health status of the tribal population in India is very poor, deficient in sanitary conditions, personal hygiene, and health education. Tribal mothers have high rates of anemia, and girl children receive less than the desired nutritional intake.

Chitre et al (1976) studied the dietary status and health of the Bihar and Maharashtra found deficiencies in calories as well as protein and essential amino acids in their diets though major signs of nutritional deficiencies were not observed.

Devendra Thakur (1986) made an elaborate study about the Santhals in Bihar. The study highlights their socio-economic conditions. It has been observed to what extent they were responsive to the projects and programmes undertaken during the different developmental plans.

Gurumurthy et al (1990) study the of demographic and health determinants of infant deaths among the Sugali tribal group in the Kalyanadurgam and Beluguppa blocks of Ananthapur district of Andhra Pradesh pointed out that out of 348 infant deaths 45.4 percent were neonatal and 54.6 per cent were post neonatal. About 25 percent infant deaths occurred due to dysentry/diarrhoea and 20 percent due to maternal factors such as prematurity, birth injury, multiple birth, low birth weight, birth asphyxia and so on.

Kanitkar and Sinha, (1988), the whole tribal community is deficient in adequate food intake. The extent of knowledge and practice of family planning was also found to be low among the Scheduled Tribes.

Luiz. A.A.D. (1962) made a detailed study of all the 48 tribes of Kerala. He has discussed their mode of living, occupation, diet, religion, taboos, marriage and rituals. He provides an insight into the changing pattern of the tribal's social life in the context of the socio-economic conditions of the State as a whole.

Nirmal Kumar Bose (1977) gives some insight into the tribe's social life. "Tribes differ from others in their social system. They have retained their own marriage regulation. Almost all marry within their restricted local group, and are sometimes guided by their own elders or political chief in internal and external affairs. In other words, they form socially distinct communities, who have been designated as tribes and listed in the Schedule for special treatment, so that within a relatively short time they can come within the mainstream of political and economic life if India".

Ray and Roth (1991) studied the fertility pattern of Juangs of Orissa. It was observed that the marital age specific fertility rate was highest (0.336%) among mothers in the 20-24 year age group whereas it was lowest (0.44%) among the 45-49 year age group. The total marital age-specific fertility rate was 1.157 among the Juang mothers. It was also observed that the Index of Overall Fertility and the Index of Marital Fertility among the Juangs were 0.49 and 0.50 respectively.

Rastogi et al. (2011) Pregnancy-related under nutrition in developing countries can be attributed to various socio-economical reasons. Poor awareness of basic nutritional requirements during pregnancy, practical and economical ways to meet these requirements further contributes to the problem. Poor maternal nutritional status and substandard antenatal care, which result in increased women's risk, low birth weight and stillbirth, afflict many countries with weak or emerging economies even today.

Shiva, (1992) malnourishment, poor medical facilities and unfavorable social conditions were the major underlying causes for high maternal mortality in India. Nutritional anemia, a serious problem in pregnancy, affected 50 percent of the women of childbearing age in South East Asia. The situation was all the more aggravated among women in the tribal belt of India because of the prevailing magic-religious and socio cultural practices.

Sutapa Maiti1 et al (2005) in their study clearly bring out the differential in the health care and health condition among the tribal women and non-tribal women in Jharkhand. The findings reveal that in each and every socio-economic, demographic as well as health parameters, the tribal women a very much poor than the non-tribal women. Malnutrition is pervasive among tribal women. There is also a high prevalence of anemia among the tribal women in Jharkhand. The utilization of maternal health care is also very less among the tribal women than non-tribal women in Jharkhand. Use of modern methods of contraception is also significantly less among the tribal women than the non-tribal women.

Verma (1960) has discussed the socio-cultural organisations of the Sanria paharias, Mal- paharias and Knmarbhag. He has examined various phases of the tribal life, pregnancy and birth, puberty, widow remarriage, place of women in the society, religion, village council and political institutions.

Ware (1984) It has been variously argued that education is but one of many indices of socioeconomic status and that the strong positive relationship between education and infant and child mortality is merely a reflection of the fact that educated mothers come from wealthier homes, live in urban settings where health care is more accessible, and are married into households that have a good source of income and therefore are better able to care for their young children through the utilization of MCH services. Thus, controlling for the possible impact of other socioeconomic variables is an important part of the exercise to determine if the positive impact of mother’s education on utilization of health-care services is real.

Though there are studies on various tribes in India and their socio – economic status, cultural practices, work status, and participation in management, etc. Socio economic profile of tribal women and its impacts on nutritional awareness, maternal and child health care practices of tribal women in the Nilgiris and Anaimali hills province has not been analysed so far. This study addresses this important issue, because the characteristics and problems of tribal women differ from one specific area to another, depending on the geographical location, historical background and the process of social change. Hence the researcher hopes that the present study will fill the gap in the literature.

RESULT AND DISCUSSION:

Table-1- Showing Demographic Variables of Tribal Women

Demographic Variables		Frequency	Percentage
Demographic Variables		Frequency	Percentage
Women's Age: (Years)	< 20 years	32	21.33
	20 – 25 Years	61	40.67
	Greater than 25 Years	57	38.00
		150	100
Husband's Age: (Years)	< 20 years	29	19.33
	20 – 25 Years	54	36.00
	Greater than 25 Years	67	44.67
		150	100
Women's Education	Illiterate	16	10.67
	Primary	28	18.67
	Middle	30	20.00
	Secondary	37	24.67
	Higher Secondary	27	18.00
	Graduates	12	8.00
		150	100
Husband's Education	Illiterate	7	4.67
	Primary	29	19.33
	Middle	33	22.00
	Secondary	43	28.67
	Higher Secondary	21	14.00
	Graduates	17	11.33
		150	100
Occupation	Agricultural	42	28.00
	Laborer	89	59.33
	Others	19	12.67
		150	100
Family Type	Simple	48	32.00
	Compound	61	40.67
	Extended	41	27.33
		150	100
No. of children	None	11	7.33
	1 to 2	26	17.33
	3 to 4	61	40.67
	Above - 4	52	34.67
		150	100
Family income per month	Below Rs. 5000	42	28.00
	Rs.5000 – Rs. 10000	84	56.00
	Above Rs. 10000	24	16.00
		150	100

Source: Primary Data

The above table illustrates that demographic variable of tribal women the Nilgiris and Anaimali hills province. 40.67 percentage of the women are belongs to the age group of 20 – 25 years, 44.67 percentage of the women’s Husband's Age is greater than 25 years, 24.67 percentage of the Women's and 28.67 percentage of the women’s Husband's are having Higher Secondary Education, 59.33 percentage of the women’s occupation is labour and 40.67 percentage are belongs to compound family type, 40.67 percentage of women’s are having 3 to 4 children and 56 percentage of women’s Family income per month is Rs.5000 – Rs. 10000.

Table-2- Showing Reasons for Non-Utilisation of HealthCare Facility

Reasons for Non-Utilisation of HealthCare Facility	Highly Agree	Percentage	Agree	Percentage	Neutral	Percentage	Disagree	Percentage	Highly Disagree	Percentage
Not necessary	32	48	19	28.5	21	31.5	37	55.5	41	61.5
Not customary	26	39	20	30	27	40.5	35	52.5	42	63
High cost	53	79.5	42	63	18	27	22	33	15	22.5
Too far from Resident	43	64.5	47	70.5	24	36	16	24	20	30
Poor quality/service	27	40.5	26	39	29	43.5	31	46.5	37	55.5
Husband/Family member did not allow	29	43.5	17	25.5	25	37.5	46	69	32	48
Lack of knowledge	44	66	37	55.5	23	34.5	20	30	26	39
No time to go	29	43.5	34	51	28	42	32	48	27	40.5
No female health provider	16	24	18	27	25	37.5	48	72	43	64.5

Source: Primary Data

HYPOTHESIS OF THE STUDY:

Ho1: There is no significance mean difference between Age of the women respondents and Reasons for Non-Utilisation of HealthCare Facility.

ANOVA TABLE -3- SHOWING AGE OF THE WOMEN RESPONDENTS AND REASONS FOR NON-UTILISATION OF HEALTHCARE FACILITY
		Sum of Squares	df	Mean Square	F	Sig.
Not necessary	Between Groups	3.15	2	1.575	.987	.375
	Within Groups	234.59	147	1.596
	Total	237.74	149
Not customary	Between Groups	0.26	2	.129	.073	.930
	Within Groups	260.91	147	1.775
	Total	261.17	149
High cost	Between Groups	2.13	2	1.065	.530	.590
	Within Groups	295.37	147	2.009
	Total	297.50	149
Too far from Resident	Between Groups	1.11	2	.556	.307	.736
	Within Groups	266.22	147	1.811
	Total	267.33	149
Poor quality/service	Between Groups	4.09	2	2.043	1.183	.309
	Within Groups	253.79	147	1.726
	Total	257.87	149
Husband/Family member did not allow	Between Groups	9.24	2	4.622	2.316	.102
	Within Groups	293.35	147	1.996
	Total	302.59	149
Lack of knowledge	Between Groups	1.43	2	.717	.396	.674
	Within Groups	266.23	147	1.811
	Total	267.66	149
No time to go	Between Groups	16.70	2	8.350	6.041	.003
	Within Groups	203.19	147	1.382
	Total	219.89	149
No female health provider	Between Groups	6.58	2	3.289	1.825	.165
	Within Groups	264.92	147	1.802
	Total	271.49	149

Source: Primary Data

ANOVA TABLE-4- SHOWING EDUCATION LEVEL OF WOMEN RESPONDENTS AND REASONS FOR NON-UTILISATION OF HEALTHCARE FACILITY
		Sum of Squares	df	Mean Square	F	Sig.
Not necessary	Between Groups	4.96	4	1.241	.773	.545
	Within Groups	232.78	145	1.605
	Total	237.74	149
Not customary	Between Groups	4.23	4	1.057	.596	.666
	Within Groups	256.95	145	1.772
	Total	261.17	149
High cost	Between Groups	3.90	4	.976	.482	.749
	Within Groups	293.60	145	2.025
	Total	297.50	149
Too far from Resident	Between Groups	10.00	4	2.501	1.409	.234
	Within Groups	257.33	145	1.775
	Total	267.33	149
Poor quality/service	Between Groups	8.34	4	2.085	1.212	.308
	Within Groups	249.53	145	1.721
	Total	257.87	149
Husband/Family member did not allow	Between Groups	7.04	4	1.760	.863	.488
	Within Groups	295.56	145	2.038
	Total	302.59	149
Lack of knowledge	Between Groups	17.52	4	4.381	2.539	.042
	Within Groups	250.14	145	1.725
	Total	267.66	149
No time to go	Between Groups	3.47	4	.866	.580	.677
	Within Groups	216.43	145	1.493
	Total	219.89	149
No female health provider	Between Groups	11.81	4	2.953	1.649	.165
	Within Groups	259.68	145	1.791
	Total	271.49	149

Source: Primary Data

The above table shows that there was no significant difference in the means among different age group of the women respondents in non utilisation of health care facilities. The results of the ANOVA are given in the above table. It is found from the results of ANOVA that F values are lesser than the table value for factors namely, Not Customary F (2,147) =.596, p=.666, High cost F (2,147) =.482, p=.749, No time to go F (2,147) =.580, p=.677. Hence, the null hypothesis the average scores of factors of Reasons for Non-Utilisation of HealthCare Facility among the respondents of the different Educational level do not differ significantly is accepted. But the F value is greater than table value for the following factors, Not necessary F (2,147) =.773, p=.545, Too far from Resident F (2,147) =1.409, p=.234, Poor quality/service F (2,147) =2.085, p=.308, Husband/Family member did not allow F (2,147) =1.760, p=.488, No female health provider F (2,147) =1.649, p=.165, Lack of knowledge F (2,147) =2.539, p=.042. Hence the hypothesis is rejected. Therefore the average scores of Reasons for Non-Utilisation of HealthCare Facility among the respondents of the different Educational level differ significantly.

CONCLUSION:

In conclusion, the paper reinforces the need for different strategies in the implementation of family welfare and healthcare services in different socio economic stratum. Along with other infrastructure development in tribal villages, attention should also be given to regular availability of doctors, nurses, and evening clinic hours for improving the availability and accessibility of healthcare services and nutritional Awareness among tribal women. The study further suggest that continued investments in education, with a special focus on tribal dominated areas for both men and women in order to reduce maternal, infant, and child mortality because the study results revels that tribals having very low level of educational background. Public policy should also focus on other factors, such as quality and accessibility of health facilities, which may affect healthcare utilization. Improving access to health facilities should go hand in hand with infrastructure developments like roads, public transportation, and emergency services, etc., particularly in tribal villages.

ACKNOWLEDGMENT:

I would like to thank the tribal pregnant women who participated in this study for being so generous with their time. Gratitude is extended to the Government Hospitals, Primary Health Centers, Nutrition and Dietetics department and the Gynecologist in Kovi Medical Centre and Hospital, Coimbatore.

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Received on 01.09.2015 Modified on 17.09.2015

Asian J. Management; 6(4): Oct. -Dec., 2015 page 314-320

DOI: 10.5958/2321-5763.2015.00046.3