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Indian Pediatr 2021;58: 20-24 |
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Diversity in Child Mortality and Life
Expectancy at Birth Among Major Tribes in Selected States of
India
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Arvind Verma
1,
Ravendra K Sharma2 and Kalyan B Saha1
From 1Indian Council of Medical Research
(ICMR) – National Institute of Research in Tribal Health,
Jabalpur, Madhya Pradesh; 2ICMR-National
Institute of Medical Statistics, New Delhi; India.
Correspondence to: Dr Arvind Verma, Principal
Technical Officer, ICMR-National Institute of Research in
Tribal Health, PO-Garha, Nagpur Road, Jabalpur 482 003,
Madhya Pradesh, India.
Email:
[email protected]
Received: January 27, 2020;
Initial review: January 30, 2020;
Accepted: September 26, 2020.
Published online: October 12, 2020;
PII:S097475591600252
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Objective: To provide tribe- specific child mortality
rates and health indicators from selected states in India.
Methods: We used Census 2011 data and Coale Demney
methodology to estimate the infant mortality rate (IMR),
under-five mortality rate (U5MR) and expectation of life at
birth (LEB) for 123 tribes of selected states of India.
Results: The estimated IMR and U5MR were higher in
scheduled tribe population compared to respective state’s
total population. The IMR varied from 124 in the Birhore
tribe of Chhattisgarh and Jharkhand, and the Bharias of
Madhya Pradesh to 48 per 1000 live births in the Gamit tribe
of Maharashtra. Similarly, the U5MR varied from the highest
(203) in the Birhore tribe of Chhattisgarh to the lowest
(57/1000 live births) in the Gamit tribe. The LEB varied
from 72 years in the Gamit tribe of Maharashtra to 51 years
in the Birhore tribe of Chhattisgarh. The study reveals that
tribes have gross variation in child mortality rates and
there is pressing need to prioritize tribe-specific action
plans to improve their health indicators.
Key words: Health, Indigenous population, Infant
mortality, Neonatal care, Under-5 mortality rate.
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I ndia has 705 Scheduled Tribal
groups (ST) with a population of 104 million (8.6% of total
population) as per 2011 census. These tribal groups
constitute the second largest tribal population in the
world, after the African continent. These tribal groups
belong to different ethnic groups and are at different
levels of development. The tribal population contributes
considerably to infant and under five deaths. As per recent
NFHS-4 survey in 2015-16, infant mortality rate (IMR) and
under -five mortality rate (U5MR) were 44 and 57 among the
ST population compared to national average of 32 and 38,
respectively [1]. Poorer health and social outcomes for
indigenous peoples than for non-indigenous populations have
been reported from across the world [2].
The Indian population census in 2011
enumerated ST population in 30 states and union territories
of the country. ST population residing in Chhattisgarh,
Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Odisha and
Rajasthan states accounts for two-third of the tribal
population of rural India [3], and are in a critical state
and consistently reporting poor vital parameters which
varied in tribal sub-groups [4]. The mortality rates for STs
of these states are much higher compared to tribes residing
in the other states [1]. However, no data is available on
tribe-specific child mortality and life expectancy in India.
Hence, in the present analysis, we estimated the IMR, U5MR
and life expectancy at birth (LEB) for major tribes residing
in Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh,
Maharashtra, Odisha and Rajasthan states of India.
METHODS
The census, 2011 of India enlisted 705
tribes/tribal groups in the country and out of them 75
tribes/tribal groups/sub-groups were classified as
particularly vulnerable tribal groups (PVTG), formerly known
as primitive tribes [3]. Of these, 268 tribes, including 38
PVTGs, reside in the selected seven states. However, only
106 tribes/ tribal groups, each having at least 5,000 women,
and 17 PVTGs, each having at least 1,000 women in the age
group (15-49), are included in the study, so as to have
relatively robust estimates. Overall, these selected tribes
encompassed about 94-97% of the respective state’s total ST
population. The data on Children Ever Born (CEB) and
Children Surviving (CS) are used for the estimation of IMR,
U5MR and life expectancy at birth LEB, and compiled from
tribes-specific tables of census, 2011 [5].
We used the Brass method for estimating
the child mortality rates. The Brass method estimates the
mortality q(x)-the probability of dying between birth and
exact age x, from the proportion of children dead among
those ever born by women in different age groups [8].
Trussell [8] version of Brass method which uses Coale Demeny
south model life tables to simulate mortality was adopted to
estimate the child mortality. The estimates of IMR, U5MR and
LEB are calculated by MORTPAK 4.3 software (United Nation)
[7]. The MORTPAK provides age group specific estimates of
IMR, U5MR and LEB. The weighted average of estimates for
women age groups 20-34 years are considered using CEB as
weights and refer to 4.6 years prior to census reference
date, i.e. 2006-07 year. The estimates of IMR, U5MR, and LEB
were calculated for Indian total population and total ST
Population, selected seven states’ total population and
total ST population, and 123 selected major tribes residing
in these states.
RESULTS
The IMR, U5MR, and LEB estimates are
summarized in Fig. I and Table I. The tribe
specific estimates of IMR, U5MR and LEB for all 123 tribes
are given in Web Annexure I.
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Fig. 1 Estimated infant
mortality rate (IMR), under-5 mortality rate (U5MR),
life expectancy at birth (LEB) for total and
scheduled tribes population of India and selected
states.
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Table I Tribe-Specific Estimates of Infant Mortality Rate (IMR), Under-5 Mortality Rate (U5MR)
and Life Expectancy at Birth in the States
| State |
Total studied |
IMR |
U5MR |
Life expectancy at |
| (Total tribes)a |
tribesb |
(per
1000 live births) |
(per
100 live births) |
birth (y) |
| |
|
Highest |
Lowest |
Totalc |
Highest |
Lowest |
Totalc |
Highest |
Lowest |
Totalc |
| Chhattisgarh (42) |
20 |
124.3 (Birhore) |
62.0 (Oraon) |
84 |
203.0 (Birhore) |
80.3 (Oraon) |
118 |
67.8 (Oraon) |
51.2 (Birhore) |
62 |
| Madhya Pradesh (46) |
14 |
123.8 (Bharia) |
68.5 (Majhi) |
89 |
194.8 (Bharia) |
88.8 (Majhi) |
123 |
66.4 (Majhi) |
52.1 (Bharia) |
61 |
| Jharkhand (30) |
22 |
124.3 (Birhore) |
67.0 (Karmali) |
81 |
195.8 (Birhore) |
86.0 (Karmali) |
109 |
66.8 (Karmali) |
52.0 (Birhore) |
63 |
| Odisha (62) |
24 |
112.6 (Koya) |
58.5 (Bathudi) |
87 |
171.4 (Koya) |
72.9 (Bathudi) |
120 |
68.9 (Bathudi, Sounti) |
54.9 (Koya) |
62 |
| Rajasthan (12) |
7 |
118.5 (Saharia) |
69.8 (Dhanka) |
83 |
183.5 (Saharia) |
90.4 (Dhanka) |
113 |
66.1(Dhanka) |
53.4 (Saharia) |
63 |
| Gujarat (29) |
19 |
76.3 (Dhanka) |
49.5 (Rabri) |
67 |
101.5 (Dhanka) |
60.2 (Rabri) |
86 |
71.3 (Rabri) |
64.4 (Dhanka) |
67 |
| Maharashtra (47) |
17 |
75.0 (Pradhan) |
47.5 (Gamit) |
60 |
99.4 (Pradhan) |
57.2 (Gamit) |
76 |
71.8 (Gamit) |
64.7 (Pradhan) |
69 |
| aTotal
number of tribes/tribal groups enumerated in the
state in census 2011; bTotal number of
tribes for which tribe-specific estimates computed;
cEstimates for total scheduled tribe
population of the state. |
The estimated IMR for India’s total
population was 65 compared to 76 per 1000 live births for
country’s total scheduled tribe (ST) population in year
2006-07. The IMR for total population varied from lowest
(53) in Maharashtra to highest (76) in Madhya Pradesh,
whereas in case of total ST population it varied from lowest
(60) in Maharashtra to highest (89) in Madhya Pradesh.
Overall, ST population in Chhattisgarh, Madhya Pradesh,
Jharkhand, Odisha and Rajasthan states had 11-14 extra
infant deaths per 1000 live births compared to respective
state’s averages. In the studied 123 tribes, 66 tribes had
higher IMR than the national ST average (76 per 1000 live
births). The mean (SD) of estimated IMR for 123
tribes/tribal groups was 80.9 (19.7) per thousand live
births, ranging from highest 124 in the Birhore tribe of
Chhattisgarh and Jharkhand states, and the Bharia tribe of
Madhya Pradesh to lowest 48 in the Gamit tribe of
Maharashtra, depicting that on an average 76 extra infants
died during first year of life in the Birhors and the Bharia
tribes compared to the Gamits of Maharashtra. The difference
in IMR was not only observed between tribes residing in
different states but also among tribes residing within the
states. A difference of 49-62 extra infant deaths was
observed among the tribes of Chhattisgarh, Madhya Pradesh,
Jharkhand, Odisha, and Rajasthan states (Table I).
The U5MR for India as a whole was
estimated at 82 deaths per 1000 live births, whereas it was
101 for total scheduled tribe (ST) of the country i.e., on
an average 19 extra deaths among children under five years
in ST population compared to the national average. The U5MR
for total population varied from lowest (64) in Maharashtra
to highest (100) in Madhya Pradesh. However, in case of
total ST population U5MR varied from lowest (76) in
Maharashtra to highest (123) in Madhya Pradesh. Overall, ST
population in Chhattisgarh, Madhya Pradesh, Jharkhand,
Odisha and Rajasthan states had 21-24 extra deaths per 1000
children under five years age compared to respective state
averages (Fig.1). Among 123 tribes, 65 tribes had
higher U5MR than the national average for ST population
(101). The mean (SD) U5MR was 112.0 (36.5) per thousand live
births ranging from highest (203) in the Birhore tribe of
Chhattisgarh to the lowest (57) in the Gamit tribe of
Maharashtra, reflecting 146 extra under five deaths in the
Birhore compared to the Gamit tribe (Table I).
The estimated LEB for total population
and total ST population of India was 67 and 65 years,
respectively. This shows that on an average, a tribal
individual survives two years lesser than the national
average. Among the selected seven states, the LEB for total
population varied from 65 years in Madhya Pradesh to 70
years in Maharashtra state. However, in case of total
scheduled tribe population, the LEB varied from 61 years in
Madhya Pradesh to 69 years in Maharashtra (Fig. 1).
Among 123 selected tribes, 70 tribes had lower LEB than the
national average for ST population (65 years).The mean (SD)
of estimated LEB for 123 tribes was 63.0 (5.3) years,
ranging from highest 72 years in the Gamit tribe of
Maharashtra to lowest 51 years in the Birhore tribe of
Chhattisgarh. The difference in LEB was not only very high
between the tribes residing in different states, but also
among tribes residing within the state. In Chhattisgarh
state, the LEB varied from 51 years in the Birhore tribe to
68 years in the Oraon tribe. A difference of 13-17 years was
observed in tribes of Chhattisgarh, Madhya Pradesh,
Jharkhand, Odisha, and Rajasthan (Table I).
DISCUSSION
Vast difference was noted to prevail in
child mortality by tribal groups. The IMR and U5MR was 44.4
and 57.7, respectively among STs compared to national
averages of 40.7 and 49.7, respectively. These child
mortality rates also vary considerably among ST population
of different Indian states. However, there is dearth of
information on different tribal communities, especially on
demographic and health indicators. The expert group on
tribal health, Government of India [8] and Saha, et al. [9]
highlighted the need to generate tribe-specific data to
formulate developmental programs accordingly.
Our estimate of IMR for total ST
population of the country is slightly higher as compared to
previous reports [2], which estimate 74.3 deaths per 1000
live births. The difference between two rates of IMR based
on census 2011 data is due to different methodologies
adopted. Anderson, et al. [2] have used Coale-Demeny model (Palloni
Heligman equation) with South Asian life-table and taken
simple average of estimates for age groups 20-34 years.
Whereas, we have used Coale-Demeny model (Trussell equation)
with South Asian life-table and taken weighted average of
estimates for age groups 20-34 years. The study has not only
demonstrated the huge differences in child mortality and
life expectancy at birth among tribes residing in different
states, but also among tribes residing within the state. The
tribes residing in economically backward states like
Chhattisgarh, Madhya Pradesh, Jharkhand, Odisha and
Rajasthan were having higher child mortality indicators
compared to those residing in relatively well-off states of
Gujarat and Maharashtra. The study also shows that most of
the PVTGs residing in different states have relatively
higher mortality rates and lower life expectancy compared to
other tribal communities residing within the states. A gap
of 76 in IMR and 146 in U5MR among tribal communities is a
matter of serious concern and needs immediate attention.
Similarly, a variance of 21 years in life expectancy at
birth reflects an extremely poor health status among some
tribal communities.
The child mortality rates may be higher
among tribal communities because of their poor
socio-economic status, geographical isolation, poor
availability and inaccessibility, and underutilization of
modern health services. Sahu, et al. [10] recorded
high IMR and U5MR among scheduled tribes of rural India and
reported that the factors associated with mortality remained
more or less same over the period of 1992-2006. The NFHS-4
shows that one-third pregnant women from ST community in
India did not receive any antenatal care during pregnancy
and majority of the deliveries (73.2%) are performed with
assistance of midwife at home; lack of proper training and
low frequency of postnatal check-ups (68.6%) pose serious
threat to the health of newborns [4]. Inequalities in the
proximate determinants of child mortality, which vary
according to their beliefs and multiplicity of cultures, and
in turn influences antenatal care, delivery practices and
postnatal care of infants [11]. Culture, ritual and
traditional beliefs of the tribes also acts as hindrance in
utilization of maternal and child health (MCH) facilities
[4]. Many tribal communities still believe in various taboos
and traditional practices. Delayed breastfeeding and
pre-lacteal, supplementary feeding practices like honey and
goat’s milk are also widespread among them [12,13]. The
presence of malnutrition, anemia, higher incidence of
infectious diseases like malaria, tuberculosis and diarrheal
diseases may further worsen the child mortality in these
tribal communities.
These estimates are derived from census
2011 data using Trussell version of Brass method, which has
its own limitations, as it assumes that age-specific
fertility and mortality rates remained constant in the
recent past, and no strong relation exists between the age
of mother and infant mortality, etc., and these estimates
are referred for the year 2006-07. In the absence of any
other tribe- specific data source, these estimates will
provide valuable information which may guide the program
managers.
In India, tribes are classified as
scheduled tribes and clubbed together for implementation of
socio-develop-ment program for their upliftment. However,
tribes are not a homogenous group and enormous variation is
observed in the estimates of IMR, U5MR and LEB. Hence there
is a need for tribe-specific approach to bridge the gap. The
present study also affirms the need to generate
tribe-specific data, prioritize the tribal group on the
basis of their vulnerability, health and mortality
parameters. Accordingly, tribe-specific developmental
programs may be formulated to improve the childhood health
and quality of life so that country can achieve SDGs targets
within the stipulated time frame.
Acknowledgments: Dr Aparup Das,
Director, ICMR-National Institute of Research in Tribal
Health, Jabalpur (MP) for his support and guidance. Prof
Chander Shekhar, IIPS, Mumbai for his valuable suggestions
to improve the quality of the paper.
Contributors: AV: Concept and design
of study, data compilation and analysis, manuscript writing;
RKS: Data analysis, literature review and manuscript
writing; KBS: Data interpretation, manuscript writing and
final editing. All authors have read final version of the
manuscript.
Funding: None; Competing
interest: None stated.
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WHAT THIS STUDY ADDS?
• We provide tribe-specific
estimates of infant mortality rate, under-five
mortality rate and life expectancy at birth for 123
tribes of seven states of India.
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