Problems in Indian Community

Community Psychology Aditi Trivedi
(LE01SPY315) (LE2012761005)
Problems in Indian Community

Community Psychology – Assignment 2
Name: Aditi Trivedi
Class: FSLE 3
Application No.: LE2012761005
Word Count: 6999
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(LE01SPY315) (LE2012761005)
Assignment 2 – Problems in Indian Community
Problem Chosen: Urban Mental Health
Target and Setting
One of the ways of defining urbanisation is the increase in the number of urban cities and the
population that resides in them. This process is greatly intertwined with industrialisation and hence,
economic development1. When cities undergo transition to become urbanised, the lifestyle that
people lead also changes. Some of the common noticeable changes include living in nuclear families,
working extra hours, living near industrial areas, etc. These lead to further issues like reduction in
support found from familial structures and decreasing quality of one’s physical health. With an
increase in urbanisation, there has also been an increase in issues related to mental health. Most
studies view causality between the two and declare urbanisation to be the independent variable and
mental health the dependent one. A general trend observed in most urban settings is the
exponential growth in population, most of which is due to migrating individuals and families who
come in search of a better life2. This migration is believed to affect the mental health of not just
individuals that move to a new city but also leaves an impact on those members of their family and
communities that they leave behind. By taking this into consideration, urbanisation can be viewed as
affecting mental health of individuals in both urban and rural settings.
Current Scenario
According to the United Nations Word Urbanisation Prospects (2008), 28% of the population in India
lives in urban settings. Further, they forecast that by 2020, it will augment to 41%3. If growth
continues at this pace, in the following few years, half of the country would classify as a part of an
urban scenario. While this leads to development of a nation’s economy and infrastructure, a debate
has often been raised regarding its impact on individuals and the societies they live in. Those
disapproving of the urbanisation process put forth arguments that generally involve its negative
effects on the life of those living in the urban setting. The stability of an individual’s mental health is
one of the issues focused upon by those taking the negative stance. The World Health Organisation
acknowledges mental health as an important component of one’s overall well-being as it can affect
various aspects on one’s life. A report by the World Health Organisation stated that disorders related
1
Srivastava, Kalpana. "Urbanization and Mental Health." Industrial Psychiatry Journal 18.2 (2009): 75-
76. Industrial Psychiatry Journal. Web. 19 Mar. 2015.
<http://www.industrialpsychiatry.org/article.asp?issn=0972-
6748;year=2009;volume=18;issue=2;spage=75;epage=76;aulast=Srivastava>.
2
Venkatashiva Reddy, B., Arti Gupta, Ayush Lohia, and Pradip Kharya. "Mental Health Issues and Challenges in
India: A Review." International Journal of Scientific and Research Publications 3.2 (2013): 1-3. International
Journal of Scientific and Research Publications. Web. 19 Mar. 2015. <http://www.ijsrp.org/research-paper-
0213/ijsrp-p14129.pdf>.
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to mental health and behavioural disorders could be held accountable for 12% of health problems
around the world4. The figures for the Indian population vary a bit.
A study by NIMHANS (2010) stated that the prevalence of different mental and behavioural
disorders was on an average 9.5 to 102 cases per 1000. A review of epidemiology studies by Ganguli
(2000) stated that when considering just the urban population, the average number was 73 cases
per 1000. In comparison, mental health disorders were slightly lesser in rural settings at 70.5 cases
per 1000. Srinath et al (2005) found that 12.5% of their chosen sample from urban and rural areas of
Bangalore had problems with their mental health. They also found that in urban areas, the
socioeconomic standing only accounted for a minute difference in the prevalence. People from
middle class families and slum areas showed almost equal number of cases. Further, research done
by Ganguli (1968) and Bhaskaran, Seth and Yadav (1970) states that workers in industrial settings are
especially at risk for mental health issues with 14-37% of them being diagnosed with psychological
disorders5. These two studies, however, may not be applicable due to the increased urbanisation
since the time period in which they were conducted. A follow-up is required and would be very
helpful as industrialisation has been considered to be an important part of urbanisation. Trivedi
(2003) found that disorders that commonly accompany urbanisation include depression, substance
abuse, alcoholism and dementia. Depression and dementia at the time of the study were most
common and by 2040, India is predicted to have 300% more cases of dementia than it did in 2001.
Reddy and Chandrashekhar (1998) had earlier found depression and neurotic disorder to be the
most prevalent6.
A difference in the prevalence pattern based on gender and ages has been observed. Deswal and
Pawar (2012) concluded that males were at higher risk for mental disorders than females7 and the
same trend was noted for mental issues like suicide8. These findings are contrary to the popular
belief that women suffer more mental disorders than men. This is probably because researches by
academics such as Almeida-Filho et al (2004) and Heise (1994)9, which put forth these trends, were
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0213/ijsrp-p14129.pdf>.
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7
0213/ijsrp-p14129.pdf>.
8
World Health Organisation. "Gender and Mental
Health."Http://www.who.int/gender/other_health/en/genderMH.pdf. World Health Organisation, June 2002.
Web. 19 Mar. 2015. <http://www.who.int/gender/other_health/en/genderMH.pdf>.
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conducted in other countries and their prevalence is not parallel to that in India. However, women
are at a greater risk for domestic violence which has the potential to foster a psychological disorder.
This becomes a source of constant stress. According to Patel and Kirkwood (2006), even women who
are divorced or widows are at risk for stress and mental disorders with an average of 19% of them
having been diagnosed. The National Crime Record Bureau (2005) published a report which put forth
substance-abuse disorders and suicides as being more common in the younger population. Shaji and
Bose (2005) used elderly people in their sample and found disorders such as dementia, generalised
anxiety disorder and bipolar disorder to be more common in this age group10.
While some people can develop psychosomatic disorders because of psychological problems, others
may be more vulnerable to mental issues because of existing physiological problems. Factors like
natural disasters may also increase chances of developing mental health issues such as post-
traumatic stress disorder and panic disorder. Math et al (2006) studied victims in the cities that
faced tsunami and found that the 30-70% of their sample showed signs of some psychological
distress11. It is important to consider that not all these figures are accurate representation of the
actual prevalence of mental health issues. In a country like India, psychological disorders are often
stigmatised and kept hidden by an individual or his/her family to avoid potential shaming. It is
viewed as a sign of weakness and hence, such cases are never reported to have an accurate official
count. Further, Kumar (2005) pointed out that in some instances, the diagnosis itself varies
depending upon the use of either the Diagnostic and Statistical Manual of Mental Disorders or the
International Classification of Diseases and could result in inaccuracy of overall prevalence rate12.
Finally, it is should also be taken into consideration that some psychological disorders have a genetic
or physiological origin.
Consequences at Individual and Community Level
The structural changes in social life and physical environment by urbanisation can be used to derive
the potential mental health-related problems that an individual can develop. The increased
population is one of the most visible factors of urbanisation. Many people are forced to migrate
from rural areas to earn a livelihood in urbanised cities. At arrival, the fast-paced life, the new-found
emphasis of cities on individualism and the relative lack of social interaction may serve as a cultural
shock, especially for those resistant to change. As a result, issues related to maladjustment may crop
up. Many people still do choose to migrate as they feel that these cities hold promises for them. But
not everyone gets the opportunity they seek. Those with a strong academic background are more
10
0213/ijsrp-p14129.pdf>.
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0213/ijsrp-p14129.pdf>.
12
Shah, Bela, Rashmi Parhee, Narendra Kumar, Tripti Khanna, and Ravinder Singh. Mental Health Research in
India. New Delhi: Indian Council of Medical Research, 2005. PDF.
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likely to succeed than others but many are forced to do menial jobs or manual labour. This would
not only affect the self-esteem, but also cause some people to delve deeply into their despair,
reducing their previously positive attributions for the life in the urban scenario. Some people are
forced into living in areas with smaller houses or even in slums. According to Patel (2001), those
living in such conditions are more vulnerable to development of psychological disorders because
their environment provides ample stressors. The hygiene factors in these settings can influence the
physical health at first but if the location of the accommodation is close to waters which have toxic
waste in them or near dumping grounds, the fumes exhaled and the food consumed could lead to
death of brain cells, leading up to degenerative disorders13.
The small living area can be accompanied with a feeling of lack of private space within the house.
Further, being surrounded by many similar houses in a small locality adds to the feeling of being
trapped. The consequences of overpopulation are also visible in those living in other parts of the
cities though, implying that just the physical area of the house is not enough to induce feelings of
lack of space. However, this is ironic since presence of social support is negatively correlated to the
process of urbanisation. Living in nuclear instead of extended families has been cited as being one of
the major sources for this. Also, the built environment is such that it only allows for smaller families
to be accommodated, especially since bigger housing arrangements are not affordable for all14.
Despite the prevalence of many disorders, most communities in India still stigmatise those suffering
through them. Soma families have been reported to have abandoned members with psychological
disorders or left them to be permanently hospitalised. This is done not just in case of adults but even
when a child has severe mental retardation or a problematic developmental disorder. A lack of
awareness causes many people to believe that an interaction with those with mental disorders
would be dangerous and that they should not be living in the same area as others. There are also
those who are aware but adopt pity instead of sympathy, often looking at those in need for
psychological help as inferior in some ways. The view adopted on the disorder varies depending
upon the person who has the disorder. Men, for example, are expected to be tougher and hence
more disapproval is meted out when they are diagnosed. In comparison, to women though, they do
receive more help. In case of schizophrenia, married men are more likely to be cared for and
financially supported by their wives while the diagnosed women are abandoned by their husbands15.
Many times, disorders in the elderly people are given more acceptance because of the mind-set that
old age brings with it some amount of degeneration. However, the change in family structures
means that they no longer live with their children and hence do not have caregivers they need. This
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Health."Http://www.who.int/gender/other_health/en/genderMH.pdf. World Health Organisation, June 2002.
Web. 19 Mar. 2015. <http://www.who.int/gender/other_health/en/genderMH.pdf>.
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problem is also shared by the elderly living in rural areas after their children have migrated to the
urban cities16.
Resources Available to Solve the Problem
With the majority of population following Hinduism, sometimes the basic tenets of the religion help
accept the disorder suffered by oneself or by someone they know. The notion of karma states that
anything adverse is life is either a result of a previous misdeed or happening before a good reward is
on its way. Parents who have children with mental health issues especially use this view but this
could lead to a very stagnant approach towards their children. The fact that this situation is looked
down upon as a punishment for a misdeed inherently has a negative connotation attached to it,
making the acceptance itself seem more similar to mere tolerance than complete acceptance. At the
same time though, many people choose to work with those with mental disorders to contribute to
charities because that would count as good karma. While this may not tackle the basic problem of
the unaccepting mind-set, it at least helps those who do accept and work for people with mental
disorders by providing them with necessary resources. In the recent times, there has also been a
reduction in the percentage of urban population that attributes presence of a disorder to black
magic practices17.
In addition to such changes in perspective adopted by people, formal measures have also been
taken to tackle mental health issues in urban India. There do exist places where one can seek
intervention or treatment but these places tend to be fewer in nature. Further, many people are not
sure if they should be approaching a psychiatrist or a psychologist due to lack of awareness
regarding their approach to psychological disorders. Many organisations, especially NGOs have been
striving to help create awareness about different mental health disorders also promote ways of
living a healthier life. Some of them themselves provide help to those who need it. Connecting, for
example, is an NGO in Pune that has awareness programs and also runs a helpline for suicide. The
Division of Noncommunicable Diseases of Indian Council for Medical Research in collaboration with
the World Health Organisation undertook a massive research project that was published in 2005.
The data gathered by them has not only helped understand the current scenario of mental health
disorders in the country but also gives suggestions for new intervention modules and lists risk factors
for many of the common mental health issues18.
Governmental hospitals are normally expected to have at least a psychiatric ward but currently only
3 beds per 100000 people are available in them. Even in places where such services are provided,
the conditions in which the patients are kept have been believed to be quite harsh. As a result, many
people choose not to seek treatment, fearing how their loved ones would live in such conditions. A
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stereotype of mental health treatments has hence come about19. The National Mental Health
Program is now attempting to improve the infrastructure for psychiatric wards and introducing
guidelines regarding the number of psychiatrists and psychologists needed in hospital settings20. The
previous policies and laws such as Indian Lunatic Asylum Act, 1858 and Indian Lunacy Act, 1912 are
very old and ignore many human rights aspects but have been used since recently. With the new
“Mental Health Action Plan 365” policy created in 2014, there is an expectation of improvement in
treatment of psychological disorders by involving different levels of governance to aid the places
that provide mental health services. To create awareness regarding issues related to mental health,
the government also introduced the National Mental Health Day starting 201421. In addition, some
funds have been allocated to educational institutes providing degrees in mental health issues so that
the lack of service providers can be tackled and research on mental health is not substandard22.
Many organisations have started working independently and also created mental health toolkits
which can help psychiatrists and psychologists as well as those into advocacy. Basic Needs India, for
example is a group that encourages NGOs to take up issues related to mental health and provides
them with the Self-Advocacy Toolkit which provides a basic understanding of psychological disorders
and current laws regarding them23. The Division of Noncommunicable Diseases of Indian Council for
Medical Research also provides many tools, one of them being the Home Risk Card which can help
diagnose a person’s suicidal tendencies, especially after one attempt has already been made24. In
Bangalore, the Medical Pastoral Association and National Institute of Mental Health and Neuro
Sciences helped create the Half-Way Home as a place of transition wherein those who have been
treated for psychological disorders can be aided in their move back to normal life. One of the
doctors from National Institute of Mental Health and Neuro Sciences has also taken the initiative of
helping the homeless who have mental health issues in the city. Similarly, in Chennai, too,
psychological disorders of those who are homeless, especially women, are catered to by the Banyan
Initiative. Other urban areas also have such active initiatives with a wide-spread reach for specific
disorders. Care of Senior Citizens in Mumbai looks specifically at mental health of the elderly people.
Chandigarh has an organisation called Care of Elderly Women that works with old women from the
urban middle or elite class. In Pune, there is the Schizophrenia Awareness Foundation. Here, there is
19
Srinivasa, Murthy. "Urban Mental Health Initiatives in India." Centro Studi Sulla Sofferenza SOQU: Urban
Mental Health Initiatives in India. Centro Studi Sulla Sofferenza, n.d. Web. 19 Mar. 2015.
<http%3A%2F%2Fwww.souqonline.it%2Fhome2_2_eng.asp%3Fidtesto%3D775%26idpadre%3D698%23.VQmq
446UeYk>.
20
Ministry of Health and Family Welfare. "National Mental Health Programme
(NMHP)." Http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf. Government of India,
n.d. Web. 19 Mar. 2015. <http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf>.
21
Ministry of Health and Family Welfare. "Country’s First Ever Mental Health Policy Unveiled." Print Release.
Press Information Bureau, Government of India, 10 Oct. 2014. Web. 19 Mar. 2015.
<http://pib.nic.in/newsite/PrintRelease.aspx?relid=110417>.
22
(NMHP)." Http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf. Government of India,
n.d. Web. 19 Mar. 2015. <http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf>.
23
Janardhana, N., and D. M. Naidu. "Inclusion of People with Mental Illness in Community Based
Rehabilitation: Need of the Day." The International Journal of Psychosocial Rehabilitation 16.1 (2012): 117-
24. The International Journal of Psychosocial Rehabilitation. Web. 19 Mar. 2015.
<http://www.psychosocial.com/IJPR_16/Inclusion_of_People_Janardhana.html>.
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also an organisation called Eklavya which provides self-help groups and support groups for those
with mental disorders25.
Strategies and Organisations as Potential Solutions
Not only are NGOs and governmental health institutions working in mental health issues, but also
psychology clinics run by individuals. Institutes like National Institute of Mental Health and Neuro
Sciences that provide education in the field of mental health also run centres that can be
approached. Many such centre benefit from the funding received by corporate organisations that
choose mental health issues for their CSR activities. In order to alleviate the condition of those with
mental health issues in urban settings, all these organisations do exist but not much awareness
regarding their work or the mental health issues themselves is present. Like the new policy adopted
by the government, there is a need to incorporate this awareness into education. However, unlike
the policy that promotes a career in mental health services, there is a need to educate students
about it in the early years. Some schools do so by being integrative in nature while others could
incorporate this into other classes like value education and even biology. This awareness could
potentially reduce stigma related to mental health and help the students accept their condition if in
future they were to experience a mental breakdown or have a family member diagnosed with a
disorder. Education boards like the International Baccalaureate Organisation encourage working
with those with mental health issues and have made it a key component of their diploma program.
Similarly, those pursuing a career in mental health services should have a component on practical
training by having compulsory internship programs. One way to alleviate mental health services is by
ensuring that those into this occupation are well-equipped to help those with disorders.
The presence of Mental Health Awareness Day might contribute to spreading knowledge about
mental health issues better. More importantly, caregivers of those who have been diagnosed need
to be made aware about the disorder and given toolkits or risk cards which can help their
interactions. They would also benefit from mutual-help or support groups such as those provided for
people with the disorder so that they can learn from each other’s experiences and even share any
negative feelings that may accompany the initial acceptance. A clarification regarding the type of
interventions available (therapy, counselling, medication, etc.) needs to be provided to them so that
they are aware of which mental health professional to approach. An awareness of this could also be
created in the general population so that people choose to seek help when needed instead of
waiting for a family member or a friend to force them to do so. An early diagnosis could increase the
chances of recovery to stable mental health. Awareness of allied issues may contribute to alleviation
of the current stigma. For example, in urban areas, the chances of a homosexual person
acknowledging his/her homosexuality are greater. People around them (neighbours, classmates or
co-workers), however, may not be as accepting as their friends or immediate family. By tackling this
root cause, the chances of a homosexual individual developing a mental health condition due to
discrimination are eliminated.
25
Srinivasa, Murthy. "Urban Mental Health Initiatives in India." Centro Studi Sulla Sofferenza SOQU: Urban
Mental Health Initiatives in India. Centro Studi Sulla Sofferenza, n.d. Web. 19 Mar. 2015.
<http%3A%2F%2Fwww.souqonline.it%2Fhome2_2_eng.asp%3Fidtesto%3D775%26idpadre%3D698%23.VQmq
446UeYk>.
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With the availability of tests such as amniocentesis, one can gage if a child will be born with mental
retardation or any gene-based psychological disorders. In urban settings, especially the elite and
middle class can afford such services and be prepared before the birth of the child. When a mental
health issue in childhood is very severe, special schools could be contacted for help. Urban centres
like Mumbai and Pune have many such special schools that work with children with different
disorders. When providing education is not a feasible option, the schools teach vocational skills that
can help these children become self-reliant adults. These children can further be helped into
transitioning into normal life after school by taking them to public spaces like the market or a movie
theatre so that they can learn to do so independently once they graduate. Some schools take the
initiative of taking trips or picnics so that the children can rejoice. This method, however, can be
used by even people that spend a lot of time at their workspace. Many people do take short trips
over the weekend or indulge in quick getaways to de-stress. Seeking healthy outlet for rage by going
to the gym or doing sports could help, as could actually finding an activity and doing it only out of
interest. Some activities such as yoga can even help prevent potential psychological problems that
may result from existing physiological problems. Today, performing arts studios provide dance,
drama, music or art therapy wherein one can combine their hobbies with intervention. These
therapies could also help those who are sceptical about or unaccepting of traditional interventions.
Stress because of the extended work hours and the hectic urban life has often been stated as the
reason behind many mental health issues. A model like the General Adaptation Syndrome can be
applied for such people so that the stress is dealt with before reaching the alarm stage. Those with
suicidal tendencies and on the verge of major depressive disorder can greatly benefit if they stress is
reduced. Even people whose obsessive-compulsive disorder is triggered by certain stressors can be
helped by providing them with an alternate way of dealing with stress. The approach taken to stress
reduction also needs to be worked upon. Women are believed to engage more in emotion-focused
coping which does not lead to a clear solution and instead leads to worsening of the condition as
they think about it over-and-over. Those who are affected because of domestic violence should be
taught not to deal with the stressor but rather not accept it in the first place. Sometimes, even the
abusive partner has a mental health issues (such as excessive aggression or alcohol dependence) and
may need help. Many successful married couples may also face problems that come about when
both of them are working professionals. Feelings of inferiority/superiority, feeling neglected, lack of
communication, etc. can be tackled to avoid a potential harm to the relationship. When a couple
such as this has children, they can seek help to manage time so that their children do not feel
neglected and as a result develop unsecure attachment. Some children may need counselling
regarding issues like succumbing to peer pressure that prevent them from indulging in behaviour
that could lead to addictions or excessively aggressive behaviour.
Problem Chosen: Maternal Health
Target and Setting
Maternal health refers to the physical well-being of a pregnant woman during the gestation period,
as well as for some time after giving birth. Now, even psychological well-being is considered as
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factors like stress or depression can affect the prenatal development of a child. Instead of an urban-
rural divide in the quality of maternal health, a trend more visible in India is based on the
socioeconomic class that the women are from and the access to different types of resources
(medical, healthcare, nutrition, information) available to them26. Women from scheduled caste,
scheduled tribes and other backward classes have been found to have the least antenatal care
available. Lack of education of women and being a part of low income index are usually present
alongside classification into one of the three categories. A lack of awareness regarding maternal
health is present in the men that belong to these classes. As a result, they do not accompany women
for pre-natal check-ups when they are available, refuse to spend money on prenatal testing or
medication and do not take issues related to maternal health seriously even when an attempt to
inform them is made. Even certain men from Muslim households have been found to follow the
same. Many men state that the reason they do not want antenatal care for their wives is because
their families do not approve of it27.
Current Scenario
The World Health Organisation states that 536000 maternal deaths are reported each year. India is
the country with the highest amount of maternal deaths at 136000 each year. These are only those
officially reported and may exclude numbers from regions where women give birth in homes, in the
care of elderly midwives28. According to a report by National Family Health Survey, the main cause
behind this is that one in five women in India do not receive any medical care when pregnant29. An
attempt has been made to reduce maternal mortality rate from 560 per 100000 in 1990, when it was
last reported, but it is still shy of internationally-set standards by the United Nations30. The United
Nations Millennium Development Goal for Maternity Health was to reduce the number to 109 per
100000 by 2015. However, the current facilities for maternal health mean that India can only
achieve a rate of 178 per 100000. If only public healthcare facilities are made more efficient and
widespread, many of these deaths could be easily prevented. National Rural Health Mission’s report
26
Prost, Audrey, Rashmi Lakshminarayana, Nirmala Nair, Prasanta Tripathy, Andrew Copas, Rajendra
Mahapatra, Shibanand Rath, Raj K. Gope, Suchitra Rath, Aparna Bajpai, Vikram Patel, and Anthony Costello.
"Predictors of Maternal Psychological Distress in Rural India: A Cross-sectional Community-based
Study." Journal of Affective Disorders 138.3 (2012): 277-86. National Centre for Biotechnology Information,
U.S. Web. 20 Mar. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343258/>.
27
National Family Health Survey 2005-2006 (NFHS-3). "8. Maternal
Health." Http://hetv.org/india/nfhs/nfhs3/NFHS-3-Chapter-08-Maternal-Health.pdf. Health Education to
Villages, Sept. 2007. Web. 20 Mar. 2015. <http://hetv.org/india/nfhs/nfhs3/NFHS-3-Chapter-08-Maternal-
Health.pdf>.
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Vora, Kranti S., Dileep V. Mavalankar, K. V. Ramani, Mudita Upadhyaya, Bharati Sharma, Sharad Iyengar,
Vikram Gupta, and Kirti Iyengar. "Maternal Health Situation in India: A Case Study." Journal of Health,
Population and Nutrition 27.2 (2009): 184-201. National Centre for Biotechnology Information, U.S. Web. 20
Mar. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761784/>.
29
Health.pdf>.
30
Barnagarwala, Tabassum. "India Has Highest Number of Maternal Deaths." India Has Highest Number of
Maternal Deaths | The Indian Express. The Indian Express, Ltd., 07 May 2014. Web. 20 Mar. 2015.
<http://indianexpress.com/article/india/india-others/india-has-highest-number-of-maternal-deaths/>.
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states that with improved access of pre- and post-natal care in remote areas and for minority social
and religious groups, the maternal mortality rate can be greatly reduced31. Uttar Pradesh, Bihar and
parts of Rajasthan have such high maternal mortality rates that it is believed to have skewed the
national total to some extent32. Ideally, four prenatal assessments are required for a pregnant
woman. In India though, only 52% of them go for three or more assessments, with majority of them
being from urban areas. Many indirect factors like proximity to a healthcare centre, qualification of
doctors, its acceptability by the family, education level of mother and costs of assessment play a role
in the steep difference33.
Most studies have looked at maternal mortality rates but it is important to consider other factors
that are a part of maternal health. Prost et al (2012) delved into the effect of psychological distress
on maternal health in rural India. The women they studied came from two states – Jharkhand and
Orissa – that have 40% of the population living below the poverty line. They found that pregnant
women who had lost an infant, were experiencing unwanted pregnancy, belonged to lower
socioeconomic classes and did not have access to adequate healthcare interventions were more
likely to experience psychological distress34. A report by the World Health Organisation has also
found that maternal health can be affected if a woman has been diagnosed with Acquired
Immunodeficiency Syndrome. 320 maternal deaths in India in the year 2013 were a result of direct
or indirect effect of the pregnant women being affected by it35.
Datta and Datta (2013) point out that issues like marriage practices of a community, awareness of
contraception and malnutrition are risk factors for poor maternal health36. Lack of vitamin intake
during pregnancy has been linked to vaginal bleeding and convulsions while if this deficiency is
chronic (present from before the pregnancy), it could result in night blindness. 48% of pregnant
woman have been found to experience excessive fatigue and 25% have swelling in different body
parts. Even fevers37 and malaria have been reported to have disrupted maternal health38. Vora et al
31
Ramchandran, Smriti K. "India May Miss U.N. Millennium Development Goal for Maternal Mortality
Rate." India May Miss U.N. Millennium Development Goal for Maternal Mortality Rate - The Hindu. The Hindu,
29 Sept. 2014. Web. 20 Mar. 2015. <http://www.thehindu.com/sci-tech/health/india-may-miss-un-
millennium-development-goal-for-maternal-mortality-rate/article6455141.ece>.
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33
Health.pdf>.
34
35
36
Dutta, Debalina, and Pratyay P. Dutta. "Maternal Mortality in India: Problems and Challenges." Asian Journal
of Medical Research 2.1 (2013): 33-35. ScopeMed. Web. 20 Mar. 2015.
<http://www.scopemed.org/?mno=33975>.
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(2009) found that in their sample of pregnant women, 86% of those who had been educated for 12
years delivered in proper healthcare institutions whereas this practice was used by only 18% of
those who were not educated39.
Consequences at Individual and Community Level
Health of a mother is very much intertwined with that of the child. As evident from the most
researches on the topic of maternal health, the maternal mortality rate is a major consequence of
maternal health deterioration. That India is the foremost country for maternal mortality rate is
alarming and points to the lack to healthcare awareness and access in many parts of the country. It
also forms a significant proportion of female deaths in the country. Most maternal deaths happen
about forty-eight hours post-delivery and indirectly affect the development of a child. Without the
presence of the mother, a child may be devoid of the breast milk, which is essential for normal
growth and nutrition during the first few months of life. A need arises to even have another primary
caregiver who can look after the child and form a similar bond as the mother would so that the
attachment pattern developed is normal and does not affect later relationships. In many
unfortunate cases, the maternal death is also accompanied by neonatal death40.
Poor health of the mother affects the prenatal development of the child. When certain nutritious
elements cannot be provided for by the mother, a needed arises to supplement regular diet with
appropriate medication. But not every woman in India has the access to such products. Even when
available, many families choose not to spend money on it. Lack of vitamin leads to vaginal bleeding
and night blindness, while, lack of use of calcium tablets has been found to cause hypertension41.
Iron deficiency, on the other hand, causes anaemia as reduced iron leads to reduced haemoglobin
and hence lower levels of oxygen and healthy red blood cells. Not receiving enough calories per day
can lead to exhaustion felt by most pregnant woman. It also further affects the development of the

Health.pdf>.
38
39
40
Health.pdf>.
41
Borade, Pratima, S. J. Haralkar, and A. V. Wadagale. "Hypertensive Disorders of Pregnancy: A Hospital Based
Cross-Sectional Study with Comparison Group." Indian Journal of Maternal & Child Health 16.1 (2014): 1-
6. Hypertensive Disorders of Pregnancy.pdf. Indian Journal of Maternal & Child Health, 2014. Web. 20 Mar.
2015.
<https://docs.google.com/a/ijmch.org/viewer?a=v&pid=sites&srcid=aWptY2gub3JnfHd3d3xneDo2Mjc1OTk4Z
GQ3ZjE2NjY5>.
12
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foetus as the small amount of nutrients needs to be shared by the mother and the child42. Other
effects of poor maternal healthcare on physical health include ante- and post-partum blood loss,
ruptured uterus, ectopic pregnancy and seizures43. Dr Suchitra Pandit states that when a pre-existing
health problem such as diabetes is present, it increases the chances of problems in maternal health.
Further, even an acquired illness during pregnancy (malaria, dengue or measles) can be a cause for
maternal death or affect normal foetal development44.
When considering the psychological health of the mother, it has been noticed that factors like
domestic violence and acceptance by one’s husband can affect the distress felt. Many women have
been reported to feel depressed when the pregnancy is unwanted and frowned upon by the family.
Further, this could extend after the delivery and result in post-partum depression. This would also
affect the child as the approach taken by the mother is not as proactive or nurturing. Sometimes,
maternal mental health may be normal throughout but is affected after birth. Chandran et al (2002),
state that this is especially true in cases where families do not accept the birth of a girl45. For those
who give birth at a young age or are having a child for the first time, looking after a child may be
overwhelming. Exhaustion then manifests even after birth and could lead to lack of confidence in
one’s parenting skills.
Some communities in the country have shown resistance to change in practices related to
pregnancy, which at times can have adverse effects on maternal health. Place of birth, for example,
is still not associated with hospitals in many places. The hygiene and lack of appropriate equipment
has often been put under scrutiny as a result. Despite this some communities believe that they need
to follow traditions related to child birth. Such stringency can be carried from one generation to the
next because of learning through observation and result in even other outcomes like less
involvement of fathers in ensuring good maternal health. People belonging to dominant religions in
India also show such a firm stance at times. An example of this is not allowing abortion even though
it is legal as it has been equated with killing of a life. For families that cannot afford to have another
child or do not want to, the birth could have both psychological and financial repercussions.
Campbell, Papp and Gogoi (2012) believe that the attitude adopted by many cultures affects the
agency felt by a woman. With not having a say in time of marriage, choice in having a child and the
right to decide what type of healthcare services to use, the patriarchal structure is reinforced. A
42
Health.pdf>.
43
Dutta, Debalina, and Pratyay P. Dutta. "Maternal Mortality in India: Problems and Challenges." Asian Journal
of Medical Research 2.1 (2013): 33-35. ScopeMed. Web. 20 Mar. 2015.
44
45
13
(LE01SPY315) (LE2012761005)
culture of silence hence emerges and prevents women from putting forth their views and needs
even in other situations46.
Resources Available to Solve the Problem
Different initiatives to eradicate poor maternal health have been taken by the Government of India.
A 3-tier system has been created where in each level is focuses on more complex maternal
healthcare. Primary care works at village level, secondary at subdistrict level and district level and
tertiary at regional level. Even some of the medical colleges now have maternal healthcare services
as an extension to the actual area in which classes are taught47. The Ministry of Health and Family
Welfare launched the Child Survival and Safe Motherhood Programme in the early 1990s. Later it
was treated as a part of Reproductive and Child Health Programme48. This program tried to provide
better maternal healthcare by adding nursing staff that so that enough experts were present for
deliveries during the day and even at night. They also provided spaces for tests for reproductive tract
infections and sexually transmitted diseases for it could indirectly affect the child. Further, they also
gave people access to abortion facilities in case it was medically necessary or if people chose it
deliberately. The Safe Motherhood Programme, on the other hand, focuses on facilitating a healthy
pregnancy. It provides required immunisation and medication, recruits more doctors and nurses so
that delivery can be handled by trained people and also spreads awareness on the need for
institutionalised birth and birth-spacing49.
Even the National Population Policy covers the issue of maternal health to some extent. But the
National Rural Health Mission has been the most impactful in tackling maternal health issues,
especially in rural areas50. The framework adopted by them is community monitoring wherein
members of a community are encouraged to work together to help the pregnant women in their
midst. Those with problems can approach the village panchayat and file a complaint. The members
of the panchayat then pass on this feedback to the public health system. The public nature of these
meetings ensures participation of all and empowers women to speak up as they get motivated by
46
Papp, Susan A., and Aparajita Gogoi. "Improving Maternal Health through Social Accountability: A Case Study
from Orissa, India."International Journal for Research, Policy and Practice, 8.4 (2013): 449-64. LSE Research
Online. Web. 20 Mar. 2015.
<http://eprints.lse.ac.uk/44823/1/Campbell_Improving_maternal_health_through_social_accountability.pdf>.
47
48
Health.pdf>.
49
50
Health.pdf>.
14
(LE01SPY315) (LE2012761005)
watching other women do the same51. The National Rural Health Mission also provides guidelines for
pregnant women, professionals working in the field of maternal healthcare and for infrastructural
requirements52. These policies adopted by the government have been based on suggestions made
by international organisations such as the World Health Organisation, United Nations and the World
Bank53. Even though the current maternal mortality rate is not as low as the threshold set by the
United Nations Millennium Development Goal for Maternity Health, there has been a significant
reduction since the year 1946, when it was 2000 per 100000. There has also been a rise in
institutionalised deliveries and a decline in the use of services of midwives54.
There are various independent organisations, which too are working towards improving maternal
healthcare. ACCESS Health International, created a list of sixteen organisations which do so and
studied their services. The basis for choosing them was the diversity of the nature of their work –
hospital-based services, community initiatives, profit-based organisation, not for profit
organisations, non-governmental organisations, etc. Some of them also are actively involved in
research on maternal health and use the findings for advocating new policies. Others recruit
volunteers who can reach those in need or spread awareness in different regions. While some have
focused only on maternal health, others incorporate issues related to women’s empowerment and
child health as well. Examples of these independent organisations include Action Research and
Training for Health (ARTH), Society for Education, Action and Research in Community Health
(SEARCH), Ekjut, Karuna Trust, Self-Employed Women’s Association (SEWA), etc. Most of them are
functional not just in urban areas or big cities but also try to provide services to those in rural areas
by forming tie-ups with the government or local private healthcare institutions55. Maternal health in
both urban and rural settings has also been an issue studied by independent mental health
practitioners as well as academics from fields like economics, psychology and political sciences. The
Indian Journal of Mental Health is one publication in which some of these researches are published
and are peer-reviewed56.
51
52
National Health Mission. "Guidelines." Guidelines - Government of India. Government of India, 2013. Web.
20 Mar. 2015. <http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-health/guidelines.html>.
53
54
55
Anant, Priya, Prabal V. Singh, Sofi Bergkvist, William A. Haseltine, and Anita George. Improving the Health of
Mother and Child: Solutions for India. New York: ACCESS Health International, 2012. PDF.
56
"Indian Journal of Maternal & Child Health." Indian Journal of Maternal & Child Health. Indian Journal of
Maternal & Child Health, n.d. Web. 20 Mar. 2015. <http://www.ijmch.org/>.
15
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Strategies and Organisations as Potential Solutions
Just like the main strategy adopted by many independent organisations, awareness is the first step
towards improving maternal health. This can be done through letting people know about the period
of gestation along with issues such as nutrition, need to educate women, not marrying young or at
least not having a child at a young age, using contraception, alternative options such as abortion and
giving up children for adoption, etc. Tackling the allied problems can indirectly help improve
maternal health. Even the need for good psychological well-being of pregnant women needs to be
given recognition as it could affect them during the pregnancy and also after giving birth. Disorders
like post-partum depression need to be understood more seriously rather than viewing them as lack
of parenting skills or being emotionally distant mother. Since, sex education is not allowed in Indian
schools, a major potential source of spreading awareness at the bottom-most level is lost. Instead,
governmental initiatives have been promoted through television adverts. While this creates
awareness regarding facilities available, it is still an ameliorative step as it does not let people know
the need for those facilities in the first place. Students of biology, medical sciences and even
psychology, however, do get educated in maternal health issues to some extent. Medical students
and pregnant women can both benefit from hospitals which are run on the same campus as the
educational institute.
A few organisations have tried to create awareness by reaching out to the women in their homes. In
some settings, this might be more appropriate. This model could also be used by the National Rural
Health Mission where the feedback using panchayats is not possible. Not all communities encourage
women to publicly voice their concerns, especially those regarding their reproductive health. In such
cases, having female intermediaries that talk to the women in their own house may be more
successful in bringing forth the problems. Having more female doctors could also help as not every
woman or family would be comfortable with a male gynaecologist. A drastic change such as creating
acceptance for male doctors or publicly raising issues related to maternal health might not be
feasible. Instead, creating acceptance towards female intermediaries and female doctors would be
easier. This could probably be done at policy-level by having guidelines regarding presence of
specific maternal healthcare professionals in hospital settings. Other problems could be tackled by
policies too. A minimum age for child birth and a minimum time period between consecutive births
could be set as not everyone is aware of the need for the two and even those who are do not
necessarily adhere to them. Complementary laws such as the ban on child marriage do exist but are
not always successful at execution stage.
Some communities have their own set of pre-natal and post-partum taboos that do work in favour
of improving maternal health. But many people now choose to not follow them because they view
them as restrictive traditions with no justifications for their presence. However, their link to
scientific research could be made known to people. Also, a few methods used by midwives that
deliver babies in the home of the pregnant women could be incorporated into institutionalised
birthing as a way of bridging the gap between the two forms of birth settings. A taboo that,
however, needs to be dealt with is that of abortion. Informing people about it could help them
decide better if it is the right option, without feeling morally wrong or guilty for the breach of
cultural beliefs. Also, abortion services need to be made available all over the country, not just in
urban area. This should be cautious in nature as sometimes the access to antenatal assessment and
abortion results in parents indulging in female foeticide. Not only does this result in skewed sex ratio
16
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but could also be harmful to the mother if not done by a medical expert. Another taboo that is
prevalent in the Indian society is related to unwed mothers. An acceptance for this may be hard to
create in smaller cities, villages and even some of the big cities but is required for the psychological
well-being of women as it could result in less stigma and discrimination.
Lack of involvement of father is now less evident in those that reside in urban and developed areas
when compared to certain other communities, indicating that a change in approach to maternal
health can get affected by education and awareness57. While living in urban middle-class or elite
areas brings with it the advantage of good education and increased awareness, it also could hamper
maternal health. Many women now choose to have children later in life which could potentially be
risky. But having the right medical assistance could help tackle this problem. Many qualified doctors
may be tempted to choose a career in the city rather than rural areas due to the facilities available at
healthcare institutions and because of the pay available. In fact, even those in the cities choose to
work in private hospitals or clinics over governmental institutions. With the improvement in
infrastructure being given focus now and guidelines for presence of a certain number of experts at
each level of the 3-tier maternal healthcare, this mind-set could be changed. An attempt by the
government to make working in rural settings compulsory for students of medicine has not been
well-received by many of them. While at the surface-level it may seem like a good idea to
compensate for the lack of staff, it needs to be taken into consideration that these students will not
hold the same level of expertise as experienced professionals and hence there would be a gap
between the quality of maternal health services available in rural and urban settings.
57
Health.pdf>.
17
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20

Problems in Indian Community - Urban Men PDF

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Community Psychology Aditi Trivedi

Name: Aditi Trivedi

Application No.: LE2012761005

Word Count: 6999

Assignment 2 – Problems in Indian Community

Problem Chosen: Urban Mental Health

Target and Setting

Consequences at Individual and Community Level

Resources Available to Solve the Problem

Strategies and Organisations as Potential Solutions

Problem Chosen: Maternal Health

Target and Setting

Consequences at Individual and Community Level

Villages, Sept. 2007. Web. 20 Mar. 2015. <http://hetv.org/india/nfhs/nfhs3/NFHS-3-Chapter-08-Maternal-

Resources Available to Solve the Problem

Strategies and Organisations as Potential Solutions

Ministry of Health and Family Welfare. "National Mental Health Programme

Ntulo, Christina A. "The Self-Advocacy

World Health Organisation. "Gender and Mental

Borade, Pratima, S. J. Haralkar, and A. V. Wadagale. "Hypertensive Disorders of Pregnancy: A

National Family Health Survey 2005-2006 (NFHS-3). "8. Maternal

449-64. LSE Research Online. Web. 20 Mar. 2015.

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