The reason of failure of the health programs is very simple as the programs have failed to strike the root cause and in this case it is the age-old practice of early marriage. We know that anemia, hemorrhage, abortion, perperual sepsis and other complications are the valid reasons of maternal mortality. Similarly, low birth weight, childhood illness are the valid reasons of infant mortality. But besides these there are several other causes, which make Malkangiri vulnerabile in regard to maternal mortality rate and infant mortality. But not a single program has focused attention on this particular issue.

This is not only the root cause of health hazards; this is also adversely affecting the education scenario of the district. Many children are leaving school at a tender age and many are deprived of higher and employable education. Literacy scenario is also quite poor in Malkangiri district.The district is having the lowest literacy in the state i.e. 31.26 %. This education level in turn has affected the skill development in the youth of this district since knowledge helps in developing new skill and expertise in many areas.

In Malkangiri women of reproductive age (15-45 years) and children (<15 years) constitute a major portion of the population. 50 % of the population is in adolescent age group and yet to begin their reproductive lives. However, early marriage (12-14 for girls and above 14 for boys) is a practice, which is both culturally and economically embedded in their society. Interestingly the district level household survey found that the age at first cohabitation in the case of 70.2% of women interviewed was below 18 years.

Early marriage is common and it is found that around 56% marriages happen below 18yrs because it fetches a bride price, which is a valued source of support to the families. And above all the practice of youth dormitory system add volume to this as this ultimately lead to elope and early marriage. Such early marriages have a direct impact on maternal and child health as the pregnancy happens before physical maturity is obtained. It puts psychological and emotional stress on the girl. The early marriage which resulted in early pregnancy makes the mother anemic. In India, study shows that in the low income group pregnant women have deficiency of 1,100 calories and lactating women 1,000 calories. Women of the lower socio-economic groups gain only around 3-5 kgs during pregnancy, which is far less than the required weight. Anemia in pregnancy accounts directly 15 to 20% of all material deaths in India.

Coming to Malkangiri the 2002 RCH survey says that 97.6% of both the adolescent girls (10-19 years) and pregnant women (15-44 years) were anemic and this condition is not improved that much within this period also. Early marriage is equivalent to child abuse and a violation of the rights of the child. It has extremely deleterious effects on the health and well being of the child. In a way it is a denial of childhood and adolescence. The child who is a victim of this evil practice latter struggle in adulthood for its very existence as it curtails personal freedom and opportunity to develop. The children loose the opportunities for personal development thru educational opportunities.

It was observed thatabout 90% of adolescent girls aged 15-19 years old are married. Girls are married by the age of 12-14 years while boys are married by the age of 15 years. Thus, the adolescent girls experience child birth by the time they are 15, usually before the physical maturity is obtained.  Again many parents prefer to get their children married at an early age in order to supplement their family income by bringing in a bride or to avoid the risk of elopement and unwanted pregnancies among girls. The major socio-cultural reasons those were observed are:

1. Social Concept of Age: Life begins at a very tender age among the tribal. The people become old at a very early age also. The food habit and the lifestyle make most of the people old at 35-40 years. The parents engage their elder child in economic activities so early that have to leave the school. The child starts to learn the household and earning works from a very young age. It seems like they want to live the whole life within that 35-40 years. So the child needs to learn everything within 10-13 years, make himself/ herself ready to marry by 13-14 years and staring the family as soon as possible. This trend runs generation after generation making most of the people’s life miserable.

2. Bride Price: In many cases the parents of a girl child prefer to get their daughter married in an early age as the bride price fetches a considerable amount of wealth to the family. Among the tribals the male pays the price to get a bride. And the parents receive the bride price in terms of cattle, cash, liquor and food grains. The cattle and cash really supplement the economy. Parents wish to get these materials as early as possible so as they can use these for themselves.

3. The youth dormitory: No doubt this particular practice is in the verge of extinction and in many villages one can not find this. But still in many places the male and female youth spend night with their own peer in a common house of the village. This help the children to build a relationship in an early age and in many cases it leads to elopement. Similarly different fairs and festivals provide enough space for them to select a mate thru the collective dance form of “Dhemsa”.

4. The gender norms: Gender norms contribute to poor health-seeking behavior. For example, women are not allowed to make health-related decisions like seeking care when unwell. Also a woman’s illness is given a low or the least preference and this further delay the care seeking. Typically, women and girl children eat last and in an already impoverished family, it implies that they often eat very little. Above all the different food restrictions during pregnancy and after delivery aggravate the problem. For example if the traditional healers says not to eat chicken, fish, few vegetables then the woman can not eat this and this happen in most of the cases as the traditional healers advise them how to keep mother and child safe from ghost and other supernatural things. Similarly in many cases it is found that few women are asked to eat only rice and bamboo stuff (karadi) after delivery and up to 5 days.

5. The Community: The communities are also not aware of the ill effects of early marriage and its implications. There is lack of knowledge on reproductive health issues as a result girls who are married young are forced for early motherhood without taking into consideration its impact on the health of the mother and child.  Even amongst adolescents, the awareness on their reproductive rights is non-existent as a result they are not able to oppose the practice.

Another reason for the continuation of early marriage is the lack of educational and development opportunities for young girls and boys. There are non-functional secondary schools and vocational institutions in the villages for higher education or skill development as a result of which young boys and girls have nothing to do and hence are married off to become more responsible.  

No doubt there are several structural issues like the other part of the country. But the major problem is that there is not any focused intervention to address this issue. And more or less most of the tribal communities of this country are facing the same problem.

But this issue needs to be addressed by the state as well as by the Country in an intensive way. It is not that there is not any governmental provision to address such issue. If the education, health and livelihood programs work jointly towards this particular issue then there is no doubt that this issue can be handled efficiently. There is a need of convergence between different departments; the time is for joint effort, collaborative effort. Working parallel in two different roads will definitely delay the desired result.