Counselling and Care – Saving a High-Risk Pregnancy in Rural Maharashtra

By Wasim Shaikh, Program Manager, CYDA

Supported by – Plan International

Shelkui is a small tribal village located in the Dhadgaon block of Maharashtra. Agriculture and daily wage labour are the primary sources of livelihood, with most households relying on the income of a single male member. Poverty, illiteracy and traditional practices make access to healthcare difficult, which worsens health conditions like anaemia. Women often face multiple pregnancies and heavy domestic responsibilities. During pregnancy, most women are discouraged from eating iron-rich foods such as meat, eggs, or green vegetables due to cultural taboos. Such practices directly reduce hemoglobin levels and increase the risk during pregnancy. Women also rely on home remedies or rituals instead of medical treatment, delaying hospital visits even when symptoms like swelling or extreme fatigue appear.

Ms Dudhi Madhya Pawara, a 41-year-old tribal woman, lives in this socio-economic setting. Already a mother of six children, she became pregnant for the seventh time. Her husband, Mr.Madhya Zombya Pawara, works as a farm laborer to sustain the family. The burden of providing for such a large family was already huge and Dudhi’s pregnancy only added to the family’s worries.

At the time of her pregnancy, Dudhi’s health was in critical condition. Her hemoglobin level was only 6 g/dl, indicating severe anaemia. She had swelling in her limbs and was considered a high-risk mother due to her age and health condition. However, she refused hospital admission because of traditional beliefs. Despite repeated requests from health staff to get admitted to the block-level Rural Hospital (RH), Dudhi initially refused, reflecting the reluctance many women in rural areas have toward institutional healthcare.

Key Challenges Affecting Maternal Health in Tribal Communities

Dudhi’s case mirrors several maternal health challenges common in tribal and rural India:

1. High prevalence of anaemia: According to NFHS-5 (2020-21), 57% of women in Maharashtra suffer from anaemia, with the prevalence being higher among rural and tribal populations. Severe anaemia during pregnancy increases the risk of maternal mortality and low-birthweight babies.
2. Multiple pregnancies and lack of family planning: Studies (IIPS & ICF, NFHS-5; International Journal of Community Medicine, 2021) show that many tribal women have limited awareness about contraceptives and continue to have more than four children. This not only weakens maternal health but also leads to malnutrition among children.
3. Old-age pregnancy risks: Research by the Indian Journal of Public Health (2019) highlights that pregnancies above 35 years carry higher risks of stillbirth, hypertension and complications during labor.
4. Healthcare access barriers: A study by UNICEF India (2018) reported that tribal women often avoid institutional deliveries due to cultural beliefs, lack of trust and financial fears.

Turning Point

 Centre for Youth Development and Activities (CYDA) was informed about Dudhi’s case through the Anganwadi Worker (AWW) and the village ASHA worker during the monthly vaccination day. Realizing the severity of her condition, CYDA, along with Ms. Kavita Parmar, Community Nutrition Worker, staff from the Health Department and the Women & Child Development Department, immediately visited Dudhi’s home. A two-hour counselling session was conducted with Dudhi and her husband. The team explained the dangers of anaemia during pregnancy; the risks associated with delivery at her age and the importance of hospital care. They reassured the family about the support available at the Rural Hospital (RH). Eventually, Dudhi and her husband were convinced and agreed to the admission.

Medical Care and Treatment

Once admitted to the RH, Dudhi received urgent and comprehensive care:

1. Two antenatal check-ups (ANC) were conducted at the hospital.
2. She underwent a blood transfusion to improve her haemoglobin levels.
3. Both doses of Iron Sucrose (Shukoj) were administered to build her strength.
4. Considering her high-risk status, she was admitted two days before her expected delivery date.

The Impact – A Safe Delivery

With the timely intervention and continuous monitoring of CYDA staff, Dudhi safely delivered twin girls. Both babies were born healthy, weighing 2.7 kgs and 2.4 kgs well above the average birth weight for twins in high-risk cases. The family was relieved and Dudhi’s life was saved through coordinated community and institutional support.

Dudhi’s case shows how awareness, counselling, and timely support can save lives. With the right guidance, even families who are unsure can be motivated to seek healthcare. Family planning and a safe gap between pregnancies also help reduce risks for mothers and improve child survival. Every mother receives the care and support she needs when Anganwadi workers, ASHAs, and NGOs like CYDA collaborate at the community level. At the same time, challenges such as poverty, large families, and women having little say in decisions need to be addressed along with medical care.

The safe delivery of Dudhi’s twin daughters is proof that collective efforts can turn a high-risk pregnancy into a positive outcome. For her family, this support saved Dudhi’s life and gave her daughters a healthy start. While financial and social struggles continue, her story reminds us that with awareness, family counselling, and strong healthcare systems, maternal health can improve. It also highlights the importance of investing in women’s health, enabling every mother- regardless of her age, location, or background-to experience a safe pregnancy and delivery.