Sandula Mangamma, who believes she is in her early 40s, has 10 children. Her eldest daughter Rajamma, in her 20s, one of six daughters, has two children herself. Mangamma’s youngest is Silakamma, 4. In another street, Ketchela Lingamma and Raghava Reddy have 11 children, of who three died; the parents aren’t sure of what illness. Their neighbours, Sandula Mangamma and Narsireddy, have 10 children. The couples were happy to have more babies through their productive ages, beginning at 15.
In Muntha Mamidi village, under the Chavadikota panchayat in Alluri Sitarama Raju district, in Andhra Pradesh’s north east, there’s an unwritten population ‘policy’. Having five children is considered the least number, with many couples having up to 10 or 11, in this village in the Eastern Ghats.
Named after a mango variety, Muntha Mamidi, cricket-ball shaped sweet treat, the rough journey across small streams and uneven ground, is forgotten with the sweet aroma of the fruit that the Konda Reddi tribe cultivates. Falling in the left-wing extremist (LWE) affected zone on the Andhra-Odisha border, the village is spread across a green hill, nearly 40 km from the tourist headquarters of Maredumilli through the which the Godavari river flows.
(For top health news of the day, subscribe to our newsletter Health Matters)
The Konda Reddi tribe is classified as a Particularly Vulnerable Tribal Group (PVTG), one of 12 in Andhra Pradesh. The tribe that lives in habitations in the dense forest, brews liquor from mango pulp for consumption during monsoon.
On a rainy day, Mangamma says, “My husband decides when I should stop having children. We both feel that I will become physically weak if I opt for birth control. If that happens, I can no longer work on the farm, which is rattu (laborious)“.
The Konda Reddi women are assigned more work than men in the Konda Podu, a form of cultivation in which the forest is cut to raise crops, mostly millets: kandulu (red gram), ragulu (finger millet), samalu (little millet), and korralu (foxtail millet). The collection of broom grass is another source of income. Three acres is the highest land holding owned by any Konda Reddi family here.
“I must be fully involved in every farm activity, from sowing and harvesting to carrying the harvest back to the house from the field,” says Mangamma. On the days she goes to the farm, at least twice a week, she walks 6 to 8 km. “What If I fall ill after the surgery? Our family will collapse,” she adds.
Her daughter, Rajamma, who went to school until class VII, herself underwent a tubectomy in May, wants her mother to have the surgery. “But my father is scared that she won’t be as strong for farm work after it. He also complains that he will not be able to handle the entire farming process if my mother doesn’t go to the field.”
The Muntha Mamidi village population currently stands at 208, as per official data of the Village Secretariat System (Andhra Pradesh): 102 male and 106 female, living in 37 households. There are 60 children (28%), with 32 in the 0 to 5 age group. According to Andhra Pradesh Tribal Welfare Department, there are 78,387 in the Godavari Agency.
Homes are built on mud floors, with plastic sheets forming roofs. Much of the space in these houses is dedicated to storing the harvest, seasonal fruits, clothes, and wood for cooking. Families spend the night in the house; days are spent outdoors. If a member falls sick, the others are prone to getting the infection because of physical proximity.
Sadala Chinnamma, 32, claims to be the first woman to undergo a tubectomy in the village. In 2020, the mother of six had the surgery in the Rampachodavaram Area Hospital. “Doctors advised me to do it. I am physically well and do not have any health complications,” says Chinnamma. Her husband, Linga Reddi, died of a heart attack last year; so did one of her children. “The responsibility of the entire family is now on me. I have enrolled four children in the tribal welfare hostel, and I look after the farm along with my three-year-old boy,” she says.
Hard to reach
Sandula Ramulamma, 27, pregnant, and the mother of three girls says, “For generations, our tribe believes that the more the children, the wealthier the family is. We believe that those who are blessed with more children could be more prosperous by expanding their farm activity.” However, she says women cannot decide on birth control on their own.
There is no ASHA worker here to take care of pregnant women, their regular medical check-ups, and institutional deliveries. Three years ago, the ASHA worker died. The last stop of the ambulance is nearly 3 km downhill. Poor road connectivity is one factor that keeps the women from accessing institutional deliveries. The mobile phone signal is low too.
The Government General Hospital (GGH-Kakinada) is the nearest big medical facility, 100 km away, and doctors treating the Konda Reddis have noted that they are hesitant to travel long distances for birth control surgeries.
“We encourage both men and women to undergo the surgery. But most of the time the women participating is much larger in number,” says Alluri Sitarama Raju District Collector Sumit Kumar.
The State government recently said they’d train the PHC doctors to treat pregnant women and conduct deliveries, but it is yet to materialise. “We do not have an Anganwadi centre that provides nutritional care for the 0 to 5 age group. The primary school has also not been opened in the present academic year,” says village volunteer S. Pratap Reddi, in his early 20s, who finished Class XII and then discontinued his education.
For this work, he gets to stay in his village and gets an honorarium of ₹5,000. “I have been creating awareness on birth control since I was appointed as the village volunteer in 2019,” he says. He has four siblings.
Men and change
Sadala Mangi Reddy was the first man to undergo a vasectomy in the village, and four more men followed him. Village volunteer Pratap Reddi says it’s more difficult to persuade men to undergo the vasectomy. “When we do try and talk about it, they take to ‘herbal medicines’,” he says.
“I have started using a preparation of locally available herbal medicines for birth control as advocated by our tribal elders,” says Ketchela Raghava Reddy, 48, the father of 11 children, out of who three died.
Children mostly take care of themselves and do the house chores after their parents leave for the farm. Income is meagre, and access to education, nutrition, and healthcare low. The drinking water is sourced from a stream nearby.
Integrated Tribal Development Authority (ITDA) Project Officer in Rampachodavaram Suraj Ganore says, “There is a huge requirement for family planning surgery in the Konda Reddi tribal pockets. We have noticed this need during the medical camps.” However, there is no road map on how to go about it, or even of reaching basic healthcare closer to the families.
In August, Ramulamma is expecting to deliver her fourth baby. If she or her husband don’t opt for birth control, they could be the next generation to adopt the unwritten ‘five-child policy’ in a district named after a freedom fighter who bore no children and fought for the rights of tribal people.