Vatsalya, an initiative to improve the health and nutritional status of women and children, was undertaken in 22 villages in Amreli’s Rajula Block
The small boat at Gujarat’s bustling Pipavav Port bobs up and down as it waits to ferry passengers to Shiyal Bet Island barely 600 metres away. It’s a rainy morning and the waters of the Arabian Sea are beginning to turn choppy. Fifty-year-old Dakuben jumps onto the boat with ease, having undertaken the 12-minute journey innumerable times to visit her daughter in Shiyal Bet. However, this time, her visit is mired in sorrow as she is going to mourn the death of her newborn granddaughter.
Gujarat’s Infant Mortality Rate (IMR) is 30 deaths per 1,000 live births and the state ranked tenth in the country according to the NITI Aayog’s 2016 IMR report. According to statistics 69 per cent of infant deaths in Gujarat were neonatal, higher than the national average of 67.60 per cent.
Anaemia is one of the major factors responsible for the rising neonatal, infant and maternal mortality in Gujarat, especially among rural women. According to the fourth National Family Health Survey (NFHS-4) conducted in 2014-15, 54.9 per cent women in the age group of 14-49 years are anaemic and 51.3 per cent of pregnant women have anaemia.
The NFHS-4 placed Gujarat among the top 15 states with the highest incidence of anaemia as the percentage of anaemic women there was higher than the national average of 53 per cent.
The survey revealed that lack of education played a major role and anaemia was particularly high among illiterate women due to lack of awareness about health-related issues.
At 31.2 per cent, Shiyal Bet’s literacy rates are much lower than the state’s 78.3 per cent (2011 census). With the island’s female literacy rate being just 15.48 per cent, it’s no surprise that awareness about anaemia and other health issues is low.
In order to change this scenario, Vatsalya, an initiative to improve the health and nutritional status of women, children, and adolescents was undertaken in Shiyal Bet and 21 villages with similar poor health and development indicators in Rajula Block in Amreli district. Launched in 2016 by the Centre for Health Education, Training, Nutrition Awareness (CHETNA), a not for profit organisation, the three-year programme has been able to bring down undernutrition, improve antenatal and postnatal care and ensure safe motherhood.
It has also been able to break myths related to early breastfeeding, promote healthy feeding practices, timely immunization and increase access to basic health services.
The intervention, supported by Gujarat Pipavav Port Limited (GPPL) APM Terminals under their corporate social responsibility initiative, used a multi-pronged strategy including games, Q&A sessions and street theatre to engage the community. Sustained efforts, coupled with community participation helped to bring down the number of children suffering from undernutrition from 30 per cent in 2016 to 14 per cent in 2019. The number of children who attained normal body mass index also rose.
The intervention marked up registration of pregnancies by almost 42 per cent and increased the number of women receiving antenatal care, tetanus injections and folic acid tablets. A rise in institutional deliveries by 9.42 per cent was also seen at the end of the three years.
“We are committed to bringing change in the lives of marginalised communities. Therefore, empowering them with factual information and linking them to government schemes and programmes was imperative. This intervention was more challenging because we had to work in difficult-to-reach villages like Shiyal Bet and with migrating populations and communities that were isolated and neglected. But we were able to make a difference in their lives thanks to our dedicated field team, and our partnership with the community, frontline health workers and panchayat leaders,” said Pallavi Patel, Director, CHETNA.
A key to this success was the strategy to train women from the community as Vatsalya mitras (friends).This gave the community a sense of ownership and led to increased participation. So when Shantuben Chauhan became a trained Vatsalya mitra, she used her influence as an anganwadi worker (AWW) to reach out to pregnant and lactating women. Chauhan, an AWW for the last 15 years, is a popular face in Shiyal Bet. With both her marital and natal home being in Shiyal Bet, Chauhan was able to mobilise the community very effectively.
However, when the CHETNA team first visited Shiyal Bet, they found that although Chauhan was articulate and good at her work as an AWW, she, like most of the others, believed in many myths related to reproductive and sexual health. One of the biggest misconceptions she had was related to menstruation. Not only was it a taboo subject, but neither she nor her three daughters practiced menstrual hygiene. Considering that only 54 per cent of rural women use a hygienic method of menstrual protection (NFHS-4), this was not surprising. The fact that women with at least 12 years of schooling were more than twice as likely to be using a hygienic method (79 per cent) as against women with no schooling (34 per cent) meant that Chauhan who is uneducated, didn’t get access to information which could help her practice menstrual hygiene.
So the first step was to demystify menstruation. The team knew that once they were able to get Chauhan on board then she would get the others. “I was ashamed to discuss this issue. The training helped me understand why I should not be ashamed and why menstrual hygiene is important. I used the scientific information to convince other women and adolescents during Vatsalya samwads (dialogue),” recalled Chauhan.
For Vatsalya mitra Vandanaben Goswami, the training cured her of the belief that she was ‘impure’ during her periods and going to the temple or kitchen was wrong. “After I became better informed, I no longer forced my daughters to follow these customs. I used my own example to convince other women and girls,” contended Goswami.
The monthly Vatsalya samwads proved to be a good move as they helped break the ice on many ‘uncomfortable’ issues like the tradition of early marriage and family planning in all 22 villages. Besides explaining the consequences of early marriage on the health of adolescents, the importance of antenatal care and postnatal care visits for pregnant and lactating women were discussed. Also addressed were myths related to early and exclusive breastfeeding. According to NFHS-4, just 50 per cent women in Gujarat start breastfeeding in the first hour of life as recommended by the World Health Organisation, thus depriving newborns of the highly nutritious first milk, colostrums, and the antibodies it contains. In fact, about one in five children who were ever breastfed were given something other than breast milk during the first three days.
Raziben’s three children were among them. She had followed the custom of feeding her children goat’s milk or hot water mixed with jaggery immediately after birth. It was only after attending the Vatsalya samwads that she understood why this was not healthy for the newborn. This helped her initiate early breastfeeding for her fourth child born last year. Inspired by this, her friend and neighbour Manjuben also breastfed her daughter within 24 hours of her birth in June this year. In fact, there was an 22 per cent increase in early breastfeeding by the end of the project.
A big factor in the improving health and nutrition indicators was the partnership with local leaders and panchayats. Leaders like Gangabhai, the sarpanch of Kundaliya Village, played an active role in mobilizing the community and promoting awareness.
“There has been a big change in my village after CHETNA began their work. The AWWs have become more informed and active. More women are attending the monthly Mamta Divas. Earlier only 7-8 women had health cards, now 60 of them have cards. I also pay visits to support and motivate them,” he said.
While the success has been encouraging, challenges remain. Considering the entrenched patriarchy and caste barriers in Gujarat, sustaining behavioural change requires greater investment of time and resources. Only then, will no one be left behind.
(The writer is a senior journalist)
