Safe motherhood
This project covered 75 mothers in total. All received regular visits by health workers who provided them with maternal health advice, along with ante-natal check-ups. The following activities were undertaken:
- Monthly home visits were made to the pregnant women, which continued until their children reached two years old. Interaction with the mother and other family members aimed to promote positive childcare practices (e.g. timely immunisation, exclusive breastfeeding for the initial six months followed by complementary feeding).
- Every Thursday, CINI health workers held a clinic in the designated local areas. Mothers received check-ups from trained doctors, received medicines, and updated their health cards.
- CINI paid for any additional medical costs incurred by either the pregnant mothers or their children (under two years), and the cost of emergency or complicated deliveries in hospital.
- Female heath workers involved all the mothers in the villages in group activities, informing them about health care during pregnancy, childcare after delivery, as well as reproductive tract infections, sexually transmitted infections, including HIV/AIDS.
- Male health workers encouraged male village members to share the domestic workload during the pregnancy period. Men were educated on the importance of antenatal care, combined treatment of reproductive tract infections and sexually transmitted infections, and family planning. CINI also provided advice to husbands and mothers in law, to promote a fairer distribution of food in the family.
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Out of the 75 mothers, 96% of pregnancies were registered within 16 weeks, and in 83% of births, a trained birth attendant was present, more than double the average for rural West Bengal which is 37%. Timely identification of pregnancies allowed mothers to have three antenatal check-ups each. All mothers were provided with basic treatment such as iron folifer (IFA) tablets and tetanus toxoide injections, recommended by the World Health Organisation for pregnant women living in India.
Within the first 48 hours of birth, the babies' weights were recorded by traditional birth attendants, health workers or in the hospital where the delivery was conducted. This information is not usually available in the state health care system, but is a valuable indicator of whether mothers have been properly nourished during pregnancy.
There has also been a clear change in male participation in household duties, and increasing numbers of men have taken their wives to the clinic and referral centres. This has had a marked impact upon the general health levels of pregnant mothers.
Child survival, growth and development
The main activities undertaken were:
- Weighing of newborn babies within 48 hours of birth
- Advising the mothers and family members on the importance of exclusive breastfeeding for six months
- Providing information on feeding practices and low cost nutritious food
- Close monitoring of the nutritional status of the children (through regular weight measurement)
- Encouraging mothers and family members to immunise children on time
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Overall, only 12.7% of babies had low birth weights (weighing less than 2.5 kg), which is half the average for West Bengal. Health workers continuously worked with the communities to raise awareness about the importance of good maternal nutrition and health, thereby reducing the numbers of babies born underweight, or essentially born malnourished.
Many women in the area reported that they did not have sufficient breast milk to fulfil their baby's appetite. Health workers have focused on advising the women and their families, on how to improve the postnatal mother's diet to promote milk secretion, and provided emotional care and support to mothers in order to encourage them to persist with breastfeeding. CINI has been able to influence infant feeding behaviour by increasing acceptance of colostrum feeding, which was not common practice in the area before, but is a vital ingredient for boosting the immune systems of babies, and known to have long-lasting health benefits.
Adolescent activities
Activities have sought to raise awareness amongst adolescents about various health, reproductive and behavioural issues. The following activities were undertaken:
- Meetings led by health workers with female and male adolescents, focusing on health, respect towards the opposite sex, and their roles and responsibilities within the community
- Eight theatre workshops focused on scripting plays about issues such as early marriage
- Twenty-five community events were held, including a socially relevant street drama
The community responded well to these activities, as they provided a valuable channel for disseminating information and initiating dialogue about the issues highlighted.
Community mobilisation and linkage
- There were 1,014 meetings with women's groups, and 521 meetings with community members and male groups were conducted, focusing on issues of child care, immunisation and child spacing.
- Village level meetings were held to discuss reproductive tract infections and sexually transmitted infections, including HIV/AIDS. This helped to address stigma surrounding such diseases, encouraging people to seek treatment.
- CINI held 90 meetings with the panchayat (locally elected representatives), focusing on improving hygiene and sanitation. 30 meetings were held with government health workers and Integrated Child Development Services functionaries.
- Training through workshops was conducted for birth attendants, rural medical practitioners and peer educators to increase their impact in the local area.
- CINI's work with local government panchayat members, local NGOs and community-based organisations ensured the longer-term sustainability of the project, by creating links between local communities and panchayat representatives.
Key lessons learned
- There was a lack of awareness of understanding the importance of working with adolescents, which made activities for adolescents difficult. There were constraints particularly on the mobility of girls. Local communities, particularly parents, need further discussion about the benefits of engaging with adolescents, before they can be fully convinced about benefits of adolescent cooperation.
- Community groups have played an important role in empowering individuals and have acted as channels for facilitating collective action. In particular, adolescent and women's groups have been instrumental in raising awareness of maternal, child and adolescent health related issues.
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