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November 2005 – October 2008 (final report) |
This three-year project directly helped 406 pregnant women, 374 infants under two years old and reached out to 1,100 adolescents and 2,000 men living in Nahazari. The aim was to ensure safe motherhood, good child survival, growth and development, adolescent health, and mobilise the community by generating greater awareness of mother, child and adolescent health. Nahazari has a population of approximately 20,000 people.
1) Support for pregnant women and progress towards safe childbirth
Pregnant women were regularly monitored and visited by health workers who provided maternal health advice and checkups pre and post delivery.
Of the 406 pregnant women in the project area:
- 98% were registered within 16 weeks of pregnancy.
- There were 23 miscarriages. In each case, the health worker sought to investigate the contributing factors and provided appropriate support to the women affected.
- All received regular home visits. CINI Health workers informed pregnant women about the importance of a nutritious diet, good hygiene, adequate rest, a reduced workload, and regular check ups during pregnancy. They also sought to involve male family members, as well as mother- in-laws, to ensure that expectant mothers received adequate care and support at home.
- 72% had at least three ante-natal checkups or more (the state average is 56%) and 28%received less than three, helping identify potential problems and ensure women were fully informed about measures they could take to protect their own health and that of their unborn children.
- 9% of the women were identified as having ‘at risk’ pregnancies requiring particular attention. These were closely monitored by CINI’s health workers, and the women informed about the symptoms or factors that indicated that they might be ‘at risk’.
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Health worker visits a pregnant mother at home |
- 96% received two tetanus toxoid injections; as is recommended for pregnant women in India
- 92% had a haemoglobin test, indicating that most were anaemic. However few were severely anaemic (46% and 39% were suffering from mild and moderate anaemia). This improved when the health worker explained the benefits of simple steps, like eating more iron rich foods and taking iron supplements regularly.
- 74% received 100 or more iron folic acid tablets (more than three times the state average which is 21%), reducing the risk of dangerous bleeding during childbirth, or abnormalities in the children
- Out of 374 births, 365 were live (98%). Verbal autopsies investigated the cause of still births, and health workers continued home visits to provide emotional support to family members.
- 54% of infants were delivered in hospital, with full access to medical support in the case of complications, compared to the average for rural West Bengal of 34%.
- Of deliveries conducted at home, 83% had a person present trained in hygiene during childbirth, spotting potential complications and the need these to report these to medical personnel as soon as possible. This is more than double the average the number of home births attended by a trained person for rural West Bengal (37%).
2) Progress towards improved child health and nutrition
Newborn is weighed by a health worker |
- All newborns were weighed within 48 hours of birth.
- Most newborn babies (76%) weighed at least 2.5kg (World Health Organisation recommended minimum weight). 16% weighed less than 2.5kg (but more than 1.8kg). 8% were severely underweight, at less than 1.8kgs. Because many of the mothers have been chronically malnourished since childhood, many are unable to fully nourish the baby in their womb, and many babies are born before reaching full-term.
- Following advice on the value of breastfeeding, 94% of infants were exclusively breastfed for the initial three months; 83% were exclusively breastfed for the first six months.
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- Out of 365 children aged 1-24 months, 320 were weighed (88%). Of these, 67% had a normal grade of nutrition and 28% were judged to be slightly underweight for their age. 4% were found to be moderately malnourished. Just one case of severe malnutrition was found.
- There was continued monitoring of the nutritional status of the child through regular weighing, and advice given accordingly to the parents of children that were underweight.
- 80% of children received complete primary immunisation (NB: this is less than we would normally expect to achieve – see challenges).
3) Improving adolescent health
Activities aimed to improve awareness of adolescent health, by understanding their needs and creating a more conducive environment for adolescents. 1,100 adolescents benefited from this work. Along with direct interaction with adolescents, parents and community members were also involved, as they often influence the decisions of many adolescents. The following activities were conducted:
- Meetings with peer educators: 34 meetings (17-18 participants) were conducted. Adolescents from the community were selected and trained as peer educators to reach out to other adolescents in the area (many adolescents find it easier to discuss concerns with fellow peers).
- Capacity building of peer educators: Four capacity building sessions for peer educators were held to discuss: common adolescent health issues, the importance of good nutrition, physical and psychological changes during adolescence, the facts vs. the myths of reproductive and sexual health, conception and contraception, and family planning. In addition, peer educators were asked to share their experiences with other adolescents, and consider the key misconceptions they thought were still firmly rooted in their community.
- Issue-based meetings: 135 meetings (14-16 participants) were held and led by the peer educators (adolescent leaders) with other adolescents. Issues discussed were: the harmful effects of early pregnancy; physical and psychological changes during adolescence; the importance of good nutrition and maintaining personal hygiene; life skills (such as decision making); and HIV and AIDS.
- Stakeholder meetings: 53 stakeholder meetings (10-11 participants) were conducted with panchayat members, community leaders, youth leaders, teachers and service providers. Meetings discussed child health, family planning, contraceptive use and immunisation.
- Meetings with parents: 43 meetings (10-12 participants) were conducted. Support from parents at this sensitive stage is vital to facilitate greater understanding, so that adolescents feel comfortable sharing concerns with their parents. With better communication, misconceptions, malpractices and peer pressure can be avoided. Issues discussed were: physical and psychological changes; the need for psychosocial support; and personal hygiene.
- Newly wed ceremonies: 41 ceremonies for newly wed couples were organised, providing a platform to inform newly married young couples (and other members of the community who witnessed the event) on the importance of family planning and contraceptives. Delayed first pregnancy and planning in advance for their family was encouraged.
- One-on-one interaction with adolescents: 745 one-on-one meetings with adolescents were held to discuss reproductive and sexual health. This enabled them to open up and discuss personal concerns without undue pressure.
4) Community mobilisation
Greater awareness was created amongst different sections of the community via community events. This was particularly important to ensure community ownership and sustainability. Moreover, community events helped to reach out to mothers who were not directly covered by the project.
- Meetings with panchayats and service
providers: These aimed to create better understanding between communities, decision makers and service providers. Discussions focused on: taking stock of current services and facilities available; the best use of government schemes and services for mothers and children; assess to more facilities; hurdles each stakeholder faces; and overall strengthening of the local government-NGO service delivery linkage mechanism to ensure improved mother and child health. (Please see Mozanull’s story for a personal account.)
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Meetings engender greater understanding between communities, decision makers and service providers |
Father who is actively involved in caring for his son |
- Meetings with pregnant women and lactating mothers: Meetings focused on pregnancy and newborn care. Issues discussed were: the importance of a nutritious diet, rest, antenatal and postnatal checkups and timely immunisation; key signs signalling when a woman is ‘at risk’; exclusive breastfeeding for the first six months and complementary feeding after six months.
- Nutrition camps: Cooking demonstrations were held to improve the community’s understanding of healthy food and hygiene. Health workers explained the importance of an increased nutritious diet amongst pregnant women, young married women and adolescent girls.
- Male involvement meetings: 2,000 men participated in meetings that stressed the roles, responsibilities and the importance of male involvement within the family, to ensure safe motherhood and child health. (Please see Salim’s story attached for a personal account.)
- Capacity building activities: Sessions refreshed the skills of staff. Issues discussed: project implementation and hurdles; child health, neo natal death and ‘at risk’ cases commonly found in the community and action to be taken when an ‘at risk’ pregnant woman or child is identified.
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- Staff sharing: Monthly meetings shared field experiences and any problems faced. Staff also developed a phase-out plan to facilitate a smooth phase over of CINI from Nahazari to various community institutions and organisations.
- Controlling an outbreak of chicken guinea: CINI planned an emergency intervention to control the spread of chicken guinea by generating awareness about prevention of the disease. Community members, local government and health service providers were involved. Stakeholders mobilised local communities through demonstrations and by a widespread distribution of informative posters. The situation was brought under control within 12 days before it could pose a dangerous threat.
Key challenges:
- With recent local elections, newly elected local government representatives had to be reoriented on CINI’s interventions to improve mother and child health in the area.
- Shortages of vaccines at local health centres hindered the timely immunisation of children
- Local outbreak of chicken guinea.
Key lessons for sharing:
- Periodically updating and involving key government health functionaries vital because their contribution is key to improving health outcomes.
- Involvement of religious leaders and influential community members is extremely valuable in maintaining community interest and support.
- The newly wed ceremonies are very effective. They present an opportunity to inform young couples about family planning before they started having their family.
- The intervention process to control the epidemic of chicken guinea united various sections of the community, demonstrating the importance of an inter-sectoral approach. CINI acted as a facilitator, bringing these sections closer.
Salim’s story: male involvement in Nahazari
Salim Haque, age 28, is resident of Nahazari. He lives with his wife Zarina, age 20, and his daughter Sunaina (6 years) and son Chand (3 years). When his wife was pregnant the first time, Salim thought that the entire process of child-rearing was Zarina’s sole responsibility. As the man of the household, Salim considered his duties to begin and end with earning money for his family. Zarina was expected to do heavy domestic chores, such as fetching the daily supply of water, even during pregnancy, and she had not considered medical checkups necessary. At the time of delivery, Salim arranged for a traditional birth attendant to be present. Unfortunately, their first-born was underweight and weak.
CINI health workers identified Zarina when she was expecting her second child, Chand. Through regular home visits, the health worker encouraged Zarina to go for regular antenatal check ups, and discussed the importance of increased food intake and increased rest during pregnancy. She involved Salim in this process, stressing the importance of husband’s support during pregnancy. Salim was encouraged to help Zarina with domestic chores, and ensure she received adequate nutritious food and rest, along with regular health checkups. The value of hospital delivery to help ensure safety of the mother and child also was explained.
He further attended the male involvement meetings organised by CINI where the health workers and supervisors discussed the various aspects of pregnancy care, childcare and the importance of male involvement in the process. Also, issues related to family planning and HIV and AIDS were discussed in these meetings. Salim now feels that such meetings must be attended by all the male members as it makes them realise their responsibilities towards their family and loved ones. After attending the first two meetings, Salim also brought two of his friends along to meetings.
At home, he ensured that Zarina did not have to do heavy work and that she ate enough. He further accompanied his wife for her medical checkups. For the birth of his second child, he took Zarina to a government hospital. “I did not want my second child to be born weak and underweight and ensured that I stood by Zarina all throughout her pregnancy”, says Salim. The couple was overjoyed with a healthy baby boy.
The health worker continued with her home visits and advised the couple on child care practices, the importance of exclusive breastfeeding for the first six months, followed by complementary feeding, and complete primary immunisation of the child. These issues were also discussed in the male involvement meetings. Salim continued attending these meetings. “I’m thankful to CINI for organising these male involvement meetings. I’m glad that I was there to ensure that my child was born healthy and that he grows well, I wish I could do the same for my first child”, he says.
(Names changed to maintain confidentiality)
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Mozanull’s story: improved health services through community mobilisation
Mozanull Haque Mollah, age 40, has been a member of Nahazari panchayat (local self government) for more than six years. Been born and brought up in this area, Mozanull recounts that it lacked qualified medical practitioners, and that the new government health centres that had only recently been made available, were insufficiently equipped with facilities or staff.
In 2005 November, when CINI first started the project, Mozanull was unsure about how effective andsustainable the benefits of this project would be for the people living in Nahazari. Over the years, he has witnessed health workers making regular home visits, motivating pregnant women to take care of themselves, and involving men in this process. Mozanull explains, “I was touched by the sheer determination of CINI, the health workers took that extra step to ensure that not only do the mother and child receive medical support but also the support of her family members, that the men also took responsibility of child birth and child care.”
Taking community mobilisation to the next level, CINI facilitated and regularised joint meetings between the service providers, community members and local legislative bodies through monthly meetings, providing the opportunity for all involved to discuss the health status of community members, the services that were available and how the situation could be improved. This was used as a platform by CINI to update everyone on current activities, future endeavours, and how everyone could contribute to this process.
Mozanull was initially sceptical of the outcomes of such meetings. However, after regular attendance his views changed. “These meetings are opportunities for all of us to understand each other better…I think it’s also a special educational platform that uniformly generates awareness amongst all of us”. Contributing to community mobilisation, these meetings allow the community members to share their concerns and opinions with the decision makers and service providers, as well as making them accountable to the local people.
Mozanull reports that he has witnessed improved health infrastructure, better equipped health centres, and increased access to maternal and child health services. He adds that prior to these changes, women in Nahazari were hesitant to go to the health centres, and lacked confidence in the government system and services. Male family members did not consider health checkups and institutional delivery important either.
“Now, a woman knows the health services she deserves, if the services are denied to her, the entire community supports her, this ensures that she receives appropriate treatment”, says Mozanull. Speaking on whether this awareness and improved health behaviour would continue, he said: “We are hopeful that the awareness amongst people will continue and spread further in Nahazari”.
Along with directly ensuring mandatory health services to pregnant women, children and adolescents, CINI also builds the capacity of key stakeholders so that the work it has initiated can continue when CINI phases out of the area.
“CINI has been an integral agent of change in my community and whether or not it continues working here, the programmes started will continue through us”, Mozanull declares.
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