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When care goes a long way

Swapna Majumdar | Updated on December 28, 2019 Published on December 28, 2019

An intervention programme in Gujarat helps achieve safe motherhood

As an anganwadi worker in Kadiyali village, Rajula block, Gujarat, Jayshreeben’s job was to look after the young children who came to her centre. It was a job she loved, being with the children was a way for Jayshreeben to overcome the trauma of two miscarriages following the birth of her first child. She had given up hope of becoming a mother again when a chance association with Vatsalya, a health and nutrition intervention, changed her life.

Two months ago, 28-year-old Jayshreeben gave birth to her second child thanks to the information she received from Vatsalya on the risk factors, signs, and causes of miscarriage, along with getting the support and treatment she needed.

Interestingly, it was a male outreach worker of the Vatsalya programme who played a key role in guiding her to a safe pregnancy. “Even though she was an anganwadi worker, she had no knowledge about reproductive health. She was not aware about the care that a pregnant woman should take before and after pregnancy and, after delivery. She was unable to understand why miscarriages were occurring, especially as she had already given birth once before. I’m happy the information we provided helped her,” says Hardikbhai Dhodiya, Vatsalya outreach worker.

Started in 2016 to empower women like Jayshreeben, the Vatsalya programme was initiated by the Centre for Health Education, Training, Nutrition Awareness (CHETNA), a not-for-profit based in Gujarat. The three-year initiative has reached out to over 5,000 women in 22 villages in Rajula block and was able to increase antenatal and postnatal care visits, improve knowledge on anaemia and promote safe motherhood. The intervention increased registration of pregnancies by almost 42 per cent and improved the number of women receiving antenatal care, tetanus injections and folic acid tablets. An increase in institutional deliveries by 9.4 per cent was also seen at the end of three years.

Key to the success has been the strategies adopted to empower the women. After a survey conducted by CHETNA in the 22 villages in Rajula block revealed that the 4,920 women in the reproductive age were mostly uneducated and had little or no knowledge on reproductive and sexual health, it was decided to use Vatsalya samwads (meetings), street plays, focus group discussions and games to increase awareness on reproductive health, family planning, anaemia, nutrition, and menstrual hygiene management. With even the anganwadi worker largely ignorant on health-related issues, it was crucial to link them to services to prevent them from falling through the cracks.

It was during one such Vatsalya samvad that anganwadi worker Jayshreeben heard about the importance of folic acid tablets. Dhodiya was sharing information on the importance of these tablets along with ante natal check-ups (ANC) and postnatal care (PNC) for pregnant and lactating women. He also mentioned how women planning to get pregnant should take folic acid supplements for a full year before conception to reduce the risk of the foetus developing any major problems. Additionally, these tablets would help to reduce anaemia, a condition that increased the risk of miscarriages.

Anaemia is a major health problem in Gujarat, especially among rural women. About 55 per cent of those in the 14-49 age group are anaemic, while 51.3 per cent of pregnant women have anaemia, according to the 2014 National Family Health Survey (NFHS-4). Gujarat is among the top 15 States with the highest incidence of anaemia, with a higher percentage of anaemic women than the national average of 53 per cent (NFHS-4).

When Jayshreeben heard about the various reasons causing miscarriage, she realised Dhodiya could help her. Shy at first to seek assistance from a male team member, Jayshreeben took several days to overcome her nervousness. But realising that the information could transform her life, she finally mustered the courage. Thereafter, she meticulously followed the guidance provided. Regular intake of folic acid tablets for a year and various other precautions taken helped Jayshreeben conceive again. She also didn’t miss any of the monthly check-ups done by the Vatsalya team or the routine ANCs at the anganwadi.

Having benefited from the knowledge shared by the intervention, Jayshreeben became a vocal advocate of the programme. During the three-year period, over 4,000 home visits were made by the Vatsalya team with the help of women like Jayshreeben to monitor and counsel 941 pregnant and 905 lactating mothers. “These visits are crucial since we work with marginalised communities. Women lack agency and information,” points out Pallavi Patel, director, CHETNA.

Another difference made by the programme has been its ability to reach out to older women who lack access to contraception and are hesitant to avail of ANCs or other services when they become pregnant for the fourth or fifth time. When 41-year-old Jyotsnaben found she had become pregnant with her sixth child after 15 years, she felt embarrassed about registering her pregnancy. When Vatsalya outreach worker Rakshaben heard about her, she made several home visits to explain the risk associated with late pregnancy and her low body weight. The sensitivity shown through counselling encouraged Jysotsnaben to register her pregnancy and follow up with proper diets and ANCs. “If the Vatsalya team had not been there, I may have lost my sixth child because of ignorance and shame. Thanks to them, both I and my child are alive.”

The writer is a senior journalist based in Delhi

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Published on December 28, 2019
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