To be a mother in rural India


To be a mother in rural India

Everyone hopes to have a house. It is, after all, a symbol of security and stability. For the women of Jharkhand’s Bada Ulatu village too, a house signifies the same. But it also means something more — it is indicative of the wellbeing of a mother and her child. How, one may ask? Well, in Ranchi and Hazaribagh districts, expectant women across 70 villages are now using a maternal services tracking tool, which entails drawing a house for every milestone they complete in their journey towards safe motherhood.

From the foundation to the first beam to the windows and door, to the roof, and finally, to the finished picture of the house with a happy family and a smiling infant, each phase is “constructed” once the new mother completes various health check-ups, starting with the pre-natal examination to the delivery and then, the post-natal stage. The inoculations for the infant are included as well.

When Oxfam India launched the Department For International Development (DFID)-supported intervention, ‘Improving Maternal Health Status in Six States of India’ in October 2012 under the Global Poverty Action Fund, the aim was to involve local women and men by creating community-based monitoring and planning tools that focused on the
social determinants of health, especially taking cognisance of nutrition services and schemes of the government. Over the last three years, Oxfam and its NGO partners have worked closely with the people in 420 villages of Bihar, Jharkhand, Chhattisgarh, Odisha, Maharashtra and Rajasthan to increase their access to public services provided under the National Rural Health Mission (NRHM), Public Distribution System (PDS) and the Integrated Child Development Services (ICDS) scheme.

Mobilising demand

“It was only befitting that we used community monitoring tools to enable the people to understand as well as keep an eye on the public services available in their areas. We mobilised them to demand their entitlements and equipped them with easy tools to keep track of the availability and quality of the services,” says Pallavi Gupta, programme coordinator-health, Oxfam India. Drawing the house is one such tool, which empowers pregnant women to access services in a timely manner, whether it is registering at the Anganwadi Centre (AWC) or ensuring that they receive their two Tetanus Toxoid (TT)
vaccine shots.

“The foundation of a pregnant woman’s house is drawn when she registers at the AWC. The walls come up after her two TT vaccinations. Once she gets her three mandatory ante-natal check-ups, has 100 iron-folic acid supplements and undergoes an institutional delivery, we add a door and two windows, the roof and roof beam for her house,” elaborates Shanti Devi, 30, a field animator with Child in Need Institute (CINI), which is implementing the project in Jharkhand. As a field animator, she monitors the implementation of health services. This dream house is finally done when a smiling infant is drawn after the new mother starts breastfeeding within the first hour of delivery.

“If she fails to do so then we draw an unhappy infant. Such pictorial representations are hugely motivating. All pregnant and lactating women strive to get that
perfect house,” remarks Jhaman Devi, 58, anganwadi worker from Ulatu village. Adds Faiz Ahmed, project coordinator, CINI, “We have barefoot auditors in every village — usually from within the community — who we train to use the monitoring tool. They, in turn, teach the village women. In all the project villages, these days, mothers eagerly look forward to getting the house with a smiling infant. A healthy baby is depicted with an inverted pyramid for its stomach after the BCG (Bacillus Calmette-Guerin) vaccine is administered within 28 days of delivery.” If the mother fails to do so, she gets an unhappy baby with an upright pyramid.

Later, when the baby gets the DPT (Diphtheria, Pertussis and Tetanus Toxoid) vaccination, a flag is pencilled into its hands. There are a total of 12 stages like this. “This tool motivates women to demand and access maternal health services, including free vaccinations, ante-natal check-ups and institutional delivery that entitles them to Rs 1,400 under the Janani Shishu Suraksha Yojana (JSSY). They can monitor their own and their friends’ and neighbours’ progress through the drawings. As the houses are built gradually, the enthusiasm of the community only grows with passing time,” says Sabina Devi, 23, the field animator of Chetanbari village.

India accounts for the maximum number of maternal deaths in the world today, even though the Maternal Mortality Ratio has come down to 167 per 100,000 live births. What can further accelerate this trend is the enthusiastic participation of the community — and that’s exactly what the simple, but efficient, community monitoring and tracking tools are doing.

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