It is a sunny afternoon in Haidarpur Naubasta village in Uttar Pradesh, one of India’s most populous and poorest states, with extremely low maternal and newborn health indicators. In a small classroom, with dusty floors and open windows that reveal barren fields, women 16 to 60 years old and wearing colorful saris are listening to their teacher, Saba. She is teaching them about adopting simple health care practices to ensure the safety of newborn babies.
This lesson is part of a community-based initiative to organize women in a collective called the “mothers’ group.” Here, pregnant women and their mothers-in-law convene to discuss and learn about maternal and newborn health practices that can benefit little babies as well as ensure the health of the mother during pregnancy.
The meetings are lively, with women singing songs and playing interactive games. Saba’s lesson involves a fable-like story about the importance of wrapping a baby warmly after delivery instead of opting for the traditional practice of bathing it in goat’s milk and honey, which can lead to illness. After her story, she uses a doll to demonstrate the proper wrapping technique.
What makes this scene remarkable is that Saba is only 12 years old. It does not seem to make a difference to the women in the room though, as they listen in rapt attention. It is apparent Saba is a favorite. Her mother, Sadhya Begum, looks on proudly from the back of the room. She is an anganwadi worker (a community-based health care worker), one of hundreds of women who are part of government health programs that seek to improve availability of and access to quality health care for those at the lowest rung of the socioeconomic ladder.
Sadhya Begum, along with another accredited social health activist (ASHA, which translates to “hope” in the Hindi language of the region), helps lead the mothers’ group meetings. Speaking about her daughter, she says with a smile, “She wants to be a teacher when she grows up. This is practice.” One of the women listening to Saba says, “She is the best teacher of all. She knows the story by heart.”
Mothers’ groups are among the many initiatives supported by Sure Start. These initiatives are crucial in the context of India’s bleak maternal and neonatal health landscape. The country accounts for a quarter of all neonatal deaths in the world: 78,000 women die annually due to pregnancy-related complications, as do a million babies. Many of these deaths can be prevented with simple health care measures.
Poverty, lack of awareness, and lack of access are often the causes for these fatalities. Government programs like the National Rural Health Mission and the Reproductive and Child Health Program seek to address this challenge, but in a country of India’s size and poverty, gaps remain. One of the biggest challenges is the widespread lack of awareness about appropriate maternal and newborn health practices and about existing government schemes that can assist poor women and communities in accessing quality health care and services.
Sure Start is helping the government by building the capacity of existing frontline workers (such as ASHAs and anganwadi workers) and creating maternal and newborn health awareness among various stakeholders in the community by identifying local barriers to behavior change, analyzing these, and mobilizing the community to overcome them.
For instance, by creating innovative communication tools for mothers’ groups meetings and working with community-based health workers, Sure Start is encouraging local women to put their and their babies’ health first. Participation in these meetings has almost doubled in a year; there have been 80,000 group meetings with nearly 100,000 women reached in the seven districts of Uttar Pradesh where the project operates. Project data suggest that the meetings, which had previously suffered from poor participation and leadership, are playing an integral role in contributing to positive behavior change among pregnant women.
In Uttar Pradesh, the number of women registering early for prenatal care and giving birth in hospitals has increased. According to project data, 55 percent of women opted for an institutional delivery in 2009; when the project started, it was 24 percent. Of course, Sure Start is not the only factor responsible, but research suggests it has played a pivotal role.
Beyond the schemes and the numbers, however, it is important to acknowledge the impact the program has had, the lives it has changed and bettered, and the women it has empowered. Consider 12-year-old Saba, now handing out charts that contain key maternal and newborn health messages, illustrated with colorful diagrams, to pregnant women much older than she is.
At a time when the Indian economy is growing rapidly and the country is making news for achievements in many spheres, Saba and her fellow volunteers represent perhaps the most heartwarming success stories in the country. They are dedicating themselves to improving maternal and newborn health in the most poverty-stricken areas of India. By doing so, they are helping India deliver its promises to generations to come.