Health worker in red sari standing in a field.

In villages without health centers or doctors, health workers like Mansa Devi offer lifesaving information and support.

After losing her own children, Mansa Devi teaches parents how to give babies the best chance at life

Mansa Devi took paint and brush and began to write: warning signs to watch for in pregnancy and childbirth and phone numbers for emergency care. She painted this lifesaving information directly on the white-washed walls in the Indian village of Devpuri.

Until Mansa trained to be an ASHA—the nickname given to Accredited Social Health Activists—she didn’t know this critical information herself. And she’d paid a heavy price.

Of Mansa’s four children—all born at home as was village tradition—only two survived. The umbilical cord wrapped tight around the neck of her first daughter, who didn’t have a trained attendant to save her. Mansa’s second baby, a son, died from tetanus when he was just two days old.

So Mansa jumped at the opportunity to become an ASHA. ASHAs are village women who learn best practices for safe pregnancy, childbirth, and infant care. In turn, they teach their neighbors. In Sanskrit, the word asha means “hope.” For women who face huge risks in childbirth, that’s exactly what Mansa and her fellow ASHAs bring.

Healthier traditions

Through training and mentoring from PATH’s Sure Start project, Mansa learned how to gently, but persistently, change age-old traditions that endanger mothers and children. She does home visits before and after a baby is born and runs mothers’ groups to educate women and their families about safe pregnancy, childbirth, and infant care.

In Sanskrit, the word asha means "hope."

Mansa and other Sure Start-supported ASHAs now run nearly 7,000 mothers’ groups. In combination with other Sure Start outreach efforts, they’ve reached more than 24 million people—akin to the whole state of Texas—with the sort of lifesaving information and support that might have saved Mansa’s babies.

Mansa is shy, but her bright red sari is emblematic of the confident and courageous woman she’s become as an ASHA. She uses stories, games, and songs to teach the steps that no one taught her: get a tetanus shot to protect your baby from infection, give birth at the health center.

“Whenever I visit a house, I share how I lost two children,” Mansa says. “I tell them, ‘I don’t want you to lose your child, too.’”

A tragedy averted

Mansa is the vital link between health providers in a distant hospital and the community. Families like Malti Devi’s, who only visit the hospital only in absolute emergencies.

When Malti experienced severe pain during her first pregnancy, the family ignored it. “I was told it was common, so I didn’t do anything,” Malti says. “Then my uterus ruptured.” Malti almost died while giving birth at home without a trained attendant.

Mother holding a child.

Malti Devi almost died the first time she gave birth. “This time,” she says, “I called my ASHA and she took me to the hospital.”

Despite this experience, Malti would have given birth at home again if Mansa hadn’t encouraged her to attend the mothers’ group meetings. This time, Malti had the information and resources she needed to seek skilled care when complications arose. It turned out to be a lifesaving decision for Malti and her daughter, Aachal.

Malti also knew what to do keep the little girl healthy—swaddle her after birth, breastfeed her right away, get her immunized. “My older children had diarrhea and other health problems,” says Malti, “but Aachal hasn’t.”

ASHAs lead the way

Mansa and her fellow ASHAs are at the heart of a transformation in maternal and child health in rural India. In a country where one million babies don’t survive beyond the first month of life and women still regularly die in childbirth, the ASHAs’ information, guidance, and support are lifesaving.

In Devpuri, it shows.

“Before,” Mansa says, “mothers and newborns used to die. But since Sure Start, there are no deaths in the village.”

Photos: PATH/Gabe Bienczycki.