What does it take to save a life?

A health worker

Of Mansa Devi’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 Accredited Social Health Activist, called an ASHA for short. ASHAs are village women who learn best practices for safe pregnancy, childbirth, and infant care. In turn, they teach their neighbors. In villages without doctors or health centers, they are often the only source of lifesaving information.

With mentoring and supervision from PATH’s Sure Start project, Mansa learned effective ways to share her new knowledge with pregnant women and their family members. She runs mothers’ groups where she uses stories, games, flashcards, and other activities to change behavior. To involve fathers, she gives letters to them with “advice” from their yet-to-be born children. And she makes home visits before and after babies are born.

Neighbor and lifesaver

Gently but persistently, Mansa is changing traditions that, unbeknownst to villagers, endanger mothers and newborns.

“Whenever I visit a house,” Mansa says, “I share how I lost two children. I tell them, ‘I don’t want you to lose your child, too.’” She even painted the warning signs to watch for in pregnancy and childbirth on the walls of the primary school where everyone can see.

Mansa has also become the link between care providers in distant health centers and villagers worried about costs and unaware of government services. When a pregnant woman is ready to deliver, Mansa accompanies her to the health center and serves as supporter and ally.

Bearer of hope

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.

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

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Mansa Devi (left) and her friend Sashi Kanti (right) share duties as health workers, or ASHAs, for the village of Devpuri. Sashi says of being an ASHA: “I go to every household and then I go again. If you go continuously, one day they will take it seriously.”

Photo: PATH/Lesley Reed.

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When Sashi visited Kamles in her ninth month of pregnancy, Kamles’ skin, eyes, and nails were yellow—signs of severe anemia. “I made the mistake of not eating well in the eighth month,” says Kamles, here with her husband and children. “I was worried about having a big baby, which would make giving birth difficult.”

Photo: PATH/Gabe Bienczycki.

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“ASHA was always there helping us,” says Kamles. “She educated me about the danger signs and helped us with transportation to the hospital. We were worried about going to the hospital, but she stayed with me until my son was born.”

Photo:  PATH/Gabe Bienczycki.

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“I started experiencing severe pain in my seventh month,” says Malti Devi. “The same thing happened in my first pregnancy. I was told it was common, so I didn’t do anything. Then my uterus ruptured. This time, I called my ASHA and she took me to the hospital.”

Photo:  PATH/Gabe Bienczycki.

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Once Aachal was safely born, Malti knew what to do keep the little girl healthy. “My older children had diarrhea and other health problems,” says Malti, “but Aachal hasn’t.”

Photo:  PATH/Gabe Bienczycki.

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“In the past, it was believed that a child would survive or not because of God’s will,” Sashi says. “There’s been a tremendous change.”

Photo:  PATH/Gabe Bienczycki.