Empowering Women, Saving Lives

Elizabeth’s five children are waiting for lunch. All she has is a handful of rice,  some watery dal and vegetables – clearly not enough. She despairs.Enter Neelam, a social worker. She sympathizes but points out that Elizabeth should have spaced her babies and practiced birth control.

 Watching them intently are 50-odd women, tightly packed together inside a tiny shanty in a colony in Dharavi, in Mumbai, Asia’s largest slum.  Elizabeth’s story is a familiar one.  And the community play gives them an entry point into issues they would otherwise never talk about openly.

The performances are basic, the actors untrained, but the message is a powerful one – Women can and should plan their babies. It’s a message that decades of government campaigns have failed to deliver effectively, because they have focused on permanent methods like sterilization. This leaves out women who want to delay babies.

A lack that  the Society for Nutrition, Education and Health Action is trying to address in a first-of-its-kind, joint initiative with the Family Planning Association of India and the Mumbai municipality. ‘We are looking at reducing unplanned pregnancies. Our objective is to get to young women, introduce correct information, remove misconceptions, tell them about temporary spacing methods and give them autonomy over their fertility,’ says Garima Deveshwar Bahl, Program Director, SNEHA.

And it is showing results here at Rajiv Gandhi Nagar colony, home to first generation migrants from the states of Uttar Pradesh, Jharkhand and Bihar. A community of 3500 households, with poor access to basic amenities like water, sanitation, and health services. Most families here have 3 to 5 children.Women want to space their children or limit family size but don’t know how to.

“When we started out here use of family planning methods was just 12% and in a short period of one year with very low-cost solutions, it has gone up to 30%. Of this 13% are just new users’, says Bahl.

Peer educators like Neelam and Elizabeth who are from the community visit homes and inform women about the range of methods available, the so-called “cafeteria approach.”  ‘In the beginning it was very difficult to reach out’, says Neelam. ‘We started by telling them about rising expenses and how it helps to space out children. Gradually they started thinking about it.’

“Mostly we pass on knowledge about condoms because it is easier for the men to use it,’ adds Elizabeth. ’We also tell women about pills and Copper-T so they know they can make a decision too. Use of injectable contraceptives has grown over the last few months.”

As Neelam and Elizabeth wrap up their play, out pour a flood of questions from the audience. “I agree with you but how do I convince my husband and mother-in-law?” asks a mother of two. Her query is an indicator of what remains a vital, but unaddressed part of the puzzle.  Given the low decision-making powers these women have at home, it’s essential to make men part of this program.  Something SNEHA says it plans to work on.

Every year, in India, over 100,000 women die during pregnancy and childbirth, a fallout of frequent and unplanned pregnancies. This low-cost community initiative is helping to change that dismal picture.

Never too young to learn

 Family Planning matters because

*Each dollar spent on preventing unintended pregnancies will save governments $31 in healthcare,water, housing and waste disposal – UNFPA2011

*It increase chances of child survival

*It reduces maternal deaths due to frequent and unplanned pregnancies

Interview with Garima Deveshwar Bahl, Program Director, SNEHA –

http://www.youtube.com/watch?v=gPRK9Py38jw&feature=youtu.be

Holding out Hope in Dharavi

‘My son had cow’s milk from birth. He looks healthy. What is so great about mother’s milk?” Sabawn’s voice resounds in a narrow, cramped lane in the heart of Asia’s largest slum, Dharavi. A local priestess, she cuts a dramatic figure in her yellow sari and orange tikka.  Gathered around are a group of women, listening in rapt attention. Many of them are heavily pregnant, some are holding newborns.

Sabawn’s comment is an indication of the challenges that lie ahead for the Maharashtra government, corporates and NGOs who have come together in a first of its kind partnership called the AHAR project. A project that aims to change the face of Dharavi, a densely packed slum, home to over a million people, mostly migrants. A well-known Mumbai landmark, immortalized in the Oscar-winning film Slumdog Millionaire, the slum is a maze of narrow lanes, shanties and overflowing gutters.

Not surprisingly it reports among the highest rates of malnutrition in the city. About 35 % children between the critical 0-3 years are malnourished.  While anganwadis or day-care centers have been set up as part of the government’s Integrated Child Development Scheme (ICDS) to provide nutrition, education and health services, the workers here are overburdened and poorly paid, with the result that many children are left behind.

It is here that the non-profit group SNEHA or the Society for Nutrition, Education and Health Action plays a critical role by training sakhis or community link workers who go door to door and advice women on nutrition, breastfeeding, family planning and maternal health.

“Imagine this is your baby” says sakhi Mangal Shinde pointing to a lifeless doll hanging on one end of a scale used to weigh vegetables.  At the other end hangs an empty bag. “What you put inside this bag decides your baby’s future,” she says adding factsheets with pictures of healthy foods for children. As the bag gets heavier, the doll rises. The women smile and clap. Sabawn still looks sceptical and clearly requires several more sessions!  Convincing her is critical as she wields tremendous influence in the community.

“It’s not easy,” admits Dr Evelet Sequeira, Head of Nutrition with SNEHA. “We tell the mother her milk is for her baby and this milk will help in brain development. So when the baby weighs 3.5 kgs at birth it has already passed Class 10. If she were to breastfeed exclusively until 6 months, the baby has cleared Class 12. For every mother her child’s intelligence is very important and this helps drive home the point.”

Simplistic though the approach may sound, it is showing results. Rates of exclusive breastfeeding have gone up. So has immunization. “More and more women are delivering in institutions,” says Priya Agarwal, Senior Advisor with SNEHA. “ Earlier women would register at the local health center in the last trimester of pregnancy. Now it’s in the first trimester.”

Another critical service SNEHA provides is crèches where working mothers can leave their babies. Now mothers no longer leave their infants with neighbors or older siblings when they go back to work. Instead they drop them off at the crèche where their health is closely monitored and they are given supplementary meals.

SNEHA believes the Dharavi experiment will lead to a sustainable model which can be replicated in urban slums across the country. “We have the government and ICDS on board and we are looking at global protocols that have been tried worldwide to see how we can adapt it to our settings”, says Dr Sequeira.

Words that hold out possibilities to thousands of children like Mehboobi, who at 2 years weighed 8 kilos, the healthy weight of a 6-month-old. When she came to the crèche last year, she would not lie down. Tests showed she had spinal TB and suffered from severe back pain. Today she is nearly 3 and weighs 10 kgs.  She has a long way to go.  Watching her perky, shining face shout out alphabets, there is hope she will get there.

For a vdeo link to the Dharavi project visit

http://www.ndtv.com/video/player/news/republic-of-hunger-malnutrition-plagues-in-maximum-city/222383