Healthy Mothers, Healthy Societies
IRUKPAL, India - Walk around the village of Irukpal , in the eastern Indian state of Chhattisgarh, and you may notice an odd decoration on the sides of some of the low, slate-roofed houses. The figure looks like a stubby tree. On some houses, the tree is a work in progress, the branches and roots still bare, the trunk showing only a few X marks at the base. On others, the diagram is complete, with each branch and root carefully crossed at regular intervals and nine X's up the trunk.
This isn't just art. The drawings are tools, low-tech but powerful databases, and for the mothers of Irukpal they can mean the difference between a healthy baby and disaster. Sumo Nayak, 22, is one of these mothers, and one of the trees is hers. She points to the drawing, explaining the meaning of each element: The six X's on the trunk represent her six months of pregnancy. The twigs on each branch show the iron/folic acid tablets she has taken to prevent anemia and birth defects. The marks on the roots indicate each time she has received supplemental rations of high-protein meal. Other details in the diagram record important events in her pregnancy, such as the dates of her tetanus vaccination and prenatal checkups.
The records stored in these drawings are one facet of a comprehensive strategy designed by CARE to keep mothers and newborn children in Irukpal healthy and strong. It's a simple tactic, but the rewards are great. Sumo herself represents another facet: She is a mitanin , or volunteer maternal health worker (the word mitanin simply means "friend" in Chhattisgarhi). She and the other mitanins visit individually with all new and expecting mothers in the village on a regular basis. They use the information recorded in the tree diagrams to make sure each woman knows and follows the best practices for maternal health and nutrition.
The approach is centered on the village health and day-care center for mothers and young children. "I came to this village after I got married," Sumo says. "After I arrived, the mitanins called me to come to the health center and I learned about the government services there – the supplemental rations they give out, the immunizations, the infant care. Now, as a mitanin myself, I tell women in my neighborhood as well: When you come to the health center, the mother will be healthy, and the child will be healthy, too."
The Indian government has a variety of programs to keep mothers and children healthy. Health workers visit the village health center every month to immunize children, distribute supplemental rations for pregnant and nursing mothers and give out vitamins, iron/folic acid tablets and other medical supplies. But such programs have little effect without the support and understanding of the community. Children can't be immunized if parents are unwilling to bring them to the health center, or even worse, hide them from community health workers. Vitamins and medicine are useless if they aren't taken or are taken incorrectly. Even the supplemental rations are only helpful if they're cooked properly and if they're reserved for the mothers, rather than given to their husbands and in-laws. One of CARE 's primary goals in Irukpal and other villages throughout Chhattisgarh is to teach better health practices to young mothers and their families so they can take full advantage of the services the government offers.
Mitanins like Sumo are the leaders in this change. Trained by CARE and local partner organizations, these women play a key role in teaching their communities about maternal and child health. Unlike the government workers, the mitanins are members of the community and are available at any time. "Previously, many children died from disease," says Sepna Ghosh, a government nurse. "There were problems with pregnancy, and stillbirths. The mitanins are able to speak the local languages and see the women every day. Health education has improved, and due to regular immunization there are fewer child deaths."
The results of these efforts have been striking. In the last five years, infant mortality has dropped 13 percent in Chhattisgarh, and malnutrition in children under 5 has dropped more than 20 percent – the greatest reduction of any state in India !
A Force for Women
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Asmati smiles as she thinks back on her success. "I feel elated. Like everyone here, I grew up on gruel and water. Never in my life did I think I'd be elected to the village or regional government. But now I have even had the opportunity to visit Raipur , the state capital."
The mitanins of Irukpal are not alone. Across Chhattisgarh, over 1,800 CARE -trained maternal health workers have been elected to the village governments. Health and nutrition issues are being discussed regularly in the village assemblies. CARE works directly with the state government to help them develop state-wide nutrition policies. The result has been a noticeable change in health and attitudes – a change that shines in the faces of mothers and children in Irukpal. "People here used to hide their children in their houses on immunization day," Asmati recalls, smiling. "Now they ask, 'When will my child be immunized?'"