A Mother's Act of Love

By Maureen Simpson

When Pratibha Devi, 25, was pregnant with her first child, she threw the prenatal iron supplements the clinic gave her in the trash. Though friends were able to convince her to get the vaccinations she and her baby needed, she remained skeptical of any benefits. "I thought government medicine supplies were no good," Pratihba said. "Affluent people don't take medicines given by the government, so I threw them away. ... I also did not bother about following their messages."

Like many women in Raipur, a poor rural village in the Samastipur District of Bihar, India, Pratibha only knew what her elders taught her about pregnancy and childbirth. In addition to low immunization rates, few women in the area complete prenatal checkups or know what to feed their infants when breast milk alone is no longer sufficient. Access to quality health services and up-to-date information on nutrition is limited.

Even though Pratibha's son was born weak and would often get sick during the first year of his life, she did not trust outsiders to be of help to her family. Her experiences and knowledge were confined to what she learned at home. Then, Pratibha said, she joined "the group."

To help introduce health, nutrition and sanitation (HNS) topics among women and young mothers like Pratibha, PCI began providing technical support to the Government of Bihar's Rural Livelihoods Mission known as JEEViKA. Through JEEViKA, more than 9.2 million women living in the most vulnerable and marginalized communities in India meet in self-help groups (SHGs) to learn about microfinance, savings and livelihood activities. With support from the Bill & Melinda Gates Foundation and the World Bank, PCI started working with JEEViKA to integrate health, nutrition and sanitation (HNS) interventions into the SHGs and related community structures.

"In the beginning, the people were not very accepting. ... Even the office staff felt awkward that their workload had increased [with these additional topics]," said Shravan Kumar, a Block HNS Coordinator for PCI and the JEEViKA Technical Support Program.

Gradually, however, both the Community Mobilizers who lead the SHGs and their members began to see the connection between HNS and livelihoods.

"Doctors treat once the disease affects [the patient]. Our Community Mobilizers help prevent the diseases," Shravan said. "The money that would be spent on illness is now getting saved."

According to the Global Nutrition Report 2018, 46 million children in India are stunted because of malnutrition and 25.5 million more suffer from "wasting," or do not weigh enough for their height. Malnourished children are highly vulnerable to disease and infections and can experience irreversible damage to their brain development and physical growth.

To help ensure women and children receive the proper nutrition and support they need during the critical stages between pregnancy and a child's 2nd birthday, trained Community Mobilizers teach SHG members about exclusive breastfeeding, complementary feeding, proper handwashing and other healthy practices through group meetings, home visits, campaign rallies and recipe demonstrations. They also connect SHG members to frontline health workers and services.

"Pregnant women started paying attention to their nutrition. They breastfed the baby and started giving complementary diet after six months," said Kamini Kumari, a Community Coordinator with JEEViKA who manages nearly 250 SHGs. "The babies are healthier now and the change has been good."

On a hot September afternoon in 2018, Pratibha joined women from her SHG and a few surrounding villages for a campaign rally through the streets of Samastipur. Together, they held signs and shouted phrases in Hindi that described complementary feeding as a gift or act of love a mother can give to her child.

Having seen the positive difference these practices have made on the health of her own children, family and finances, Pratibha is determined to share what she has learned with as many women in Bihar who will listen.

"My family should stay well, but my state should also stay well," she said. "I want people around me to have a good life."