As a part of my fellowship project for Youth for India 2016/17, I have adopted Walwanda village Jawhar tehsil, Palghar district, as my focus village. According to my understanding of the issue of malnutrition in that village, there are precisely three main factors that lead to malnutrition among children, adolescent girls, mothers, pregnant women and lactating women. The three Ms of malnutrition are:
1) Child marriage
2) Seasonal migration post-harvest season
3) Erratic meal intake timings at the ashram schools / residential tribal schools
I hope to address the three Ms and other equally relevant and critical factors via behavioural change communication, dissemination of knowledge, information of ill-effects of child marriage, informing and educating the village tribal community (SHG, gram panchayat, village residents, etc.) and mobilising the community through community resource persons.
It is imperative to understand the issue of malnutrition and also the factors contributing to malnutrition. Factors like stunting, wasting and under-nourishment. It would help address the issue of malnutrition prevalent in this village. For this purpose, I have been conducting baseline surveys and holding meetings and interviews with key stakeholders in the village health ecosystem to gauge the gravity of the issue at hand.
The baseline survey questionnaires being conducted in the village households include gathering information on various biological factors, socio-demographic factors, socio-cultural factors, socio-economic factors, environmental factors, behavioural factors, among others. In conjunction with the above critical factors, height, weight, length measurements, body mass index (BMI), etc., of children and mothers are also included as part of the project. These factors are crucial to ascertain the health profile of the village generally and the malnutrition index of the village, specifically.
My motive is to address the problem of malnutrition with the following approaches. Behavioural change communication(BCC), information, education and communication (IEC), interpersonal communication (IPC) and community mobilisation(CM). My project design is based on a socio-demographic survey with an ethnographic design. The project entails both qualitative and quantitative analyses of the multiple conventional and non-conventional factors that directly or indirectly result in malnutrition among infants, young children (below five years old), pregnant women, lactating women and mothers.
For the purpose of conducting the baseline surveys in a comprehensive manner, I held various meetings and interviewed the major stakeholders and parties involved. The stakeholders covered included inter alia the primary health centre (PHC) and sub-centre, anganwadi workers, accredited social health activists, auxiliary midwives, self-help groups (SHGs), community resource personnel, the village community, school children, adolescent girls and boys, the panchayat samiti officials, gram sewaks, gram panchayat leader (sarpanch), the panchayat members and local NGOs.
All these meetings and interactions I have conducted over the past couple of months, point towards the major health concern of malnutrition in almost all of the villages and hamlets. Malnutrition, by far, has been the primary cause of deaths among children aged 0-5 years. Lack of nutrition, early marriages, frequent births, high fertility rate and a lack of proper birth spacing has led to widespread anaemia, related diseases and worsening health conditions among the young mothers, pregnant women and lactating women. This has further resulted in exacerbation of the maternal mortality rates in Jawhar.
I made a note of all the issues that were communicated to me. Factors such as early marriage, seasonal migration and meal intake among children were some of the factors that featured high above, amongst rest of the factors that also contributed to poor nutrition among children, adolescent girls and mothers. Other factors such as lack of awareness of institutional deliveries (home deliveries carried out by the inexperienced dai or the traditional birth attendants), cultural barriers, superstitions and lack of antenatal care (ANC) and postnatal care (PNC).
My understanding is that the other non-conventional factors such as poor sanitation, hygiene, health, poverty, unemployment, poor environmental health conditions are equally critical factors contributing to the menace of malnutrition in Jawhar, Palghar. Thus, awareness and the need to address these aforementioned issues is pertinent. Identification of issues and factors leading up to malnutrition is not rocket science. The most difficult task is to bring about a positive social change in community behaviour. It is a herculean task to alter habits, behaviours, rigid belief systems and age-old cultural practices followed by the village tribal community.
The issue of malnutrition can be effectively addressed if these three Ms are addressed. The aforementioned factors are not mutually exclusive and have to be addressed simultaneously to bring about a tangible change in the behaviour of the village tribal community.