Putting a stop to Child Malnutrition

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With nearly a quarter of its children stunted (or being too short for their age), India has its work cut out to reduce the prevalence of malnutrition among its youngest citizens. The World Bank estimates that malnutrition costs India’s economy $12bn a year in lost productivity and higher healthcare spending. Beyond macroeconomic losses, malnutrition is very hard on the average family residing in a slum. It makes children more susceptible to diseases and affects cognitive growth. Malnourished children grow up to earn lesser wages, studies have shown. The worst effect of malnutrition is that a significant chunk of the population never fulfils its true potential as human beings and that it keeps families entrapped in abject poverty.

SNEHA, a Mumbai-based non-profit organization that has been implementing public health programs, in partnership with public systems since 2000, takes a holistic and systemic view of malnutrition. ‘We follow a two-pronged approach, we work closely with communities, to improve health seeking behaviour, feeding practices and knowledge of health systems and schemes, to seek relevant services, while working closely with the Integrated Child Development Services (ICDS) scheme, to improve the quality of its services and build capacity among its staff and field workers to match the needs and expectations of vulnerable populations,’ says Anagha Waingankar, Associate Programme Director, Child Health & Nutrition.

SNEHA’s flagship child malnutrition programme, Aahar, currently works with 150 anganwadis (childcare centres), across Wadala and Dharavi, to upskill and build greater capability among ICDS sevikas (Government employed community health workers) to improve coverage of nutrition services to pregnant women and children under the age of 3 years. In its previous phase, Aahar, worked focused on early screening and treatment of malnourished children, using UNICEF’s Community-based Management of Acute Malnutrition (CMAM) Approach. Covering 300 anganwadis across Dharavi, Aahar I successfully reduced acute malnutrition by 25% among 0-3 year olds. Aahar II, which has been implemented since 2016 is focusing on building capacity and supporting the ICDS to deliver better quality services across its core areas. While working on the supply side, Aahar II also works with communities to identify a cadre of volunteers to promote community ownership of child nutrition while becoming proactive users of public health services.

Reaching over a lakh and a half people through our work, we are privileged to witness incredible stories of transformation. We dug into our story bank to bring to you some of the best stories:

Mobina’s story

Mobina is a 29-year-old woman who stays with her husband and in-laws in a joint family at Naik Nagar, Dharavi. She is a homemaker, while her husband works as a helper in a local shop. The ICDS Sevika, SNEHA’s Community Organizer (CO) and a local Volunteer met Mobina and her husband on one of their community mobilization visits, and found Mobina to be in her seventh month of pregnancy. She seemed to be very frail and introverted and didn’t communicate much. After spending some time in their house, Mobina’s husband revealed to the Sevika and CO that Mobina was in her seventh month of pregnancy and was fearful about the future as she had undergone five miscarriages previously.

When the Sevika asked her husband about her quiet nature, he revealed that being into seventh month of pregnancy, a fear hovered around her since she had five miscarriages in the past. The husband also explained that Mobina had poor eating habits. The Sevika and CO took out nutrition flashcards and explained to Mobina’s husband various nutritional foods such as vegetables, meat, pulses and fruits, their nutritional values and health benefits, as well as when and in what quantities to be consumed. Mobina’s husband diligently followed Sevika’s instructions and started giving her nutritious food. He thanked the Sevika and CO for sharing such valuable knowledge about nutrition. By the time Mobina approached childbirth, her nutritional status had improved. However, in view of her past miscarriages and her current health status, her gynaecologist strongly suggested that Mobina undergo a C-section. The doctor told Mobina’s husband to arrange for O-ve blood group within 48 hours since it was not available with the hospital. Her husband enquired at various blood banks and started searching for donors with O –ve blood group, but panicked because he couldn’t find any donors. Out of despair, he approached an Aahar community volunteer and explained the urgency of the situation. The volunteer happened to know a donor with the said blood group and immediately requested the donor to rush to the hospital for help. The donor arrived at the hospital the very next morning. His blood group was confirmed and the blood was utilized during Mobina’s C-section. She gave birth to a healthy baby boy weighing 3.30 kgs. Her husband got very emotional and sincerely thanked the volunteer for his exceptional presence of mind and help just in time. Mobina’s husband got inspired to such an extent that now he has taken up active volunteerism with SNEHA and is helping his community with referrals to the ICDS, for child malnutrition and antenatal care.

Motivating excellence

S (name withheld to protect privacy) is a 37-year old woman working as an ICDS Sevika for the last 3 years. In Aahar’s early days of intervention, S came across as a very reluctant person and the Aahar staff found it difficult to approach her for joint weighing and other activities and events. She chose to remain aloof most of the times and rarely cooperated with the other works at the anganwadi. It took several months of working with S for SNEHA’s Community Organiser to work with her and bring about an immense change in both attitude and behaviour. The Community Organizer meticulously took up community mobilization, weighing, THR distribution, planning and organization of community events in sync with S. She motivated S at every step and appreciated her painstaking efforts during mother’s group meetings. Such kind gestures transformed S into an exceptionally attentive and cooperative Sevika. So much so that once she was down with high fever on the day when weighing activities were to be conducted at her anganwadi. On learning about her ill health, the Community Organizer and other ICDS workers began with weighing, but were suprised to see her arrive at the Anganwadi in spite of her high fever. She diligently started weighing children and looked after documentation work. Seeing that only a few children had been brought in for weighing activities, she even went and mobilized the families in the community and convinced them to come at the Anganwadi. S was able to achieve an incredible 100% in her weighing targets.  S thanked the Community Organizer for her immense motivation and appreciation that helped bring a significant change in her.

Every vaccination is a victory

Rasheeda is a 30-year-old woman staying with her husband and four children in Naik Nagar, Sion. She is a housewife, while her husband works at a footwear manufacturing unit. Rasheeda’s mother lives nearby. On one of their home visit days, a Sevika and SNEHA Community Organizer came across Rasheeda and her family. The Sevika enquired about the four children and remarked that the third and fourth children were very close in age. First, Rasheeda lied to the Sevika saying that the fourth child wasn’t hers but her neighbour’s. After a while, Rasheeda confessed that the fourth child belonged to her and was born recently, and was unplanned. The Sevika asked Rasheeda if she took the baby for weighing at the anganwadi and if he was vaccinated. Rasheeda admitted that she had not taken the baby and that he was unvaccinated. The Sevika and Community Organizer took the opportunity to explain about the importance of vaccination and how it protected a child’s immune system against opportunistic infections. Meanwhile, Rasheeda’s mother arrived and reacted harshly after hearing that the Sevika and Community Organizer wished to see the child’s hospital birth documents. She got furious and asked the Sevika and Community Organizer to leave their home instantly. It was from neighbours the Sevika got to know that all four children were born at home and Rasheeda did not avail antenatal care at any public or private hospital. The Sevika and Community Organizer then took the help of the local Health Post’s Community Health Volunteer (CHV), requesting her to accompany them on their next visit to Rasheeda’s home and convince her about vaccinating the baby. The CHV agreed and accompanied the Sevika and Community Organizer. When they went to Rasheeda’s house, they noticed her mother’s presence. Once again, Rasheeda’s mother raised her voice asking the Sevika and Community Organizer to leave again. But when the CHV came forward and introduced herself as a representative of the Health Post, Rasheeda’s mother calmed down. Further, the CHV explained them the importance of vaccination in depth, asked Rasheeda to bring the child to the health post for registration and creation of his records, handed over the vaccination schedule and instructed Rasheeda and her mother to bring the child to the vaccination camp which was to happen the very next day in the community. Rasheeda and her mother diligently followed the CHV’s instructions and got the child vaccinated.

Rasheeda thanked the Sevika, Community Organizer and CHV for opening her and her mother’s eyes and for being concerned and considerate towards her child’s health and wellbeing.

 

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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