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Together for change

Photos: Meeta Parti

Hoping for better days: Children at the Shivnagar slum and Sister Arokhya Mary talking to community women (right).

Babita, 35, a dai in Shivnagar slum, Indore, says earlier she did about three deliveries a month. In the last few months, she has done none. “My own work of speaking to pregnant women, ensuring they take their shots and escor ting them to hospital for delivery has rendered me jobless. But I don’t mind that,” she says cheerfully.

Susheela, a 50-something woman in Rustom ka Bagicha, a slum in central Indore, says she constantly counsels pregnant women in the community. There are about 20 such trained health workers like her, each covering 50 households. They go house to house telling women about immunisation, antenatal care, nutrition, ORS (Oral Rehydration Salts), benefits of institutional delivery. Over the last four years, they are seeing better healthcare for children and pregnant women. “Earlier, we saw many women and infants die — not anymore,” says Savitri, 26, community worker.

Forty per cent of the world’s poor lives in India. Lesser opportunities in rural areas has led to increasing migration. Estimates say while the annual population growth rate for India is 2 per cent, it is 5 per cent for slums. An estimated 60 per cent of Mumbai’s population lives in the slums and 40 per cent of Delhi’s. In second-tier cities such as Indore, the slum population is about 20 per cent and growing.

Landlessness, lack of basic amenities such as water, electricity, sanitation and access to health services make the urban poor highly vulnerable. Says Dr. Siddharth Agarwal, Urban Health Resource Centre (UHRC), an NGO that has been working in Indore’s slums for the last four years: “There is need for basic services for pregnant women and infants. In our work, we have focused on ensuring better reproductive and child health.”

UHRC is currently working in 135 slums, covering a population of 2.5 lakhs — 40 per cent of the city’s slum population. Since the programme began four years ago, complete immunisation of pregnant women and children has shot up from 32 per cent to 72 per cent. Institutional deliveries have risen from 38 per cent to 52 per cent. Malnutrition indicators have also improved over the last few years. Breastfeeding has helped ensure nutrition and immunity. This, together with immunisation, has helped considerably.

The thrust of the programme has been partnership with Government agencies to ensure the ANM makes regular visits. About 80 access points have been set up across the city, where on a designated day, each month pregnant women can access iron and vitamin tablets, immunisation services. Monthly health camps are organised for specialised services and better antenatal care.

Programme staff say providing health service is only one part of the picture. Community women have been trained to motivate their peers to access services. As Dr. Agarwal says, “Just having the service does not ensure women access it.”

The community health workers say the community is responsive. Renuka, 35, who runs a petty shop in Shivnagar says, “We tell women about immunisation. Now they come and ask us — when do we have to come for the next tika.& #8221; Pushpa, a woman in Rustam ka Bagicha, says the community health workers are a great support. Clutching a seven-month-old baby, she recounts how a community health worker took her to the hospital for delivery in the dead of night and borrowed money from the self-help group to buy essential medicines.

In a population group which does not have the safety net of an extended family to take care of pregnant women and children, these health workers provide critical support. The women have set up self-help groups, and a small health fund for use in emergencies. Pregnant women are encouraged to save for their delivery. “The health fund is small — nothing big. But it is big, if it manages to save lives,” they say.

Although most deliveries are taking place in hospitals, dais in slums have been trained and instructed to use a new blade to cut the cord, use new thread and ensure they don’t apply anything on the navel. Doctors say just this precaution will ensure safety.

Sister Arokhya Mary, 35, a spirited, energetic Catholic nun from Pondicherry, has been working in Indore’s slums for the last eight years. A field worker with the NGO Indore Diocese Social Service Society, she says, “It is frustrating when we work with pregnant women over nine months and then at the time of delivery it is the mother-in-law or sister-in-law who comes. They don’t listen to what the women have to say and it is back to the age-old practices.”

Some practices they are working hard to implement but which are junked include applying brick paste on the navel when the cord is cut; ensuring immediate breastfeeding. Earlier, the child was given gur or water or weak tea for three days before being breastfed. In some communities, they would bathe the newborn, putting it to risk. “Now we insist on not applying anything on the navel, exclusive breastfeeding must begin immediately, no bathing, just clean the baby,” says Dr. Agarwal.

With the Janani Surakhsa Yojna in place in Madhya Pradesh to promote institutional deliveries, the motivation to deliver in hospitals is high. Under the scheme, women who deliver in hospitals in urban areas get Rs. 1,000 and the escort who is the “motivator” gets Rs. 200. In rural areas, this is Rs, 1,400 and 600 respectively. Babita, a trained dai, says she charges Rs. 400 for delivery if it’s a girl; Rs. 500 if it’s a boy. “But I know people here are poor and they cannot afford that much. So I tell them I will take them to the hospital. They get Rs. 1,000 and I get Rs. 200. Now I give advice, my job is gone. Only when deliveries happen at night, or there is some emergency, do I perform the delivery.”

Renuka says access is a major problem in their area. Even though the public hospital is just two km away, the slum is not accessible by road. “Recently, a woman delivered in the rickshaw itself. That is our next agenda — to get the road built.”

In some cases women go to their village to deliver, in which case the hard work goes to waste. But the reverse is also true. Health workers say they share their knowledge when they go to their sasural in the village. Says Sangita fr om Shivnagar, “I tell them what to do and how. Everyone is impressed. Since when did you become a doctor, they ask; how do you know all this, they say.”

Women who are health workers say they are illiterate, have never been to school, always had the hunger for knowledge. They value the information NGO trainings are giving them. Some say their children help them write the records in the books. “Till a few years back we were in ghunghat, we hardly stepped out of the house. Today, we know about immunisation, antenatal care, nutrition, breastfeeding,” says one. “We are talking to the Collector and Corporator to ensure garbage dumps are cleared,” adds another.

Savitri, 26, says she was extremely shy. “I didn’t know anything. Sister Mary told me about antenatal care and nutrition. We are given training so we can advise pregnant women on antenatal care, iron tablets, nutrition. I keep track of them, constantly talk to them and tell them I can take them to the hospital at the time of delivery.” In the last two years, she has helped 10-15 deliveries.

Clearly, for these health workers, it is the thrill of stepping out of home, learning something new, getting community recognition. There is no monetary benefit. “What makes me most happy is working for the safety of mother and child, and good health for all,” says Savitri. “Our own transformation is also wonderful. We didn’t know so many things,” adds Renuka. Babita says, “Now, in my house when my family sees me finishing housework fast, they ask, do you have to go for a meeting? It is like this. We want to do this community work so we have to quickly finish cooking and cleaning. Otherwise they say you don’t do housework.”

India has had a bad report card when it comes to maternal and infant mortality and malnutrition. Simple measures and a little bit of knowledge is helping save lives of women and children. At the same time, it is giving the older women a new lease of life as they shed their ghunghat and become community leaders.

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