India is one of the world’s largest and fastest-expanding economies, but despite this, it has the highest absolute number of maternal, newborn and child deaths in the world.
In this huge country:
- 69 out of 1,000 children die before their fifth birthday
- Half of all child deaths occur during the first month of life
- One woman in every 70 is likely, over her lifetime, to die during or shortly after pregnancy.
India has made outstanding improvements in maternal and child survival in the last 20 years but these are not enough to reach either the national targets or Millennium Development Goals 4 and 5.
The chances of babies dying just before, during or soon after birth (the newborn or neonatal mortality rate) are not evenly spread throughout the population: there are wide variations within states and between social groups.
- The newborn mortality rate (NMR) in rural areas is about one and a half times that of urban areas
- The poorest people are twice as likely to lose a newborn baby as the richest.
Around one third of women who give birth have access to antenatal check-ups and half have a skilled birth attendant at delivery, and only 37% receive any postnatal care. These average figures conceal wide differences between rich and poor: eight out of 10 of the richest women have four antenatal check-ups, compared with only one in 10 of the poorest women.
Women and Children First has worked in innovative ways in India to include both rural and urban women.
In the rural context, between 2008 and 2013 the Institute for Global Health at University College London received a Big Lottery (BIG) strategic grant to work with Women and Children First, Ekjut in India (as well as PCP in Bangladesh) to improve maternal and child health in deprived communities.
In an urban setting in Mumbai, Women and Children First worked with SNEHA, the Society for Nutrition, Education and Health Action.
We use three complementary approaches:
- mobilising communities through community groups
- strengthening health care
- influencing policy makers
Care in the countryside
In the rural areas of Jharkhand and Odisha we work with our longstanding partner, the voluntary organisation, Ekjut, and the indigenous communities it represents (Ekjut means ‘coming together for the cause’).
In many poor communities women do not have regular access to other community members, nor are they given the opportunity to voice their opinions. Ekjut has established more than 1,000 participatory women’s groups, which empower women to discuss and take action on the key factors that affect their health.
In Jharkhand and Odisha, the women’s group intervention has brought significant improvements in home care practices during delivery and the postnatal period.
Key results are:
- 45% reduction in newborn mortality
- 25% reduction in perinatal mortality (death of the fetus after the 24th week of pregnancy or of newborns within a week of birth)
- significant improvements in hygienic delivery and early child care practices.
Evidence from the Ekjut programme demonstrates that the effect of participatory women’s groups on newborn survival, in rural areas where newborn mortality is high, is sustainable and replicable.
The groups attract marginalised and disadvantaged women, and those who were most marginalised benefited the most.
The groups are widening the range of issues they cover to include topics such as family planning and nutrition.
Ekjut is expanding its work with key partners and stakeholders to make the health system stronger and more sustainable at every level.
Working in the city
In 2010 we started working with a new Indian partner, the Society for Nutrition, Education and Health Action (SNEHA) to strengthen basic health services for women and children in the Mumbai slums (in Sanskrit Sneha means ‘love’).
We have assisted health facilities to:
- Offer free maternal and newborn health services
- Establish maternal and newborn health referral systems across Mumbai
- Improve maternal, newborn and child health policy and implementation through advocacy and communications.
As a result, 29 health posts are now offering free maternal and newborn health services covering a population of nearly 2.5 million. The project was funded by the UK Department for International Development (DFID).
The SNEHA-jut project worked to increase the uptake of family planning in Mumbai’s slums. Dharavi slum in Mumbai is home to around 25,000 people. This project, funded by the Conservation, Food and Health Foundation, targeted married women of reproductive age, with four objectives, to:
- improve the contraceptive prevalence rate in the community
- improve capacity (knowledge, attitudes, skills) of married women regarding family planning
- create direct links between the community and health service providers
- improve service delivery at the community municipal health post.
Read more about this important work on Ruth Duebbert’s blog.
Also in Dharavi, we have worked with SNEHA since 2011 to reduce malnutrition among children under three years old. The project included:
- Running two day care centres and providing nutritious meals for 140 children
- Organising nutrition programmes for women and adolescent girls, offering education in groups about nutrition, hygiene and childcare practices
- Community nutrition committee meetings and training
- Raising awareness through community campaigns and events
- Advocacy at both state and national levels.
There is also a focus on raising awareness of good feeding practices in the community and on referring ill children to the appropriate health facilities. The project is funded by The Breadsticks Foundation.
Success stories. Read about two women who have been supported in improving their own and their children's prospects, and can now look forward to a healthy future.
This guide describes an approach that has the potential to reduce maternal and newborn deaths, based on projects in India and Bangladesh.
Research and funding
Women and Children's work in India was funded by:
- UK Department for International Development (DFID)
- Big Lottery
- The Breadsticks Foundation
- Conservation, Food and Health Foundation
The research projects in India and Bangladesh were carried out in collaboration with:
Women and Children First's partner organisations in India were:
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