India

Background

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.

Even so, India has made outstanding improvements in maternal and child survival in the last 20 years.

However these are not enough to reach national targets or Millennium Development Goals 4 and 5. Neonatal mortality rates (NMRs) vary widely 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 half of women who give birth have access to antenatal check-ups and a skilled birth attendant, and only 37% receive any postnatal care. Again, these average figures conceal wide differences between rich and poor.

Working in partnership

The work of Women and Children First in the Indian Subcontinent is moving in exciting directions, to include both rural and urban women.

Saving lives 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).

In Dharavi slum, Mumbai, we are working with SNEHA to reduce malnutrition among children under three years old. The project includes:

• Running two day care centres and providing nutritious meals for 140 children
• Running nutrition programmes for women and adolescent girls who are educated in groups about nutrition, hygiene and child care practices
• Community nutrition committee meetings and training
• Community campaigns and events for awareness raising
• State and national level advocacy.

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.

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 participatory women’s groups which empower women to take action on the key factors that affect their health. The groups bring women together to discuss topics of concern to them and begin to devise their own solutions.

In Jharkhand and Odisha, the women’s group intervention brought significant improvements in home care practices during delivery and the postnatal period, culminating in a 45% reduction in newborn mortality.

There are now nearly 900 women’s groups, covering a total population of over half a million. These groups are widening the range of issues they cover to include such topics as family planning and nutrition. At the same time, Ekjut has also expanded its work with key partners and stakeholders to make the health system stronger and more sustainable at every level.

Women and Children First also assists SNEHA and Ekjut (and PCP in Bangladesh) in developing advocacy strategies, and has developed a Good Practice Guide based on the experience of Ekjut and PCP in facilitating women’s groups.