A bit of background of the health status of girls and women in the 4 villages I am working with Barefoot College -(i) Poor menstrual hygiene management (ii) lack of basic diagnostic care (iii) high prevalence of undernourishment (in particular anemia). Though government has a dedicated program on Integrated Child Development system, programs on awareness on menstrual hygiene management and diagnostic care seem to be non-existing in these regions. With no provision for iron supplementation programs for periconceptional groups (before and around the time of conception) , the programs fail to achieve the desired hemoglobin levels during the earlier stages of pregnancy which is the most crucial stage for embryogenesis, organogenesis and fetal development.These gaps contribute significantly in perpetuating intergenerational cycle of poor health.
Poor status of health in rural girls and women
The project “Breaking the inter-generational cycle of poor health in women” was designed to target four major time point of intervention – adolescence, periconception, pregnancy and lactation. The first two intervention of conducting awareness session and diagnostic medical camps have been briefly discussed in the previous blog posts Awareness session and medical diagnostic camps
The third intervention was providing a local product to alleviate anemia levels. In quest of finding a solution which is locally available, affordable and accepted by the community, I came across “Amritchurna”. Amritchurna is an indigenous product made up of wheat, black gram, groundnut, sesame seed and jaggery in a defined proportion.It has a well balanced mix of carbohydrate, protein, iron, calcium and magnesium and met all the criteria we were looking for. The best part was that it has a high content of iron.
Food based nutritional intervention
We revived its production and distribution with the help of members of the health department and community members. The health coordinator Meghraj ji and local health worker Mangi lalji and other memenrs were a great support throughout the project.
Community involvement in the preparation of Amritchurna
For distribution, a simple packaging with clearly written instruction on the dosage was adopted. More than 100 women and girls who were anemic were distributed Amritchurna with nominal fee of Rs 30 per Kg (60% subsidy from the making price).
Simple packaging and easy to follow instruction for Amritchurna consumption
Awareness session on the prevalence of iron deficiency, the reasons why girls and women in general are more vulnerable to this deficiency, its long term impact on the health and measures for its alleviation through various solutions are discussed. Regular meetings were conducted to motivate women to consume Amritchurna regularly.
Nutritional awareness session and Amritchurna ddistribution
To monitor the effectiveness of the product, weight and hemoglobin levels were recorded at regular intervals.
Continual monitoring of the beneficiaries
After consumption of Amritchurna for 4 months, many of the girls and women who were anemic have now haemoglobin ranging from 9-11 gm/dL. The trend of increasing haemoglobin levels by 2-3 gm/dL is very encouraging. More than any graph, the story of Kripa will summarize the kind of impact we have started seeing in the community.
“Kripa came with her aunty and pregnant sister-in law for the blood check-up camp. She looked very pale and thin and as expected she was severely anemic. We explained her about the condition and motivated her to take Amritchurna. During our first follow-up check up for the beneficiaries, she informed that she had been sick and was on medicines. Hence she didn’t consume Amritchurna. We advised her to start having it after she had finished her medicine course. After 1 months of regular intake, we went for the check-up again and were pleasantly surprised that her haemoglobin levels were increased to 9 gm/dL. I was very skeptical and decided to redo her tests again. To our surprise we got the same result after conducting the test multiple times. This motivated her to take it every day and during the last check-up, the team couldn’t even recognize her. She looks healthy and had put on decent weight. Her haemoglobin level is now 11.6 gm/dL”
Improvement in the health of the beneficiary through the integrated approach
The project had its own share of challenges. One of the biggest challenge was to motivate the girls and women for continual intake of “Amritchurna” which will ensure maintenance of the right hemoglobin levels. Also not many girls had physical transformation like Kripa though they had increased haemoglobin levels. The comparison of how much it can benefit an individual is something which is difficult to predict and at times becomes the cause of dissent among beneficiaries.
Impact and way forward
There has been growing recognition of the first 1000 days of life in the policies concerning tackling the problem of malnutrition. However many epidemiological studies and research have pointed out the role of preconception and periconception period being one of the most crucial periods in determining the long term health. In simple terms it means that the health of the mother not only during pregnancy but also before can significantly affect the health of the baby. To assure good health for mother and the baby, we need to provide the women the right start which is the period of adolescence when the body is undergoing many changes.
In a country where the health status is measured through maternal and child mortality rates, this project is an attempt to work towards reduction of the morbidity rates in girls and women which would ensure a healthy present and future generation. The project has at least managed to reinforce the idea that “Focus on the girls and women to fight inter-generational of poor health”.
Addressing girls and women health issues doesn’t only improve her health but also empowers them to make right choices to improve the entire family’s health. It also plays a larger role in improving the productivity; income, promoting gender equality and giving more decision making power to the women. In that respect the project “Breaking the intergenerational cycle of poor women health” has been able to cover 7 out of 17 sustainable goals which have been accepted as a framework for measuring development. The project has warranted a highly focused plan on targeting a continuum care right from adolescence till lactation and beyond to achieve a progressive increase in the health status of the country.
Susustainable Dvelopmental Goals achieved with improving women health and nutrition