Breaking the intergenrational cycle on poor health

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.

DSC_0110Poor 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  int 1 and 2Awareness 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.

interventionFood 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.

 

Preparation AmritchurnaCommunity 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).

PackagingSimple 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.

community distribution.jpgNutritional awareness session and Amritchurna ddistribution

To monitor the effectiveness of the product, weight and hemoglobin levels were recorded at regular intervals.

IMG_20160615_144908Continual 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”

 kripaImprovement 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.

SDG

Susustainable Dvelopmental Goals achieved with improving women health and nutrition

Advertisements

The vicious cycle of anemia

I had read about vicious cycle on undernourishment as one of my  first research papers for my literature review during my PhD. Never did I know then that I would be back to a village where I would actually come across not one but many families specially women suffering from the condition.

Intergenrational

One of my earliest observations during my visits to the villages  is the stunted growth of the children (mostly girls).Recalling my most used diagram during my thesis, I decided to check the records of the hemoglobin levels of some of the women.

IMG_1119A severe case of malnourishment

To my dismay many of the women never had hemoglobin levels checked even during pregnancy (even when the government has put a place an extensive system of ASHA and ANMs to look after maternal health during pregnancy and lactating period). This obviously means adolescents girls and other women wouldn’t have ever known about these tests.

The first thing we did in 4 villages in Silora block is to conduct health check-ups for adolescent girls and women. Out of 200 girls and women who came for the check-up in the past 4 months,  more than 70% of them were anemic. Haemglobin level 6-8 was so common that I had started considering 9 gm/dL as normal (the normal being 12-15 gm/dL).  Also more that 70% were underweight and malnourished. I was pained to find out many 3rd trimester pregnancy with 6 gm/dL which can be  life threatening to both the mother and the baby.

IMG_1557Simple Hemoglobin test using color matching in Chota Narena

DSC_0117Medical camp in Junda

The Impact: These mobile health camps have been instrumental in changing the behavior of these women towards their own health. The women have started noting down / remembering their weight and Hb. Many of them even got their relatives from near by villages for the check-up. It has enabled us to understand the severity of the matter and we could sense the urgency of a nutritional intervention for the right target population “the girls and the women”

IMG_092111Medical camp at Chirr

The next challenge: The obvious next step was to spread awareness among the girls and women the importance of a good balanced and nutritious diet. This was met with numerous challenges. There is minimal diversification of food and food is overcooked to taste the palate.  The monetary factor also plays one of the most decisive role . Most families in order to save money live on roti and chillies. There is a need of a local product which is not very expensive, easily available and suit the taste buds of the local people.

What  I find disappointing is the way how we look at the health status in our country is through mortality rates. Hardly any emphasize is given on quality of life and reduction of morbidity. This is exactly why we are missing out on implementing strategies  for a healthy childhood, adolescence and leading to a healthy motherhood.

In the next blog post, we will discuss the nutritional supplement we have been working on and its role in alleviating anemia in rural girls and women enabling them to lead a healthy life

 

 

 

 

 

 

 

Breaking silence, overcoming inhibitions

When speaking about menstrual and reproductive health is no more a taboo, meet our solar trainers and change makers from Tumkur district of Karnataka and Bettiah of Bihar.

IMG_20160125_163135468

These women are now confident to speak about menstrual and reproductive health, can explain why  menstruation occurs and why we need to understand our reproductive system and map our menstrual cycle.IMG_20160125_1504354341

IMG_20160125_153521376_HDR

They will soon go back to our communities where they will not only light their villages with solar power but also with their knowledge on health issues. These women would disseminate the knowledge and empower more women  so that they have more control on their reproductive health.

There are equipped with the information on various sanitary products and its proper usage and disposal. The various methods of contraception they can use and safe and unsafe period of their menstrual cycle. They would encourage the women and girls from their communities to break silence on menstrual and reproductive health health, know their right to good menstrual hygiene and safe delivery.

It was not an easy task to achieve this level of openness on this issue but no where these women can be blamed. They have so many issues they had to deal with that they have never had a chance to prioritize their own health in their lives. However, as we have spent roughly four months together talking about these issues casually over a cup of tea or during a full fledged session, I can see the change in their attitude. After each class, I have found one or two women who would stay back and discuss about various gynecological problems they are facing There was an inflow of more of them to the barefoot hospital with gynecological problems. They have requested for all the materials which we used during our educational sessions which they can take back and educate the women in their village.

IMG_20160125_160820239

I can now proudly say that we together have achieved a platform where we are comfortable to share our experiences, break silence on issues which are important for our healthy lives and empower more women in our communities with knowledge and right information.

Let’s talk about period without any whispers!!

International day for rural women hadn’t had such meaning in my life as it is today  as I am surrounded by “empowered” rural women here in Barefoot college,Tilonia. Women who are supposed to be only involved in household chores, do what they are asked to do, keep quiet in  a distress situation and accept their troubled backgrounds as their destiny have  found a new home here where their voices are heard, where they are known for skills and willingness to learn more than anything else, where engineering jobs are not meant only for men and women outnumber men in solar department and most importantly where women speak freely about their body, menstrual  and reproductive health.

In spite of being raised in a semi-urban environment , menstruation was something which was hardly discussed openly and is still considered a taboo in many parts of the country. Period for me was almost synonymous to a black polythene where the shopkeeper would put a newspaper wrapped pad pack.However I was surprised at the ease at which these rural women, specially the health care workers and trained daimas discuss about menstrual hygiene and reproductive health. These initiatives have brought a big shift in the attitude of both men and women of these areas regarding women health. Here you can find men and women discussing and taking collective decision on production of sanitary pads as well as holding meetings on menstrual hygiene management. We have recently organised a 3 day workshop on menstrual hygiene management with Eco femme, and as expected women came forward to facilitate educational sessions and start dialog about menstruation among adolescent girls and women. I guess this is what empowerment means in the true sense where they are made to realize that it is absolute normal and essential to talk about these issues, provide a conducive environment where they can do so and  in doing so they are encouraging many more women to speak up and break the shame associated with these issues.

Below are some pictures from the 3 day workshop which have managed to change my mind on the whole issue of menstruation

Kamala ji , one of the trained traditional birth attendants (Daima as they are commonly known) explained female reproductive system and menstrual cycle in the most simple language possible (This is no doubt my favorite picture of the lot)

IMG_0591

Health workers came forward and facilitated the entire session on menstrual hygiene management

IMG_0505IMG_0583

Adolescence girls actively participated in a 3 hour long session where they enjoyed mapping and understanding their menstrual cycle and understanding

IMG_0559 IMG_0514

Our rural women having a funny moment with menstrual cups

aIMG_6429IMG_0696

The barefoot Medical team who are champions for menstrual hygiene management 🙂

IMG_0814