Keeping Mothers Healthy in Irukpal

A mother stands in front of the tree diagram painted on her home in Irukpal, India. The diagram records important facts about her pregnancy. (©2006 Ami Vitale/CARE)

The drawings are not just art. These trees are tools, low-tech but powerful databases, and for the mothers of Irukpal they can mean the difference between a healthy baby and disaster.

Sumo Nayak, 22, is one of these mothers, and one of the trees is hers. She points to the drawing, explaining the meaning of each element: The six X's on the trunk represent her six months of pregnancy. The twigs on each branch show the iron folic acid tablets she has taken to prevent anemia. The marks on the roots indicate each time she has received supplemental rations of high-protein meal. Other details in the diagram record important events in her pregnancy, such as the dates of her tetanus vaccination and antenatal checkups.

The records stored in these diagrams are one facet of a comprehensive strategy, designed by CARE, devoted to keeping mothers and newborn children in Irukpal healthy and strong. Sumo herself represents another facet: she is a mitanin, or volunteer maternal health worker (the word mitanin simply means "friend" in Chhatisgarhi). She and the other mitanins visit individually with all new and expecting mothers in the village on a regular basis, using the information recorded in the tree diagrams to make sure each woman knows and follows the best practices for maternal health and nutrition.

The strategy is centered around the village health and day-care center for mothers and young children. "I came to this village after I got married," Sumo says. "After I arrived, the mitanins called me to come to the health center, and I learned about the government services there — the supplemental rations they give out, the immunizations, the antenatal care. Now, as a mitanin myself, I tell women in my neighborhood as well: when you come to the center, the mother will be healthy, and the child will be healthy too."

Listen to a special recording of a song used to help mothers in Irukpal remember the sequence of immunizations and other health practices.

Leading Change

Sumo Nayak, a CARE-trained volunteer health worker, distributes supplemental meal for mothers at the community health center. (©2006 Ami Vitale/CARE)

But such programs have little effect without the support and understanding of the community. Children can't be immunized if parents are unwilling to bring them to the health center or hide them from the health workers. Vitamins and medicine are useless if they aren't taken or are taken incorrectly. Even the supplemental rations are only helpful if they're cooked properly and if they're reserved for the mothers, rather than given to their husbands and in-laws. One of CARE's primary goals in Irukpal and other villages throughout Chhatisgarh is to change the behavior of young mothers and their families so they can take full advantage of the services the government offers.

Mitanins like Sumo are the leaders in this change. Trained by CARE and local partner organizations, these women play a key role in teaching their communities about maternal and child health. Unlike the government workers, the mitanins are members of the community and are available at any time. "Previously, many children died from disease," says Sepna Ghosh, a government nurse. "There were problems with pregnancy, and stillbirths. The mitanins are able to speak the local languages and see the women every day. Health education has improved, and due to regular immunization there are fewer child deaths."

The results of these efforts have been striking. In the last five years, infant mortality has dropped 13 percent in Chhatisgarh, and malnutrition in children under 5 has dropped more than 20 percent — the greatest reduction of any state in India.

A Force for Women

The mitanins' work in Irukpal has not only made a difference in maternal health; it has also changed the position of women in the village. The mitanins have become a voice for women in the community, and play an active role in the panchayat, or village government. Sumo has held elected positions in the village government, and Asmati now represents Irukpal and several other villages in the regional government.

"Visiting families every day as a mitanin, I was able to get support from the people," Asmati says. "Before, women would never go to the village assembly. They didn't know what to say, and they were hesitant. There were too many men there. Now they raise issues in the assembly. For example, women have to go long distances to fetch water. There should be more hand pumps in the village. Men don't fetch water, so they didn't even know this was a problem."

Asmati smiles as she thinks back on her success. "I feel elated. Like everyone here, I grew up on gruel and water. Never in my life did I think I'd be elected to the village or the regional government. But now I have even had the opportunity to visit Raipur, the state capital."

The mitanins of Irukpal are not alone. Across Chhatisgarh, over 1,800 CARE-trained maternal health workers have been elected to the local governments. Health and nutrition issues are being discussed regularly in the village assemblies. CARE works directly with the state government to help them develop state-wide nutrition policies.

The result has been a noticeable change in health and attitudes — a change that shines in the faces of mothers and children in Irukpal. "People here used to hide their children in their houses on immunization day," Asmati recalls, smiling. "Now they ask, 'When will my child be immunized?'"