Nourishing habits

An organisation in Bengal is striving to improve maternal & child health by tackling its root causes

Maternal mortality and infant health in India are inextricably linked to nutrition and health practices. The government’s approach to tackling these problems is to provide nutritional supplements to mothers and children at risk. However, this approach has failed to have the desired impact. West Bengal-based Child in Need Institute (CINI), thinks it may know why. Founded by pediatrician Samir Chaudhuri, CINI has been working since 1974 to improve maternal and child health by tackling its root causes: poverty, powerlessness, low status of women, illiteracy and inadequate health and sanitation practices. “With our experience in the field, we were convinced that without changing people’s daily food and health habits, nutritional supplements would serve little purpose,” says Ranjan Panda of CINI. “To address the issue of malnutrition and improve maternal and infant health, the need of the hour is a holistic behaviour change, involving both the individual and the community.” 

CINI’s approach towards improving nutritional behaviour hinges on educating and training mothers and Anganwadi workers about food and nutrition — rather than just handing out supplements. For instance, many women it has engaged with believed they should feed the entire family first, and eat only leftovers. “We explain to them how important maternal health is for the entire household, and have slowly begun to see discernable improvements in their diets,” he says. CINI is, additionally, training Anganwadi workers to ensure that all children under their jurisdiction follow the prescribed immunisation schedule. “Since many diseases in the villages of West Bengal and Jharkhand where we work are water-borne, we also educate the community about the importance of clean drinking water, and maintaining sanitary facilities in their neighbourhood,” says Panda. 

This holistic approach has shown perceptible results. Here’s a case in point. When a CINI facilitator saw nine-month-old Abir Ghosh for the first time, he was severely underweight at 4.5 kg. It was found through counselling that the child, the son of a daily-wage labourer, did not receive supplementary food at the right age. He was mostly breastfed and received only biscuit paste with milk or water. The facilitator asked his mother to come for regular counselling, and advised her to feed the child low-cost, nutritious homemade foods. The facilitator also visited his home every week, and ensured that the child was administered nutritional supplements. In four months, the child gained 2.5 kg. Today, he remains moderately underweight for his age, but is a healthy active child. 

Additionally, to ensure that government nutrition and health programmes are properly implemented, CINI has helped local stakeholders to form self-help groups (SHGs). “These act as pressure groups, and also ensure that mothers and the children receive the health benefits that they are entitled to,” says Panda. SHGs also identify mothers and children in need of help. “Often they inform us that a particular child or pregnant woman is looking ill or malnourished, we assess the situation and work with the village panchayat to access government welfare schemes to help them,” says Panda.

Indeed, increasingly, CINI’s focus has been shifting from an emphasis on direct service provision to a focus on facilitating governance processes and enhance access to services, programmes and budgets that are increasingly being made available in India, especially by government. “Other than nutritional counselling and setting up of SHGs, one of our biggest mandates today is to inform communities about their most fundamental entitlements,” says Panda. Operational in several districts of West Bengal, including Murshidabad, South 24 Parganas and Jalpaiguri and well as in Khunti District in the State of Jharkhand, these tripartite alliances of community, service providers and local elected representatives work as watchdogs. They draft child and woman-focused multi-sectoral development plans, monitor compliance by duty-bearer and ensure equitable access to social services. CINI is also in talks with other states such as Jharkhand, to extend their area of work. 

CINI’s approach is, in some ways, broadening the very definition of development, and has earned several awards and recognitions, the latest being the 2017 HCL grant of Rs 5 crore. Most significantly, their work on implementing and optimising government projects and policies of women and child welfare to improve developmental outcomes has shown that sometimes, the most effective solutions to weighty social problems are also the most obvious.

To learn more, visit www.cini-india.org and check out their Facebook page

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