Maternal and Young Child Health Initiative

The Maternal and Young Child Health Initiative is a three-year pilot project started in late 2005 that is designed to improve health knowledge and increase access to healthcare for young pregnant women and their children ages 0-3 living in the Fakir Bagan slums of Howrah, India. The primary goal is to reduce maternal and infant mortality and to foster better health outcomes for young mothers and children in the geographic area served by Calcutta Kids. Statistics indicate that the majority of India�s population lack access to health care and to important health knowledge. Prenatal and young child healthcare also remains a critical issue in India. According to UNICEF:

• Only 15% of mothers in India receive adequate prenatal care, resulting in a staggering number of unnecessary maternal and child deaths (maternal mortality in India is 100 times higher than that of most industrialized nations; 63 out of every 1,000 children born in India die before one year of age).
• 30% of Indian infants are born with low birthweight, a figure that has not changed in twenty-five years.

This is particularly devastating to vulnerable segments of society, the children, adolescents, and women that reside in the slums of Howrah and Kolkata, and that comprise our target population. Young women, especially adolescents, who become pregnant face a higher risk for medical complications and poor pregnancy outcomes than women in their 20s or early 30s. There is also a significantly higher incidence of maternal mortality and infant mortality in India�s slums compared to non-slum areas. The health situation of women living in India�s slums is compounded by their lack of access to education and economic resources. Improved health and health knowledge of children and young adults is essential to their future well-being and impacts their ability to advance in school, seek employment and attempt to rise out of poverty. Calcutta Kids seeks to improve access to health care, promote health and nutrition education, and to empower the communities it serves to attain a better quality of life. The approach involves the implementation of preventive health measures at key points in the life cycle, notably pregnancy (intrauterine growth) and the critical developmental period of the first three years of life. In late 2005, our organization identified young, pregnant mothers as a top priority. The Maternal and Young Child Health Initiative is designed to assist and empower young mothers in attaining optimal prenatal and postnatal health for themselves and their babies. The Calcutta Kids approach is unique in these slum areas, as is the extended, personal contact with Community Health Workers � a feature sadly lacking in those government sponsored programs which exist is such areas. In early 2006, Calcutta Kids conducted a baseline survey in the slum of Fakir Bagan, Howrah. Of the women surveyed: over 30% of those who had been pregnant within the past 3 years reported having had a child who died; 40% of women reported that they did not get more rest then usual during their last pregnancy; 14% had not received any antenatal care; 34% did not receive iron-folate tablets; and only 28% fed colostrum to their newborn infants. Such problematic practices and service delivery shortcomings are likely to lead to negative health outcomes for both young mothers and their babies. These findings strongly supported the urgent need for health and nutrition counseling, improved access to health care, and effective community-based health initiatives.

COMMUNITY HEALTH WORKERS

Sustained interaction with Community Health Workers is a key component of this Initiative. The Maternal and Young Child Health Initiative trains Community Health Workers (CHWs) to advocate for, educate, and assist pregnant women and children under the age of three with their health care needs. Under the guidance of the Calcutta Kids Managing Director and Project Coordinator, five CHWs have been hired (all are from the communities that they serve or surrounding areas) and have undergone rigorous in house training as well as training from the Community Development Medicinal Unit (CDMU), a non-governmental organization which provides training on effective community health education and medicine counseling.
Each CHW is in charge of a distinct area of the slum and carries a minimum caseload of 15 families (maximum 25 families). Each meets weekly with her clients and is responsible for:

• Counseling pregnant women and newly married couples on the need for adequate prenatal care checkups, nutrition, and daytime rest during pregnancy
• Monitoring the progress of each pregnant woman
• Addressing common problematic practices during pregnancy (among them the common practice of �eating down� because of fear that a larger fetus will result in a difficult delivery; the practice of not getting adequate rest; and the practice of not taking iron/folate tablets � common in the absence of counseling on side effects.)
• Directing those underserved by prenatal care to the Udit Nursing Home (a well-respected medical clinic that is contracted by Calcutta Kids for this purpose)
• Identifying high-risk pregnancies - Calcutta Kids will subsidize the cost of a facility-based delivery in these cases.
• Assuring that each infant receives necessary immunizations and micronutrient supplementation
• Counseling on best-infant care practices, including breastfeeding, oral rehydration therapy, and immunization
• Counseling women about the importance of birth spacing
• Leading health awareness camps every month where health information is disseminated through puppet shows, films, and participatory methods

Benefits

The Maternal and Young Child Initiative works from within the community to empower the local population to understand the importance of prenatal care and infant health. Furthermore, the initiative provides vital resources to facilitate healthy pregnancies and healthy children aged 0-3. Anticipated benefits include decreased maternal and infant mortality; higher birth weights; and decreased incidence of Measles, Whooping Cough, Tuberculosis, Respiratory Tract Infections, Malaria, Vitamin A Deficiency, and Diarrhea as a result of regular immunizations and preventive care. A stronger local awareness of prenatal and best infant health practices will not only benefit those women directly served, but also benefit those with whom the women share their knowledge. The strategy employed by the Maternal and Young Child Initiative is based on empirical evidence indicating that �undernutrition�s most damaging effect occurs during pregnancy and in the first two years of life, and the effects of this early damage on health, brain development, intelligence, educability, and productivity are largely irreversible�1. Finally, research to date persuasively suggests that reducing the incidence of low birth weight has substantial economic benefits, such as increased labor productivity later in life and decreased costs associated with infant illness or death.2 The anticipated benefits of this Initiative will be instrumental in providing disadvantaged children with the opportunity to experience gains in cognitive, social, and health development similar to those of their economically better-off peers.

Preliminary Analysis

Have we made a difference? And where do we go from here? These are the questions Calcutta Kids has been asking itself now nearly two years into our three year trial of the Maternal and Young Child Health Initiative. In response to the first question, the evidence already is in � and it is dramatically positive. With your help, Calcutta Kids has made a significant positive difference in the lives of both women and children in our catchment area of Fakir Bagan. On the surface, positive change is apparent in the health seeking behavior of families in Fakir Bagan who are utilizing responsibly the medical services available to them. It also can be seen in the outpouring of community involvement, with large numbers of women now actively participating in Calcutta Kids activities despite the time constraints of their demanding lives.


But the most important accomplishments have to do with the bottom lines. The first is the sharp reductions in maternal mortality during childbirth. With Calcutta Kids� system of identifying potentially difficult and dangerous pregnancy cases in advance, and providing these women with safe facility-based deliveries, far fewer women are dying. Second, the infants being born are much healthier as a result of the pregnancy counseling their moms have been receiving. The best measure of this is birthweight. During the past year, just under 80% of the infants born in Fakir Bagan have had birthweights of at least 2.5 kilograms (WHO�s low birthweight cut-off point.) And the average birthweight has increased from a disgraceful 1.8 kilograms at our baseline in late 2005 to 2.8 kilograms in August 2007. To our dedicated field staff � and to the women of Fakir Bagan who have been participating so enthusiastically, we bow our heads. If the end-line evaluation of the Maternal and Young Child Health Initiative, to be carried out after three years of program activity, reveals a significant improvement in the health and health knowledge of the community it serves, Calcutta Kids envisions making this initiative a cornerstone of its programming. In addition, we will examine means by which the successful activities of our organization might be replicated in other contexts.