Sixty years after India’s independence, despite a “booming” urban economy, 300 million Indians (roughly the size of the USA) still live in abject poverty and one could argue that the biggest price they pay for being poor is their health. While health services in India are generally designed to be inclusive of all people regardless of caste, gender, geographic location, socio-economic status, or any other basis of exclusion, this doesn’t always hold true in practice.
One area where lack of inclusiveness can have especially dire consequences is that of newborn and child health. The country has the unfortunate distinction of claiming 30 percent of the total neonatal deaths in the world. Every year, 1.2 million of the 27 million babies born in India die within the first month of life, according to the latest National Family Health Survey (NFHS-III).
Part of the problem is limited access to hospital and institutional support. In India, 65 percent of all births occur at home, often without the assistance of a skilled birth practitioner. When something goes wrong, there is no one to help and often no plan to get the woman to the local medical center. In rural areas, women often die because transport is not available.
The Indian government has come up with schemes such as the National Rural Health Mission (NRHM) and the soon-to-be-launched National Urban Health Mission (NUHM). Both schemes give high priority to the issue of maternal and newborn health for marginalized communities, and seek to improve the availability of and access to quality health care for those at the lowest rung of the socio-economic ladder. Additionally, government programs such as the Janani Suraksha Yojana incentivize delivery in hospitals by encouraging mothers to opt for institutional deliveries.
Unfortunately, in a country of India’s size, many local communities are unaware of these schemes. Those that are aware of the schemes are often confused about the details and how to go about accessing the services. Even more common is the lack of awareness about why these schemes are important in the first place. In many Indian households, where the basic issues of survival take center stage, the health of mothers and their newborns is often sidelined.
Not so in Sabji village in Uttar Pradesh where Ms. Ramvati works. She is a government-sponsored trained Accredited Social Health Activist (ASHA). ASHAs are part of an initiative that falls under the NRHM with the aim of bringing communities and health services closer. Ms. Ramvati makes home visits to pregnant women in the village, educating them about safe birthing practices.
She explains that the process of bringing about change has not been easy, but using materials and training provided by a project called Sure Start has eased the way a lot. The project¾a five-year initiative based at PATH, an international not-for-profit organization supported by the Bill & Melinda Gates Foundation¾is working with rural communities in Uttar Pradesh and marginalized urban settlements in Maharashtra to help mothers and children survive and stay healthy.
Projects such as these work on the premise of community action and involvement. They work in tandem with the Indian government’s efforts to develop community-level systems for improved services. The goal is to actively engage with the community to bring about change from the inside out.
“Earlier, people were somewhat suspicious and some even forbade me from coming into their houses, but I now receive a lot of respect,” says Ms. Ramvati. “People ask me to sit, offer me tea, and actually listen to what I say.”
Ms. Sudama, a mother of three who is expecting her fourth child, says, “Didi [Ms. Ramvati] comes to our house, and therefore I know how to access a four-wheel vehicle when I need to go to the hospital. I have also kept the telephone number of the doctor handy.” Ms. Sudama’s birth preparation calendar-a gift from Ms. Ramvati-is displayed prominently on her wall.
On another of Ms. Ramvati’s visits, Ms. Sudama was given a tiffin box. While the expectant mother cannot break with the Indian custom of feeding her family first, she now uses the tiffin box to put aside some cooked food for herself and consumes it after everyone else. “I already have three children,” Ms. Sudama says, “but this time around I will do some things differently.”
At a time when India’s heroes and success stories are often about economic titans or big business ventures, it is important for us to remember and strive for another, more fundamental kind of success-we must celebrate, encourage, and support the numerous people who are working tirelessly to create tangible change from village to village, city to city, and life to life. Together they are doing something sacred… nurturing India’s future and the people who carry it for nine months.