Antara Foundation works at the grassroots of public health delivery with some of the most marginalized communities in rural India. What is “community” for us? First, government frontline health workers, drawn mostly from local communities – the nurse-midwife (or ANM), the ASHA worker (village health mobilizer) and the anganwadi worker (nutrition caretaker). The second, the larger community of village populations, with our interventions focused on pregnant women, lactating mothers, newborns, and children. This article introduces you to the latter, that is, our end beneficiaries, and highlights various aspects of their lives.
We work in the state of Madhya Pradesh, India’s fifth most populous state (~85m people) and second largest in expanse. Located at the heart of India (“Madhya” means central in Hindi), the state’s terrain is characterized by low mountain ranges, extensive plateaus and river valleys and is home to ten national parks.
Large areas
within the state are characterized by extreme poverty, inadequate
infrastructure and development, challenging terrain, and consequently poor
socio-economic indicators. In three of our districts, almost 40% of the
communities are tribal populations. The Indian government designates
populations as “tribal” based on factors such as primitive traits, distinct
culture, geographical isolation, shyness, and backwardness. Historically
disadvantaged and discriminated against, tribal communities have significantly
worse socio-economic metrics.
Health
situation
Amidst its
diverse cultures and beautiful landscapes, Madhya Pradesh also has some of the
worst health outcomes in the country. Tribal populations are extremely
heterogenous, each with diverse cultures and distinct social norms. Several of
these norms are based around the critical 1,000 days between conception and
age-2 of a child, and are severely detrimental to health. Some stark examples
include – giving inadequate food to pregnant women to reduce the baby’s size,
spiritual healing for severe labor pain, discarding colostrum (nutritious first
breast milk, critical for the newborn), and conducting rituals to heal
malnourished children. These communities, therefore, account for a
disproportionate share of the health burden.
Access to
proper healthcare is also challenging. There are issues of livelihood – the
average monthly income per agricultural household is as low as INR 8,300
($110), with many households surviving on daily wages. Access to health
facilities is problematic, with poor public transport and lack of roads in many
villages. Travelling to a health institute for check-up, or treatment
kilometers away means losing out on a day’s wages. Many a time, health is
overshadowed by issues like water, food, and gender norms.
The issues
are exacerbated due to the intersectionality of rurality, poverty, traditional
belief systems and adverse socio-cultural norms. Rural women at the
intersection of these factors become particularly more vulnerable, because they
are disempowered to have a say on their health and the health of their
children.
Working
with and through our communities
We strongly
believe that the best solutions to complex health problems come from those
closest to, and most affected by the issues. Listening to and learning from our
village communities is therefore a crucial element of our program design. We
work in some of the remotest villages, often reached only by foot.
Our teams
regularly visit these communities to meet and learn from pregnant and lactating
women, frontline health workers, broader women’s groups, and other village
change agents such as elected representatives and adolescent girls. This is key
for us to understand health-related challenges better, find ways to overcome
health barriers and create impactful and lasting solutions.
As we actively work with frontline health workers and facility staff to improve the quality of public health services, we are also piloting interventions that can create ‘active, aware, and empowered’ beneficiaries. We hope to work collaboratively with government and communities to stimulate demand for proper health. Our vision is for an equitable society, and a health system that is responsive to the needs of every mother and child.
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