Championing the cause of mother and child health in rural Rajasthan

Lakshmi Bairva is eight-months-pregnant and eagerly awaits home visits by Rajendra Kushwaha. Since the beginning of her pregnancy, 27-year-old Kushwaha has been guiding her about her daily food intake, monitoring her weight gain, and also educating her about taking care of a newborn. This isn’t Lakshmi Bairva’s first pregnancy. The resident of Gatta village in Rajasthan’s Baran district has a four-year-old child Mehek. But, there is a sea change between her first and second pregnancies, and all due to the efforts of Kushwaha, who is a Poshan Champion. A Poshan Champion is a field-level community worker whose responsibilities include home visits for counselling of expectant mothers, enrollment of eligible beneficiaries into the government’s maternity cash benefit scheme, and raising awareness on nutrition and other health issues. Kushwaha has been selected as a ‘Poshan Champion’ by the Sanskar Seva Santhan — a Baran-based non-governmental organisation which works for promoting rural healthcare in the region. The welfare initiative by the non-profit is aligned with the RajPusht initiatives to improve the health of mothers and infants. There are 38 Poshan Champions in Baran district including 27 men and 11 women. They are responsible for ensuring better nutritional outcomes in the health of expectant mothers and their newborn kids. “I cover about 45 villages in Baran district where there are currently between 70-80 expectant mothers. I visit them regularly and if I can’t physically reach their villages, I counsel them on the mobile,” Kushwaha told . Due to the efforts of the Poshan Champion, eight-months-pregnant Lakshmi, who has studied till class nine, has been regularly going for a health check to the nearest anganwadi, or Primary Health Centre. Kushwaha also regularly monitors her weight, something that is otherwise ignored by underprivileged and barely educated women in India’s rural hinterland. “On April 23, Lakshmi weighed 52 kgs; on June 9, she weighed 55 kilogrammes and 200 grams,” said a proud Kushwaha. POSHAN on wheels, nutri-kits and mobile anganwadis to tackle malnutrition in Assam There are five main tenets that RajPusht promotes for pregnant women. Eat well and frequently, ensure the food includes greens, grains, dairy, pulses and fruits, rest adequately, and ensure there is enough calcium and iron in the diet. The fifth is that the pregnant women get themselves weighed regularly. In its first phase, RajPusht is being implemented in Udaipur, Dungarpur, Pratapgarh, Banswara, and Baran districts in the southern region of Rajasthan, which has a significant population of the tribal communities. “While the government of Rajasthan has reduced the burden of undernutrition in the state over the decades, low birth weight, wasting, stunting and anaemia remain serious concerns in these regions and they fare worse on nutritional indicators compared to other districts in the state,” mentions the official website of RajPusht. According to the National Family Health Survey 5 (NFHS 5) 2019-21, infant mortality rate (IMR) in Rajasthan’s rural areas is 32.2 deaths per 1,000 live births. Under-5 mortality rate in the state is 37.6 per 1,000 live births. Meanwhile, 46.3 per cent pregnant women (15-49 years) are anaemic. The RajPusht project focuses on two critical and complementary channels for improved maternal health outcomes. The first is to provide multi-tiered behaviour change communication to pregnant and lactating mothers and their families. And the second provides resources at the household level through cash transfers; empower women to enact on the received advice and shift the power of informed nutrition decisions to women. The RajPusht project introduced an innovation in the five districts to ensure identification of babies with low birth-weight at the earliest. A newborn is weighed digitally as soon as he/she is born, and a photograph is taken and uploaded onto the mobile application that records all the medical parameters of the baby. The Project is being implemented by IPE Global Ltd, a Delhi-based development consulting group known for providing technical assistance and solutions for sustainable development in developing countries. RajPusht has assisted two key departments of Women and Child Development (DWCD), and Medical, Health and Family Welfare (DMH&FW) of the Rajasthan government to set up a seamless cash transfer system. Laxmi Narayan Kahar, the programme manager of the Sanskar Sewa Sansthan in Baran district told that each of his poshan champions covers 40-45 anganwadi centres in the district. “These poshan champions work closely with the anganwadi workers, ASHAs [Accredited Social Health Activist], ANMs [Auxiliary Nurse Midwife]. These young men and women are required to physically visit the anganwadi centres regularly and keep a tab on the pregnant women in their allotted areas,” he said. A traditional Odia millet dish Atkel is helping fight infant and maternal mortality in Kalahandi “I knew nothing about the importance of nutrition when I was carrying my son, Akshay, who is not six years old,” Lakshmi Sahariya, a rural resident of Baran district’s Govardhanpur village told . But, her second pregnancy was vastly different due to Poshan Champion Kushwaha, she said. “When my daughter was born, she weighed two-and-a-half kilos. And, someone from the anganwadi, an ASHA [Accredited Social Health Activist] worker, or a poshan champion would visit every fortnight to check on us,” said Lakshmi Sahariya, whose daughter Nandini is now one-and-a-half-years old. All through her second pregnancy, Kushwaha guided Lakshmi Sahariya reminding her to be mindful of her diet, hygiene and regular visits to the anganwadi centre to keep a tab on her overall wellness. The Poshan Champions also help pregnant women and their families to access the Pradhan Mantri Matru Vandana Yojana (PMMVY) — a centrally sponsored DBT [direct beneficiary transfer] scheme with the cash incentive of Rs 5,000 (in three instalments) being provided directly in the bank or post office accounts of pregnant women and lactating mothers. They also help them access the Indira Gandhi Matritva Poshan Yojana for a host of benefits which the scheme offers. “For her first delivery, a woman gets Rs 5,000 in two instalments under the PMMVY scheme. After she has registered and has a Mamta Card made, she is paid Rs 2,000. Once the baby is born, and is inoculated at three months, she gets the balance of Rs 3,000,” explained a spokesperson of the IPE Global RajPusht Baran team. The second time a woman gets pregnant, she is paid Rs 1,000 twice, after her first check-up at 120 days of pregnancy and second check-up at 180 days. If she bears a son, the woman gets Rs 4,000 under the state government’s IGMPY, and if she has a daughter she gets Rs 6,000. “The women in the village are so much better informed due to RajPusht. They were reluctant initially to listen to what we had to tell them and rarely followed what we advised,” Susheel Bai, an anganwadi worker since 2001, told . “Now they are alert and keep tabs on the inoculations, vaccines, nutrition, and their body weight among others,” she added. The Baran RajPusht team said that every year about 20,000 children are born in Baran district. About 80 per cent of them are covered by the PMMVY and the state government’s Indira Gandhi Matritva Poshan Yojana [IGMPY] scheme. Cash transfers to the tune of Rs 18,181,000 have already been given to 9,274 expectant women in Baran district, they added. “The amount is transferred digitally into the accounts of the beneficiaries,” Krishna Singh Gohil, operation manager, Rajpusht, Rajasthan, told . The RajPusht team keeps tabs on how the money is spent. “We ensure the amount is spent on the nourishment of the woman. We visit their homes and find out details from the family. So far, we have not heard of any misuse of those funds,” Gohil added. Lohe ki kadhai and tricolour thaali show the way to a nutritious life in Jharkhand As part of the RajPusht project, even husbands are counselled by the Poshan Champions. Lakshmi Bairva's husband Rajkumar Bairva confessed he had learnt a lot about maternal health through Kushwaha. “I knew nothing about the nutrition of women before we were counselled. But now, I ensure my wife eats a healthy serving of greens and fruits, I share the household chores with her and make sure she has regular blood tests,” the 25-year-old told . Regular videos he gets on his mobile from the RajPusht team on prenatal health also help him take good care of his wife, he told . Ravi Mittal, the planning officer of Women and Child Development Scheme in the Kishanganj block told that prior to the sensitisation drives organised under the RajPusht programme, the young husbands in the block were careless and self-absorbed. “They chewed betel, , and drank heavily. Now, they are not as careless as they were before and take interest in the academics of their children too,” he said. Through the Rajpusht project, the aim is to ensure the occurrence of underweight babies is reduced and the health and nutrition of mothers and the babies is maintained. However, not all is well when it comes to the implementation of the welfare programme. In many cases, the identification documents of the beneficiaries are not in order and it often creates hurdles in transferring the financial assistance to the beneficiaries. The RajPusht team in Baran told that these problems in transferring the money take time to resolve.

Championing the cause of mother and child health in rural Rajasthan

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