By Riya Patel
I strongly believe that the health of women parallels the health of a society. Women’s critical role as life givers allows our society to move forward, but we must ensure that we move forward as a wholesome and healthy society. The health of women during pregnancy is of utmost importance not only for the child but also for the mother herself and her existing family. For this reason, I decided to focus my stretch project on the maternal health awareness in the slum, semi-slum, and middle-class populations of urban Vadodara, Gujarat, India.
I joined the primary Urban Health Center (UHC) in Subhanpura, under Medical Officer, Dr. Namrata Chauhan as an intern on July 18th, 2018. Primary health centers are localized for an approximate population of 50,000 people and provide basic medical care to patients. However, UHCs are also the platform where various health and awareness programs are implemented to increase knowledge/awareness within the community.
I joined my stretch at the beginning of a rigorous Measles-Rubella (MR) vaccination campaign led by the government of Gujarat. The campaign allowed me to visit schools with the Auxiliary-Nurse-Midwives (ANM) and Accredited Social Health Activists (ASHA) workers which gave me the advantage of going into the field and witnessing the structural organization of UHCs.
I knew that doing public health outreach and awareness in the world’s second most populous country would require a great amount of structure within the implementation process. However, I was in awe when I witnessed how the information is passed on from the government to the people and vice versa. ASHA workers are the first point of contact and the backbones of India’s primary health care which do a majority of the field work. They are trusted women from within the community who go house to house, to raise awareness about concerning health problems within the community and help collect demographical data for analysis. Each ASHA worker is responsible for approx. 2000 population. The ASHA workers then report to their ANMs, which are professionally trained nurses who are responsible for four to five ASHA works and overlook the approx. 10,000 population.
The first few days of tagging along with ANMs and ASHA workers to schools to see how the MR campaign is being carried out allowed me to interact and build relationships with the staff. At first, I had to get accustomed to addressing everyone as ma’am/ sir based on their position. I gained confidence in my Gujarati by interacting with the students at the schools which allowed me to communicate with the ANMs more openly and develop a comfort level which would help me when I go with them into the field to learn more about maternal health awareness.
My first exposure to maternal health awareness was on World Population Day (WPD) when UHC held an Anganwadi (Playschool) presentation for women. Angadwadis are playschool buildings located in each community and easily accessible by the women, which are used for awareness presentations and programs. On WPD we had Dr. Prathiba a respected doctor, member of the community, and Reproductive Child Health Officer in the Vadodara Municipal Corporation (VMC) come in to talk about women’s health. The topics covered ranged from family planning methods (contraception) to the waiting period between children and anemia. There have been many instances where I did not know what to say because culturally India is very different from Canada. Girls in India are not introduced to contraception methods in schools or universities as we are in North America and the public programs in place to give information and access to contraception, are only for married women.
Females get married at a young age (early 20s) in India, especially within the slum and slum-like communities, thus they also become mothers earlier on. One program which falls under maternal health is the Family Planning program, where ASHA workers and ANMs educate married women about the health risks and benefits on when it is the proper time to become a first-time mother, what the age gap between two children should be so that it gives time for the mother to heal from her previous pregnancy, etc.
Shadowing Dr. Chauhan while she attended patients allowed me to experience interactive medical care and discuss the topics on maternal health as they came up. One thing I noticed was the vast cultural and scientific differences when it came to certain medical advice for expectant mothers. For example, mothers are told to provide nothing but breastmilk to their babies until the age of six months, after which certain soluble foods can be offered. However, certain cultural practices say otherwise, therefore, the task for doctors and ANMs/ASHA workers become more difficult as they must counter old cultural practices and convince mothers to take up the healthier path.
One main maternal health problem women face in India, and specifically in Gujarat, is iron deficiency anemia. Anemia is one of the most prevalent causes of maternal death in Gujarat. There is a preventative program in place, National Iron Plus Initiative (NIPI), which strives to decrease anemia within the population by giving free iron supplements (as required) to females of all ages, free of cost. The cultural practices of preparing food as well as social and economic factors of accessibility to iron-rich foods provide the greatest hindrance to women’s health.
For the next part of my stretch project, I will be attending World Breastfeeding Week from August 1st to 7th and be focusing on Anemia awareness programs for pregnant women. The UHC will be holding various interactive presentations held at Anganwadis throughout the 7 days to educate women about the benefits of breastfeeding. This will be done to raise awareness about the Infant and Young Child Feeding Practices (IYCF) Program. I am looking forward to participating in the presentations and interacting with women at the presentations to gain insights from their perspective of how UHC programs are benefitting them.
I’m half-way through my stretch and have been grateful to learn so much about government involvement public health programs and implementation of these programs by Medical Officers, ANMs and ASHA workers. As the end of my stretch approaches, I realize that there is so much more to do to decrease the maternal mortality rate in India, however, the small steps and efforts of all the people who work tirelessly to ensure awareness consistently is being spread, need to be applauded and encouraged. I could not have been more grateful for this life-changing experience.