A Silent Movement That Lead to Zero Maternal Deaths in a Rural Indian Town

In 2015, Karnataka topped South India in Maternal Mortality Rate. The state registered 133 maternal deaths per lakh, which is more than double of its neighbouring state Kerala, which recorded 61 maternal deaths per lakh. The highest number of maternal death cases are recorded from North Karnataka districts.

These high rates have been a result of lack of awareness, reluctance to seek medical help on time, anaemia and uneven eating habits.

In 2012, Save a Mother, a non-profit organisation with a mission to improve maternal and infant health in rural districts along with Hubli based Deshpande Foundation entered North Karnataka and started their work in 167 villages of its three districts including Gadag, Sherahatti, and Mundargi.

Since their inception in the region, the situation has improved drastically. In 2013, the MMR was 141/lakh while IMR stood at 15.47/1000. As per SAM’s latest reports, the region did not record any maternal death in 2017 and IMR came down to 4/1000 after five years of SAM’s intervention.

By addressing one mother at a time, SAM has managed to bring maternal deaths to zero in 2017 in the region.

Not just a health advice- Hemavati’s troubled memories

Hemavati, a 21-year-old lady from Lakundi village of Gadag district was emotionally distressed and two months pregnant when she got in touch with Save a Mother. She ran away from her husband’s house during pregnancy because of the torture she was undergoing there. Her alcoholic husband and in-laws demanded dowry from her and when she refused to do so, they emotionally and physically assaulted her.

“My mother-in-law would mix some stuff in my food while I was pregnant. This led to food poisoning and my severe ill health. I decided to come back to my parents’ house here,” Hemavati said.

Her husband broke all ties with her and never came back to visit her. Emotionally unstable Hemavati ignored her health. She did not eat properly, weighed just 39 kgs and was under depression. Her parents advised her to never go back to her husband’s house and get the child aborted.

Save a Mother entered just in time and gave her and her family extensive mental counseling. Renuka, SAM’s field facilitator from Gadag, played a crucial role in being a friend in need and helped her come out of depression after several weeks and months of conversations.

Gradually, Hemavati started having a timely meal, went for routine medical check-ups and became more stable emotionally.

Four months ago, she delivered a healthy baby boy of 2.75 kgs. Her husband came one time after the delivery to take the baby boy away from her but she refused.

“I want to raise him myself. I think after a few months I can take up a small job,” said Hemavati, who has cleared her 2nd PUC exams.

But somewhere deep down she still wants to be with her husband, in spite of all the wrong she has done to her. “I do want to go back to him. I still love him. But I will go back only when he mends his ways and accepts me for who I am,” she said.

Helping critical cases- Bismilla’s breakdown after a lost child

Bismilla B Dauked, a 34-year-old lady from Narsapur village of Gadag got pregnant with her third child in 2011. In the seventh month of her pregnancy, she realised that there is no movement in her body by the baby. She consulted a doctor who told her that the baby had died in the womb. As soon as she heard the news, she suffered a severe emotional shock. This caused her a neurological problem and she became mentally unstable.

Still not fully recovered from that shock, Bismilla somehow tries to express her emotions.

“We were so shocked that we did not even ask the doctor about the cause behind the death of our unborn child. I don’t know what went wrong,” she said.

Seven years after that incident, Bismilla conceived again. This was an unplanned pregnancy. The family was scared and wanted to get the child aborted. SAM again stepped in and counseled them. The field facilitator explained to them the complications of getting an abortion done in the fourth month of pregnancy. Bismilla was further helped to get the right kind of treatment and nutrition. Since she was mentally unstable, her husband was also counseled to take proper care of her.

“SAM asked us to include fruits, groundnut, green vegetables in the meal. We were also given a schedule to take timely medication and go for routine checkups,” Babulal, Bismilla’s husband said.

In November 2017, Bismilla gave birth to a healthy baby boy, Arhaan. He now gets a regular vaccination and Bismilla can’t stop smiling because of the new addition to her family.

The much needed timely intervention- Omkareshwari’s multiple miscarriages

Omkareshwari, a 23-year-old lady from Lakundi village was seven months pregnant in 2015 when one day during a regular checkup she found out that her baby was underdeveloped. The baby’s body parts except his head were not developing. Omkareshwari and her husband decided to abort the baby with a heavy heart.

In 2016, one year after the incident, Omkareshwari conceived again. In the fourth month of the pregnancy, she visited a temple. The long drive in a taxi led to many bumps on the way and affected her health. After coming back from the temple, she did not take rest and started doing other household chores and heavy lifting. She noticed a sudden bleeding and her family rushed her to the hospital. The doctor announced that she had lost her baby due to excess activity during a crucial period.

In 2017, Omkareshwari again got pregnant. This time the couple wanted to make sure everything was right. SAM’s field facilitator identified Omkareshwari and started guiding her throughout her delivery.

Renuka advised her to drink lots of water and go for the monthly checkups. Because of her previous experience, Omkareshwari was very scared. She would sit the entire day and would take excess rest. This caused her excess pain and sickness. SAM advised her to do proper exercises and go for regular walks.

A clueless Omkareshwari was now getting regular health advice. She now knew where to go and whom to ask for the right medical help.

“I used to feel a lot of weakness and this is why I would rest the entire day. I had low BP which caused fatigue. SAM guided me with the right kind of food intake. I also started to walk a bit during my pregnancy. This made me feel relaxed. They told me to not use stairs much. I was earlier not having enough water, now I drink about five litres of water every day,” recalled Omkareshwari.

She delivered a healthy baby girl of about three kgs in February 2018.

Handling medical requirements- Laxmi’s high-risk pregnancy

Laxmi Hatti, a 26-year-old woman from Lakundi village was six months pregnant when she lost her unborn baby. The baby got stuck in the umbilical cord and died before birth. Just three months after the incident, Laxmi got pregnant again, which made her a high-risk case.

“We did not plan this pregnancy. When I found out about my pregnancy, I was already four months pregnant. We thought to abort it initially. But SAM’s field facilitator adviced us against it,” said Laxmi.

Laxmi was weak and anemic. She frequently fell sick, was going through iron and blood deficiency and was unprepared for yet another delivery. Her second child caught white jaundice after birth and this was another reason she was skeptical about having another child. She was too scared to take care of both her and her baby’s health.

SAM intervened as soon as they found out about her status. They helped her plan a nutritious meal. They explained her the side effects of getting the abortion since she recently underwent an unsuccessful delivery.

Laxmi is nine months pregnant now. The baby in the womb looks healthy and already weighs 2.8 kgs. Laxmi’s health has also improved gradually and she is excited to welcome her latest and also as she calls it the last addition to her family.

How they do it?

SAM starts with identifying pregnant women with help of their field facilitators. These field facilitators are all women and speak the local language. They are further trained in reproductive health, sanitation, and innovative behavioural change communication modules on health literacy.

Aanganwadi teachers and local health clinics are roped in to reach out to the pregnant women. Field facilitators then organise weekly sessions in the village on preventive healthcare and general eating habits. Women are encouraged to go for regular checkups and take timely medication.

Each field facilitator keeps track of pregnant women through proper documentation and timely visits. High-risk cases of women with the haemoglobin level of less than one and weight below 40 are given extra assistance.

Once a healthy baby is delivered, post-delivery visits are organised to help women understand their body and child requirements better,

“We tell them to eat a meal, which covers four colours; red (apple., meat, etc.), yellow (banana, cereals), white (milk products) and green (vegetables). We also tell them to wash their hands regularly before they nurse their baby,” shared Renuka.

DF plays a crucial role in the process by providing funding and technical help. With help of DF, the field facilitators started using tablets to digitally document the data of the women they are working with. The GPS tracking system has also helped to better understand where the field facilitators are currently.

“The entire North Karnataka belt of our work is supported by DF. They have also helped us to partner with other like-minded organisations to scale our work,” said Prashant Uppar, Programme Head, Gadag.

“What we plan to do in future with help of DF is to drop a few villages where already good government health facilities are available and adopt villages, which do not have any facilities,” Uppar further added.

Sensitizing the family members

In cases where a behavioural change is required in a family’s attitude, many counseling sessions and door to door conversations are organised.

In Devakka’s case, her mother in law, Mallavva, played a crucial role in helping her deliver a healthy baby. After a few counseling sessions with SAM, Mallavva learned about the importance of professional medical help. She also personally took care of Devakka’s eating habits since she weighed just 36 Kgs during the beginning of her pregnancy.

Mallavva’s constant care helped in increasing Devakka’s Haemoglobin level from 8 to 9.6. Her weight also reached 40 kgs in a few months.

The Challenge and road ahead

In spite of many success stories, a challenge which SAM still faces is to break into the ecosystem of villages initially. Women are reluctant to share a sensitive topic like this to a third person. Also, unless they see a tangible benefit, they do not show much interest in counseling and prefer doing household chores and farm work over SAM sessions and workshops.

“Another challenge is to reach the remote locations. Often we have to walk a few kilometres to reach a village. And when we reach there, many times the women are not available. So it wastes the entire process. We take help of government ambulances sometimes to reach these villages,” said Renuka.

An extremely useful resource to SAM, Renuka has personally experienced the overall positive change in the maternal health in the region. She is not just a field facilitator but a friend and confidant for these rural women who have nowhere to go to get their doubts cleared.

The organisation wants to expand to more areas and is looking for volunteers to join their enthusiastic team. SAM, however, has a set model but it works differently with every new case.

Check out their website to know more about them.

Photos: Shreya Pareek

This story is a result of a month-long on the ground effort in documenting stories from North Karnataka, which has been made possible by Deshpande Foundation, a Hubli based organisation that aims to create a nurturing environment for grassroots innovations and social entrepreneurship.

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