During the year 2013-14, the Govt. of Andhra Pradesh has significantly focused on vulnerable groups of women and children as the MMR/IMR found to be highest (see table below) in the district in comparison to state average. They further noted in their consultative meetings it is due to lack of facilities, access and awareness amongst the communities in spite of NRHM District Action Plans prepared. Absence of reliable data including primary health services for various complications such as identification and treatment of neonatal sepsis, pneumonia and hypothermia. High risk of maternal mortality is due to haemorrhage, pregnancy with anaemia, puerperal sepsis, obstructed labour and lack of ANC check-ups, lack of skilled attendance at birth, percentage of institutional delivery is less, percentage of ante natal care & post-natal care is below average and high percentage of girls married at age below 18 years.Inadequate Spacing is a significant factor and the reasons being unmet need for spacing method is high, inadequate birth intervals, adolescent pregnancy rate being high and birth order of 3 and above is maximum.Poor awareness and poor personnel hygiene practices contributes in ill health of women and particularly of the children. The recent SDG goal 3 & 5 emphasises to achieve the good health and wellbeing complementing the gender equality should be a priority and the goals must be achieved by 2030. YFA committed to the cause and initiated the need based health and nutritional interventions and particularly, supporting high risk mothers and children addressing various health ailments communicable diseases, HIV infections and particularly, stressing on the requirements of preventing and reducing maternal and child deaths. Large number of interventions have been made but few of those experiences in a form of case studies have been projected below:
Mobile based audio conference saved my life – the story of Jayalaxmi:
My name is Jayalaxmi and I am about 22 years old. I live in Thomalapally village and my husband Shiva a farmer. We cultivate crops and many of times earn our livelihoods through agriculture labour. I am an active member of our sangha called RenukhaSujalaArogyaSamithi.
My first pregnancy has unfortunately started with complications. My feet used to get swelling and I also used to feel giddiness during my work. I have approached the ANM and the doctors in Private Hospitals but I could not get any relief. Thereafter, I lost my health and my family felt that I may not be able to live for a long. My husband took me to medical college in Mahabubnagar and spend about Rs.25000. At these circumstances I got pregnant and it was a failure as my health was not good. However, after few months due to negligence I got the second pregnancy and once again the same problems have cropped up which resulted in misunderstanding in the family and my husband always used to quarrel with me. The ArgoyaKaryaKartha of my village (Chennamma) has counselled my husband and also members of my family. Few times ArogyaKaryaKartha was accompanied by Asha worker and also ANM. In my village there was audio conferences regularly organized by our sangha. Earlier I did not go to attend audio conference as I was approaching the private hospitals but, after having discussions with our KaryaKartha I participated in the conference and discussed with Dr.Prabhakar Rao about by problems. My discussions with Dr.Prabhakar Rao contributed in implementation of his suggestions resulted in good health. First, he counselled me and increased my confidence that nothing will happen to my life. And thereafter, he suggested me to put pillows under my feet whenever I go to sleep. Further he advised me to eat one pomegranate fruit and requested Karyakartha to give me every day IFA tablets. He further requested me that I should be always positive and lead a happy and peaceful life. During all these months of pregnancy I felt healthy and always happy. AKK has finally taken me to the local Government Hospital and I got successful delivery without investing any money. My child is about 3 kgs weight and very healthy. The audio conference and the YFA team led by Dr.Prabhakar Rao and AKK gifted me a healthy child and also saved my life.
VijayaLaxmi, 35-year-old, wife of Srinivasulufrom Savaigudem, Wanaparthy Mandal. VijayaLaxmi studied upto8th class and has been working as ArogyaKaryaKartha for more than 3 years. In her village she was a member of SriramaArogyaMahilaSangham of self-help group of 15 members. She narrates her training experience and support to her community members. She says the refresher trainings given to her during the year were very useful. They were taught on hygiene, minor ailments, few medicines, women’s health problems, pregnant mothers, deliveries, nutrition etc. They were sent to Wanaparthy hospital for 2 days and saw how to conduct deliveries. One obstetrician (as per VijayaLaxmi’s version) Dr. Uma taught how to observe the delivery process, how to monitor contractions (every ½ hour and every 5 minutes) checking foetal heart sounds supporting the perineum, cutting the cord, how to observe for s/s placenta, detachment and delivery of placenta, giving fluids. She recalled all the points and told that the madam (Dr. Uma) had explained very nicely and cannot forget what she learnt. Her performance as AKK in the village: She is able to assist the ANM and coordinate the work. She identifies the pregnant women below three months, brings to ANC clinic. ANM registers her name, ANC check-up is done. Both AKK and ANM give health education to the pregnant women, they promote every women to take IFA tablets. She advises the pregnant women to take TT injection at 7th and 9th month. She says that she could use few English terminologies like anemia, diarrhea and can also confidently suggests the primary medicine.When YFA team member questioned her that what medicine she would prescribed to the patient for severe body pains ?she suggested for usingBrufen; for motions use Fenoxone; Metrogyl for arresting white discharge; Coldact for mild colds and Avil for cold and Allergy. She further says she was a very timid and introvert persons but now she is able to take others to the doctors. She is also confident in using thermometer and is confident in interacting with doctors and ANM. Many of times she assists local Daya (traditional mid-wife) to conduct safe deliveries and today she is one of the best karyakarthas of our YFA collaboration. The other AKKs gets inspired by her as they still require time and training. VijayaLaxmi says that now she can train the new Karyakarthas and assume the role of health mentor.
Training enhanced my skills and my dedication – the story of VijayaLaxmi of Vallabapurchina thanda
I belong to a tribal family and continued my studies upto 10th standard. Thereafter, my studies have been stopped but I had a conviction to improve my education and also contribute to my communities. I have been attending sangha meetings as a regular member and opted for getting training as ArogyaKaryakartha so that I can serve women and children as the health services are still not accessible to women and children due to gender discrimination in the society. I have been given extensive training and thereafter, I started functioning. During the training I have learned about the interventions of the Government but found their services were highly irregular. I have seen how one of my friend Jyothi W/o Gopal could not get enough nutrition to deliver a child and result to that she had to experience the natural abortion. Jyothi was mentally suffered and her husband and in-laws did not support and also could not understand the reason behind the abortion. I had to counsel Jyothi and her family and result to that Jyothi was once again got pregnant. This time her husband realized that the malnutrition of his wife contributed in first abortion and hence, he started providing greens, eggs and other supplementary food. The sangha ensured regular check-ups and filling up of ANC card. In one of the meetings the issue of “malnutrition” and the case of Jyothi was discussed by the sangha members. All of us concluded that there are schemes such as Janani Suraksha and supplementary food through ICDS. On behalf of sangha I took the responsibility of writing a petition to child development project officer (CDPO) for non-functioning of and implementation of ICDS scheme which is totally funded by Government of India. CDPO immediately responded to the request and sent a team to undertake a survey of our Thanda and promised for the food supply. I am proud to say that the Anganwadi started functioning since last 3 months and for our information we took a blood and hemoglobin test on several women including Jyothi and we once again took the test now on her and found that within 3 months her hemoglobin level raised from 8.2 three months ago to 10.9 today. The increase in the hemoglobin level contributed in good health of Jyothi and today I am happy to inform that Jyothi has become a proud mother. I have supervised and assisted for safe delivery at home and everyone in the Thanda respects me. Such good functional education has increased my dignity as ArogyaKaryaKartha.
Assisting the most vulnerable through Grain Bank – pioneering work by Ambedkar women farmers sangha of Mungamanedinne:
Mungamanedinne village is one of the flood affected and also the village was submerged during the floods of 2010-11. Thereafter, the village also experienced droughts. During the meetings the people of the sangha particularly women of Ambedkar women farmer sangha was searching for solutions during such disasters. Nagamani a women farmer of the sangha shared her experience during the floods of 2010-11 that how the people especially the children had to suffer on account of malnutrition and starvation as the village was totally cut off from the highways and the relief could not reached to village. In those circumstances many people and particularly the pregnant women had to face the serious threats of malnutrition. She further explained that how about 40% of the able bodied migrated during the drought and the elders and children had to suffer due to food shortage. Since then they were searching for solutions to get enough food during such situation and one of the ideas put forward by the communities to initiate grain saving strategy. Accordingly, the communities requested YFA to help them with storage support structures so that they can conserve and save the food during the harvest season and later use for providing food assistance to needy. Chennamma a landless dalit women says that she does not have any asset and work as agriculture labour. One of these days during the drought period I have become unhealthy and suffered with regular fever and backache. I was not able to move and my children were suffering. Looking at my situation the other sangha members from Ambedkar society came forward and discussed with me about my present socio-economic condition. Based on her situation, the committee members decided to provide about 40 kgs of grains including rice and Perl millets. The food provided was sufficient for 2 children and herself for about 20 crucial days in the drought period. Today Chennamma is recovered from her ill-health and salutes Ambedkar women farmer’s sangha and YFA for their timely support and intervention of a good idea in a form of grain Bank.
Revival of Traditional Crops:
The revival of crops namely Ragi, Sorghum, Pulses and Vegetables have proved to be assuring positive impact on women’s health and nutritional security. Such strategy was also found useful in reducing high input cost of crops and also conserved precious water. The strategy could able to generate positive impacts in terms of increasing productivity and thus assured food security and further prevention of malnutrition and anaemia amongst the target group members. Now the challenge before YFA is to replicate the actions within and neighbouring villages mobilising support from the government and banks where in YFA will be playing a catalytic role of facilitator.
Varalaxmi is an active member of Mallaipally village of Pangal Mandal. She eaks out her living by attending daily agriculture labour work and many of times she would never get labour work. Her family had 1.8 acres of land and mostly they used to grow groundnut and partial rice crop. “Many of times the available agriculture work was not sufficient and payment for my labour work was not on time”-says Varalaxmi. There used to be unpleasant quarrel with my husband for fulfilling the needs of the large family. I used to attend the sangha meetings regularly to get new ideas and information. In one of the meetings Mr.Pawar and Mr.Chandraiah of YFA informed us in comparison to regular traditional crop it is better to go for vegetable crop as it would consume less water and generate income and fulfil nutritional needs of the family. The YFA staff has also given information on the existing schemes of nutritional food availability from the Anganwadi centres and also Bankable schemes for crop inputs. My self and few women approached the bank at Pangal for mobilisation of crop loans but the schemes are not being implemented as the government has not released subsidies for the scheme. Even though, they got demoralised but Varalaxmi decided to approach YFA through sangha for the support. YFA readily agreed to conduct on informal technical training and also provided the needed assistance of Rs.3000 for purchase of inputs for vegetable cultivation. Varalaxmi says that the transplantation of Tomatos, Ladies finger, Brinjal and Spinache started providing returns within 35 days. The first crop of spinache used for household consumption as well as sale in the market. Sometimes I go to Pangal and Pebbair for sale of vegetable. On an average I started getting about Rs.100 per day and now the food security situation of my home is better. Quarrels with my husband has come down and my children and myself felt hale and healthy. I sincerely thank YFA for the encouragement.