Feeds:
Posts
Comments

Posts Tagged ‘Jamshedpur’

This post is the first in a series on maternal health in the Seraikela block of Jharkhand, India. 

In 2009, Sarah Blake and I worked together at the Maternal Health Task Force, a Gates Foundation funded maternal health initiative based at EngenderHealth in New York City. Since then, Sarah went on to work as a consultant with several non-profit organizations, including UNFPA and Women Deliver.  I took off for India as a Clinton Fellow with the American India Foundation where I have been working for the past nine months on a maternal and newborn health project in Jharkhand, a state with high levels of maternal and newborn deaths.

A new mom holds her newborn in a small community called Sini, in the Seraikela block, as community members look on.

Sarah and I recently teamed up again (this time, in India) to explore our common interest in maternal health. Over the past two weeks, we have visited hospitals, health centers, government offices, rural villages, and homes in the Seraikela block, a rural area with rugged terrain and limited infrastructure outside the industrial city of Jamshedpur, in the state of Jharkhand.  We conducted a series of interviews with women, families, health workers, and government health officials. We asked questions about pregnancy, childbirth and the postpartum period. We learned about the women’s experiences with home and institutional deliveries–and the factors that influence their decision to deliver at home or in an institution. We explored the implementation of and attitudes toward Janani Suraksha Yojana, a conditional cash transfer program that aims to increase institutional deliveries across India.

A collapsed road on the way from Jamshedpur to the Seraikela Block of Jharkhand.

Conditional cash transfers are trendy. Various governments, non-governmental organizations, and private enterprises across the globe are supporting cash transfer initiatives in efforts to improve school attendance, reduce child under-nutrition, improve maternal and newborn health, and to address other development goals.

What is a conditional cash transfer program? According to the World Bank, “conditional cash transfer programs provide cash payments to poor households that meet certain behavioral requirements, generally related to children’s health care and education”.

Janani Suraksha Yojana (JSY) is a widely discussed (mostly within the global health community but to some extent in mainstream media) and frequently praised cash transfer program. JSY was launched by the Indian government as part of the National Rural Health Mission in 2005, in an effort to reduce maternal and newborn deaths by increasing institutional deliveries.

JSY provides cash incentives to women who deliver in government health institutions as well as accredited private health centers. The program also provides a cash incentive to the health worker who supports the woman throughout her pregnancy and accompanies her to the facility. (For details and FAQs on JSY, click here.)

A community health worker accompanies a pregnant woman to Mahatma Gandhi Memorial Hospital in Jamshedpur, the main referral hospital for the surrounding rural communities.

Maternal and newborn death rates have gradually been declining across India (and the world), but the problem has yet to be resolved. Both maternal and newborn deaths in India continue to make up an extremely large percentage of the overall global burden. According to a study published in the Lancet last year, 20% of global maternal deaths and 31% of global newborn deaths in 2005 occurred in India.

JSY is a big program (the biggest of its kind in the world) that aims to deal with a big problem. The lessons that are drawn from it have the potential to influence global health policy in a big way. The 2010 evaluation of JSY published in the Lancet suggested that the program is having a significant impact on perinatal and neonatal health, but the paper asserted that the verdict was still out in terms of any impact on maternal mortality.

The lesson that has emerged from JSY for newborn health is that giving women money increases institutional deliveries and reduces perinatal and neonatal mortality.  It is likely that the same message will emerge in terms of reducing maternal mortality—and there is a good chance that this approach will be picked up in national health programs in numerous other countries that also have high levels of maternal and newborn mortality.

Our concern is that JSY is far more complex than providing women with money—and reducing maternal mortality is far more complex than increasing institutional delivery.

Given the scope, cost, and potential of JSY; it is incredibly important that we ask questions about the nuances of JSY—the role of money as an incentive for women, families and health workers; the readiness of institutions;  the challenges with transportation; the human rights implications of the program; and a variety of other related factors.

Over the next week (or couple of weeks), Sarah and I will share our experiences and insights from our time with the women, families, health workers, and government health officials of the Seraikela block of Jharkhand, a focus state for JSY. We will highlight stories from the people most impacted by and involved in Janani Suraksha Yojana.

We believe that we have scratched the surface of some interesting issues related to JSY, but our time in Seraikela certainly left us with more questions than answers, and we will be sharing those questions in upcoming posts.

We will also be asking our colleagues working in maternal and newborn health to share their thoughts through guest blog posts. If you are interested in submitting a guest post, contact us at katemitch@gmail.com and sarahcblake@gmail.com.

Tata Steel Rural Development Society, my host organization for my fellowship, provided us with transportation and interpreter services. Many thanks to Shabnam Khaled for her help with translation. 

Advertisements

Read Full Post »

On Monday, I traveled with my colleague, Anupam Sarkar, a nutrition and newborn health expert and Project Advisor for the Maternal and Newborn Survival Initiative (MANSI), to Hudu, a small, hard-to-reach village amidst forest, steel plants, and roaming wild elephants. It took us nearly 2 hours from Jamshedpur, weaving around and cutting through steel plants and villages along bumpy and muddy roads–the same roads that pregnant women must travel on if they opt for institutional delivery. We were heading to Hudu to observe a Seraikela Chhau peformance.

Seraikela Chhau is a traditional form of dance that originates in the Seraikela block of Jharkhand, part of the eastern steel belt of India. Over the past six months, I have been working as a Clinton Fellow with the Maternal and Newborn Survival Initiative in the Seraikela block. MANSI is a partnership between the American India Foundation, Tata Steel Rural Development Society, and the local government—with technical support from SEARCH. As part of our project activities, our team has recently coordinated a series of Seraikela Chhau performances that will combine the native dance form with key maternal and newborn health messages throughout the 174 villages of our project area.

When Anupam and I arrived in Hudu, we learned that a pair of twins had recently passed away in the village and we decided to visit the family before the performance began. We are conducting similar home visits for every maternal and newborn death that has been reported in our project area (spanning 174 villages) since the baseline survey was completed in 2009. The goal of the home visits is to gain a better understanding of the ground realities and knowledge gaps so that we can shape and inform the messages of the MANSI health communication campaigns in a way that meets the needs of the communities.

The local health worker guided us to the home where the twins had passed away. The parents were not at home–but we were able to meet with the paternal grandparents, Asha and Ganesh Sardar.

 

They shared their story…

The mother of the twins, Vilasi, is 28 years old. She and her husband, Ragdu, already had four children, all girls, and the family was  eager to have a boy. Soon they became pregnant with twins, one girl and one boy. All four of the previous children were delivered at home without complication–and the family assumed that this delivery would also be free of complications. They explained that they were unaware of the benefits of institutional delivery. When the twins were born, they seemed very small. Immediately following delivery, the mother put the babies to her breasts to feed them. They were weak and unable to suckle. Initially the family thought about giving them goat’s milk–but eventually decided to give sugar water (locally called Misri Pani). When it became clear that the babies were extremely weak and in critical condition, the family wanted to take the infants to the hospital but they had not anticipated the emergency. They were not prepared. They did not have a transportation plan or money set aside. One baby died the very same day–and the other died the following day.

We thanked the grandparents for sharing their story and asked them if it would be OK if we also shared their story with other communities. The grandparents agreed and the grandfather said, “After losing the twins, I have come to know about the importance of institutional delivery. Why not share our story and let others also come to know?”

It is tough to know precisely what led to the death of the twins—and if giving birth in a facility would have made a difference. But it is clear that many factors were stacked against them. The family was faced with poor roads, long distances to health centers, limited resources, combined with a lack of information at the community level about birth spacing and planning, care of low birth weight babies, danger signs, institutional delivery, and information on how to tap into government schemes that offer cash incentives for institutional delivery—all potential topics for future Chhau performances.

With the story of the twins on our minds, we returned to the center of the village to observe the performance.

With no electricity in the village, the performers rigged their loud speaker system to their vehicle battery. They began beating their drums and singing loudly, calling on community members to gather in the village center.

It did not take long for community members to gather, all curious to know what the commotion was about. They formed a crowd of boys and girls, and men and women of all ages. Soon the drumming and singing picked up pace, a performer dressed in a traditional colorful costume with a big mask jumped out from behind the vehicle, and the show began!

The performers acted out various situations, using dance and drama to cover several critical maternal and newborn health topics—with a focus on the importance of institutional delivery, birth planning/preparedness, and the five cleans of safe delivery. The audience watched with great enthusiasm.

As we traveled the bumpy roads away from Hudu, a jagged rock punctured our tire–delaying our return to Jamshedpur and reminding me of the numerous barriers that women face in accessing care. While we waited for the tire to get repaired, I thought of the twins and the grandparents who we interviewed. I also thought of the Chhau dance and all of the community members in attendance. That day, I witnessed the consequences of the various factors that were stacked against the twins. I also witnessed one strategy for building community awareness of critical maternal and newborn health information. I left feeling confident that the Chhau performance that we observed will help to equip the community of Hudu with key information about maternal and newborn health—and will serve as one of many important steps toward the overall goal of protecting the health of women and infants in the Seraikela block.

Read Full Post »