Mayurbhanj (Women's Feature Service) – When Mani Hansda, 23, had her first child in 2000 she was just 15. As a result of a difficult childbirth, Hansda found it difficult to breast feed the infant. So, she switched to the powdered top feed, Lactogen. Unfortunately, the cost of powdered milk compelled her to water down each bottle-feed. Under nourished and weak, baby Rajali suffered severe bouts of diarrhoea and barely survived. She suffered like this till she was a year old and was put on solids such as rice.
Fortunately, the practice of not giving solid food to babies till after they turn one, feeding them only breast milk or tinned powder milk and undermining their chances of survival is now a thing of the past in the 90-odd tribal households in Ditikadeipur village of Mayurbhanj district in Orissa.
Kuni Murmu's fourth child, Luca, was only 1.4 kilograms at birth, more than a kilogram below the norm. No one in the family thought that the little girl would survive. But she has, in fact, moved up from Grade IV malnutrition level to Grade I in just 10 months. Moreover, Bishnupriya Jena, the anganwadi worker (AWW), or a village level childcare worker, has assured Kuni, 25, that her daughter would be out of the woods by her first birthday.
Prior to 2004, Luca's case would have astonished many. But that's not the case anymore, thanks to the Positive Deviance Approach (PDA). Starting with three, today there are 74 anganwadi centres (AWCs), or village-level government childcare centres, across the tribal-dominated Udala bock, where the average annual household incomes are as low as Rs 6,000. Statewide, there are 6,200 AWCs, who implement this programme.
The PDA, a concept introduced in the 1970s by social scientists Joe Wray and Peter Greaves, refers to children who possess normal growth and development despite being brought up in deprived families. The PDA used in Orissa is based on a simple but important premise: a community will learn from the positive behaviour of mothers - of the community and similar income groups - who have managed to rear healthy children by using resources available to them from within the community.
The state government uses the PDA as a cornerstone strategy for improving early childcare practices, which in turn contributes to improving the nutritional status of children. This is achieved through a campaign 'Ame Bi Paribu' or 'We Too Can' as part of the Integrated Child Development Services (ICDS), the flagship programme of the Government of India's Women and Child Development Ministry, partnered by UNICEF.
The contribution of 'We Too Can' is already reflecting in the National Family Health Survey III (NFHS III - 2005-06) in which the number of under weight children under three years in Orissa has come down by a substantial 10 per cent to 44 per cent from 54.4 per cent in NFHS II (1998-99). In the same period, the all-India figures have only marginally improved from 47 per cent to 46 per cent.
Posted as paediatrician at the Kaptipada Sub-divisional Hospital, Udala, for the last seven years, Dr Laxmikant Pati substantiates this improvement at the grassroots. He has seen referral cases of malnutrition (Grade III and IV) among zero to three-years-olds come down from seven to eight per month in 2001 to just one or two in 2008. "The behavioural change due to PDA has been remarkable here," he states.
Harapriya Patra has been working as a Child Development Project Officer, a key executive field functionary of the ICDS, for 15 years. He has also observed a "sea-change in the behaviour of mothers after the implementation of PDA. The change can be seen in their informed handling of children when they become sick. Awareness about cleanliness, safe and sufficient drinking water, too, has improved. Child diarrhoea is today no longer as much of a concern as it was just a few years back. A psychological change has come about... Now they do not have a defeatist attitude; 'We Too Can' is no longer a slogan, it part of the attitude of people here."
Sita Tudu's story clearly exemplifies this change that Patra has talked of. Five kilometres from Nuagaon, at Dutikadei AWC, Sita's daughter Basanti - conceived after 10 years of marriage - was born a mere 1.5 kilograms. Both husband and wife earn a subsistence income as daily wage farm labourers. When Sita, 32, refused to go to work so that she could breast feed her baby, her husband, Naika, often quarrelled with her. But she remained adamant. Sita was determined to ensure that the frail infant survived. And thanks to AWWs she knew how she could do that. After Basanti completed six months, the mother brought her at the local AWC regularly for a rice-lentil gruel and also kept a check on her weight. Today, at age three, Basanti has improved her chances of survival to Grade I.
Mothers like Sita traverse almost a kilometre at least 12 days in a month to bring their babies to the PDA centre, which functions out of the AWC. There are some like Rajali Baske, 23, from Salakhunta village, who even cross the local Sono river to reach the Khaladi AWC with her one-year-old. "A far cry from the pre-PDA days when we had to go door-to-door urging mothers to bring their babies to the centre," recalls Urmila Behera, who is in her mid-30s and the supervisor of 25 AWCs in Khadipada area of Udala block. Fussy children eat better when they are with children of their own age group. "The first batch of PDA kids are doing better in school, too," informs Subhasini Behera, 36, AWW of Dutikadei village.
Another change that has come about is that women are no longer having many children. With infants getting healthier and their chances of survival brighter, parents are now opting for smaller families. "We want two children, so that we can take care of them and send them to school," says Sita Baske, 26, of Khaladi village.
But are the communities really taking charge of their nutritional needs? Surprisingly well, in fact. Mothers are ensuring nutritional balance in every mid-day meal at the AWCs, through the 'akhsay patra' or 'the vegetable basket that is never empty'. The basket is an important fixture at the AWC into which every mother contributes some vegetable - be it a home grown papaya, a slice of gourd, a bunch of beans, leafy greens or even a single potato. All this goes into the rice-and-lentil gruel that is dished out 12 days a month to babies between six months to one year as well as those who are in malnourished grades of I to IV. This has meant that kitchen gardens get more attention. So does cleanliness - using soap is in, cleaning hands with kitchen ash is out. Mothers also contribute as little as 50 paise or a rupee every month to the community health fund, which is used for contingencies like grinding the government supplied ingredients for the Take Home Ration - wheat, lentil and groundnut - a nutritious ready mix for the target group children, to be fed at home the rest of the 18 days of the month.
Today, older persons in the family are converts too, claims Sumitra Rout, Khaladi AWW. "They no longer insist on harmful traditional practices like giving honey and water (often polluted) to a new-born or bathing them immediately after birth, which can result in pneumonia. In fact, they urge their pregnant daughters-in-law to not only eat well but munch on some puffed rice in-between meals - a far cry from customary restrictions on food, lest the child grow too big and make delivery difficult." Big changes it seems are now afoot in remote corners as PDA spreads.
(Courtesy: Women's Feature Service)