The women come one by one. Some bring blankets and some little brown sacks to sit on. They spread the blankets and the sacks neatly in front of the house. One of them starts counting the heads and figuring out who is not yet there. After a few more minutes of chattering in groups, loudly calling for the ones who have not yet arrived, and asking the younger ones to settle down, the meeting starts. Today's meeting is about children's nutrition. A role play generates a lively discussion about the nutritional value of fruit and vegetables in the village and the community vegetable patch.
I am witnessing a monthly meeting by the Chandrajarkie village women's group, which is organised and monitored by the village women. I'm here because I want to understand how the group has achieved a public health and social breakthrough: a massive reduction in neonatal mortality, and a huge step forward in the self-confidence of women.
Chandrajarkie Village in Jharkhand, one of India's poorest states, is over 100km from Ranchi, the state capital. The hills and forests of Jharkhand, whilst beautiful, exacerbate the difficulties of ensuring essential services reach these remote areas. The poverty is stark. Illiteracy is high in Jharkhand even in comparison to neighbouring states. The social, economic and cultural dynamics of India - where caste, class and patriarchy are fused with raw poverty and geographical isolation - have kept poor, rural women down for far too long.
But in a place where the national and state government have failed, these women's groups have risen to the challenge, with only minor help from experts who were involved at the drafting stage of mother and new born manuals, and in the monitoring and evaluation of the process. Women's groups provide social, emotional and occasional financial support to see that women are looked after during and after pregnancy, and share information about how to care for infants. As a result, they have helped cut down neonatal mortality in their communities by 45%. This reduction, detailed in the Lancet (Tripathy et al.,"Effect of Participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trail", Lancet 2010), is in comparison with women who did not participate in the groups, even though their access to healthcare services was the same.
The effect on women's mental health was also impressive, with a 57% reduction in the moderate maternal depression among women who attended the groups. Substantial improvements in home care practices were also demonstrated - mothers were more likely to have birth attendants wash their hands, use a safe delivery kit and a plastic sheet, boil the threat used to tie the cord and then cut it cleanly. The proportion of mothers practicing exclusive breastfeeding was also higher among women who had participated in the trail. There may have also been some contribution to a reduction in maternal deaths, which were markedly lower among women who had participated in the women's groups.
Archana Kumari from Kumharriding village is a shining example for these exemplary women's group's achievements. Archana is 17-year-old and expecting her second baby in a month's time. Archana was married when she was 13-years-old and gave birth to her first born at the age of 14 at home. She didn't know then about the health facilities or schemes she could access. Now, as a member of the local Women's group, she has learnt from the other women about taking iron tablets, tetanus injections, sanitation, nutrition, preparations for delivery, and why an institutional delivery is safer. She is more confident now too. This time, Archana will deliver her baby in a hospital. She has contact details of a delivery van to book for a ride to the hospital.
But she is much more than a beneficiary. The role and the ability of young women in South Asian cultures have been hugely underestimated, and it is about time we take a good look at how they are changing not only their own lives but also other around them. Like the other women in her group, Archana is a leader. By letting every pregnant woman in her village know her story, she is empowering them with knowledge and inspiring them to re-imagine what is possible. Through the group and through her example she is saving and changing lives. I feel like I've seen the future, and she is called Archana.
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