How poshan sakhis are transforming reproductive health in Odisha

Women trained as poshan sakhis, or nutrition friends, advise and help rural women, particularly expectant and lactating mothers, on nutrition to overcome anemia and underweight deliveries.

Swapnarani (21), an expectant mother, finishes her household work quickly to attend the monthly maitri baithak at her village, Bhutanagar in Badakeranga panchayat of Odisha’s Koraput district. Maitri baithak, or friendship meeting, provides space for women to discuss issues that concern them. The discussions range from their personal health, children’s health, food and nutrition, to sensitive matters such as menstrual hygiene and sanitation.

Diagnosed as undernourished by the accredited social health activist (ASHA), Swapnarani hopes that the poshan sakhi (nutrition friend) at the maitri baithak will guide her on health and nutrition so that she would deliver a healthy child.

Here, trained nutrition advocates educate young women and adolescent girls, and guide them about intake of nutritious food to ensure their health and the health of the future generation.

Health activists’ support

Swapnarani got married as an adolescent. Ignorant about contraceptives, when she conceived and then suffered a miscarriage, the doctor explained that her womb was not yet ready to bear a child.

As a result of her miscarriage, added to the burden of household work and lack of care to nurture her back to health, she lost weight and became anemic. When she conceived two years later, the ASHA advised her to watch her food, nutrition and health, lest she delivered a low birthweight child.

“When ASHA told me I was anemic, I was upset,” Swapnarani told VillageSquare.in. “But, she told me to attend maitri baithak and get advice on improving nutrition by eating locally available vegetables and fruits during pregnancy, so that I could deliver a healthy child.”

“When Swapnarani came to attend maitri baithak, her mid-upper arm circumference (MUAC), a mandatory measurement for pregnant women, was under 23cm,” Rukmini Khora, poshan sakhi of Bhutanagar told VillageSquare.in. “We advised her on food and nutrient intake and she has improved.”

Nutritional deficiency

Findings of the new Global Nutrition Report 2017 place India at the bottom of the table. As per the report, India has the maximum number of anemic women in the world. According to the data, 51 percent of all women of reproductive age in India have anemia.

Lack of awareness, illiteracy and the practice of giving importance to family before self are factors that often deter women from ensuring proper nutrition for themselves, leading to anemia.

A baseline study conducted in Koraput Sadar administrative block of Koraput district and Pallahada block in Angul district in 2016 revealed that the women lacked awareness about intake of nutritious food, resulting in undernourishment among women, and low birthweight among children.

The study suggested that self-help groups (SHGs) had the potential to improve last-mile delivery of essential nutrition services for women, provided they were enabled, supervised, and protected against violence and exploitation.

Poshan sakhis

To improve the health and nutritional status of adolescent girls, pregnant women and lactating mothers through an integrated multi-sectorial approach, Odisha Livelihood Mission (OLM) piloted the Swabhimaan programme with the support of developmental organisations United Nations International Children’s Emergency Fund (UNICEF) and Living Farms.

“We trained community resource persons as poshan sakhis to engage with SHGs and form adolescent girls’ clubs, farmer producer groups on nutrition sensitive agricultural techniques and support nutritionally at-risk women and newlyweds,” Snehalata Mishra, block project manager at OLM, told VillageSquare.in.

 Household-level assessment

Before gathering the women into groups to create awareness, poshan sakhis do an assessment study of each household in the village.

“At maitri baithak, we discuss various issues including their problems such as lack of drinking water, toilet facility and ration from public distribution system (PDS),” said Parbati Khora, a poshan sakhi, pointing to a chart on the wall.

“The red and green stickers in the chart indicate the problems and those resolved, which helps the women gain confidence,” she said. “From the chart, anyone visiting the Swabhimaan centre can learn about the number of households, population, health status, and nutritional intake of all family members,” Snehalata said.

Nutrition for all

Raila Jani, a middle-aged woman who attends maitri baithak regularly, said that it is the family’s responsibility to attend to the nutrition needs of a pregnant woman, if they want a healthy child. “Normally we feel that nutrition is needed for pregnant women and lactating mothers,” Smita Jena, poshan sakhi of Cherengaguda village in Padmapur panchayat, told VillageSquare.in. “But nutrition is essential for women of all ages and more important for adolescent girls.”

She encourages adolescent girls to attend the meeting. “If they understand the need for proper food and nutrient intake, it will have a positive impact on future generations, since a healthy mother will deliver a healthy child,” she said. The poshan sakhis visit the houses of pregnant women who cannot attend the meetings.

To educate women about food and nutrition and to help them remember the same easily, poshan sakhis relate it to the colors of the national flag. “We have a picture of the national flag in the Swabhimaan center; the saffron refers to body growth, white to energy, green physical care, blue of Ashok chakra to oil, and the brown stick to water,” Smita said. “All these are essential for women of all ages.”

Nutrition from the kitchen garden

Poshan sakhis encourage the women to grow vegetables and fruits in their backyards. Sandhya Rout, a mother of two who has a backyard garden, said that they eat a variety of vegetables now.

“We train them to develop a nutritional garden of mixed vegetables, at a minimal cost, and provide a small loan, if necessary,” Jasaswini Padhy, coordinator of Swabhimaan project, told VillageSquare.in.

The food demonstrations on millet, corn, greens, and tubers that are plentifully available in these parts help the women add variety to their regular meals.

Positive drive

In Koraput Sadar, where the Swabhimaan programme has been piloted, 25 poshan sakhis have undergone training. “We plan to increase the number to 50 by the end of this financial year; next year, we plan to implement the programme in the entire district,” Sushmita Samantray, district project manager of OLM, Koraput, told VillageSquare.in.

“Access to health education and nutrition has reduced the number of low birthweight and premature babies in these areas,” Tanuja Behera, auxiliary nurse midwife, of Padmapur panchayat told VillageSquare.in.

Disclaimer: This article was first published in VillageSquare.in. The views expressed by the author are his/her own and do not necessarily reflect that of YourStory.