Hum ka kaa sikhahu, ou aaj ki awal bhai…' (What will this chit of a girl teach me !) – When this is the attitude of the mother-in-law towards the health worker, counselling on reproductive health is unlikely to flourish. It is this realization that gave birth to the innovative idea of involving mothers-in-law through 'Saas Mandalis' (mother-in-law groups). Since many of the mothers-in-law also conduct deliveries in the family, the strategy that evolved provided for the community based distribution worker (CBD) in each of these villages to identify 8-10 such mothers-in-law and hold regular meetings with them. The CBD equips them with information on all aspects of reproductive and child health and seeks their support to gain access to the younger women as well. Additionally enlightened mothers-in-law ensure that pregnant women undergo regular check-ups, get immunized and safe practices are adopted during delivery. This has led to the 'Saas ban jaay TBA' (mother-in-law becomes a trained birth attendant) movement in these villages.
his SIFPSA funded project is being implemented by Dr. Shambhunath Singh Research Foundation (SRF), an NGO working in 118 villages covering a population of more than 120,000 of Pindra block in Varanasi district. The organization made a modest beginning with a small theatre group made up of concerned citizens, who through their performances motivated people to form youth groups and work for their community. The SIFPSA project was an opportunity for it to focus its activities on reproductive health and rights of women.
The project staff established an instant rapport with the community through entertaining street plays with messages on reproductive health, enacted by the supervisors. Women's groups called 'paherua' (guardians) were then formed in each village by CBD workers who facilitated regular meetings of these groups, disseminating information on all aspects of reproductive & child health. A centrally located building in the village or the sub-centre was chosen for these meetings and for providing RCH services.
The project team developed 'phads' (colourfully illustrated cloth scrolls) on various issues, which were used during meetings to initiate discussion on the issue of the day.
Innovative songs developed on various topics were used during group meetings to motivate prospective clients. Catchy slogans on gender equality, health care and family planning serve as vehicles to generate interest. The CBD invites a person from the community to start writing the slogan, and once a small crowd gathers, the slogan is discussed in all its aspects and its meaning conveyed.
This project implemented for three years initially, showed encouraging results and has been extended up to March 2002. The new implementation strategy focuses on making the programme sustainable.
Home visits are gradually giving way to group activity and special emphasis is being laid on contraceptive social marketing. Self-help groups in villages now involve women who make monthly contributions to a corpus to be used for income-generating activities through loans for the members.
'We strongly believe that only quality work will have a lasting impact and thus is essential to make the programme sustainable' says Ms. Roli Singh, the dedicated Project Coordinator.
Nanni Begum who has three daughters-in-law, learnt to conduct deliveries from her maternal aunt. The SIFPSA-SRF project taught her safe delivery under the 'Saas Ban Jaay TBA' (Mother-in-law becomes a trained birth attendant) programme. She now advocates TT immunization, regular check-ups by the ANM and the use of five cleans to all in her traditional muslim community. 'Gone are the bad days..' she admits, '..when new borns died due to tetanus and myths & rumours prevailed. Now there are vaccines to prevent diseases and we know the importance of cleanliness. The future generation is safe!' TBAs like her also strongly advocate use of spacing family planning methods. As news of her skills spread, younger women have started coming to her for advice, often surreptitiously ! .