New research by Freedom from Hunger India Trust and Grameen Foundation reveals promising approaches to combat anemia, improve maternal and infant health. The organizations worked with local partners in Rajasthan and West Bengal to train 200,000 rural women on nutrition, health and household finances. Participants variously increased their food security, dietary diversity, household decision-making and use of the government’s Integrated Child Development Services.
New research and project results from the Rajasthan Nutrition Project show dramatic improvement in the food security, nutrition, and health practices of women, girls and infants. In just two years time, the percentage of female heads of households reporting that they are food secure increased from 21 to 53 percent, with similar increases for their children.
The program, designed by Grameen Foundation and Freedom from Hunger India Trust (FFHIT) reached 30,000 people, the vast majority in vulnerable tribal communities. A second program in West Bengal and Jharkhand has reached 178,000 women, greatly improving their knowledge of the causes of anemia and preventative action.
“These results offer hope for Indian women, more than half of whom suffer from anemia, which can be devastating for mothers and their babies,” said Mr. A.R. Nanda, Board Chair of FFHIT. “Simple solutions such as nutrient supplements often fall short. But we have found a cost-effective, holistic approach to solving India’s crisis of rural malnutrition.”
Anemia is a leading cause of maternal deaths in India. It raises the risk of premature and low-birth-weight babies, and of neonatal death. In adults, it causes fatigue, lowered productivity, and confusion. In young children, anemia and other forms of malnutrition can irreversibly damage physical growth and brain function. In India, half of children under three are either stunted or underweight due to malnutrition, and 79 percent are anemic.
New heroines: Community Nutrition Advocates
Research conducted early on for the Rajasthan Nutrition Project found that the greater women’s’ decision-making authority in a household, the greater their food security: 39 percent of women classified as having a high degree of autonomy were food secure, versus only 12 percent of women with low autonomy.
“We concluded that any efforts designed to improve food security and nutrition had to aim to improve women’s autonomy and decision-making within the household,” explains Kathleen Stack, Executive Vice President of Grameen Foundation. “To do so, we built on the strength of women’s self-help groups, millions of which exist across the country.”
Grameen Foundation and FFHIT, with Ahmedabad-based training partner, CHETNA, developed an innovative, pictorial-based curriculum to train a new type of local leader: Community Nutrition Advocates (CNAs). Partnering with two local organizations, PRADAN and Vaagdhara, they trained 1,250 mostly illiterate women as CNAs. The women became experts in nutrition, health practices, local health resources, and household financial management. The CNAs in turn trained 8,131 women, reaching 30,000 family members. They also linked women to partners, including government agencies and health providers.
Noting that the government should replicate the success, Dr. Arun Panda, Mission Director, National Health Mission, said, “We need to learn from the community… simple and cost-effective solutions can easily be understood, adopted and sustained.”
Husbands and wives participated in gender dialogues to improve decision-making on food security and nutrition. As a result, joint decisions by husbands and wives–rather than by men alone–became more common. For example, joint decisions on food purchases increased from 27 to 55 percent, while husband-only decisions went from 69 to 28 percent.
“Women gained more decision-making power within the home, and more freedom of movement outside the home,” said Saraswathi Rao, CEO of FFHIT. “And with this, they began to change the crops they grew, what they ate and fed their children, how they treated common childhood illnesses like diarrhea, and when and where they sought health care.”
To evaluate the program’s impact, researchers conducted in-depth interviews with 400 program participants at the beginning and at the end of the project. Among the findings:
- Food security increased for female heads of households (from 21 to 53 percent) and for children (from 23 to 53 percent).
- Dietary diversity increased by an average of three additional foods a day, especially milk, vegetables, and roots and tubers–now grown in home gardens.
- The percentage of new mothers who breastfed their infants within the first hour of birth went from 47 to 83 percent.
- More than half of women (52 percent) reported setting aside more savings in the past six months, and those saving for health increased from 65 to 80 percent.
- The number of women accessing the government’s Integrated Child Development Services increased by 30 percentage points.
Meanwhile, the Maa aur Shishu Swasthya (Mother and Child Health) Program tackled anemia in West Bengal and Jharkhand, where rates have remained unchanged for the past ten years. Grameen Foundation, Freedom from Hunger India Trust, and RESULTS Educational Fund brought together two microfinance institutions, Aikyatan Development Society (ADS) and Bandhan to reach 178,000 women. The program delivered anemia education along with financial services to microfinance clients and women’s self-help groups. A study following the training showed that consumption of foods high in iron and in vitamin C (to aid iron absorption) improved by up to 35 percentage points.