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Nutrition Advocates

Poshan sakhis transform reproductive health in Odisha

Women trained as poshan sakhis, or nutrition friends, advice and help rural women, particularly expectant and lactating mothers, to eat nutritious food and overcome anemia and underweight deliveries
A poshan sakhi explains the importance of women, especially expectant and lactating mothers, eating nutritious food (Photo by Rakhi Ghosh)

A poshan sakhi explains the importance of women, especially expectant and lactating mothers, eating nutritious food (Photo by Rakhi Ghosh)

Swapnarani (21), an expectant mother, finishes her household work fast 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.

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.”

A poshan sakhi checks the mid upper arm circumference (MUAC) of an expectant mother. MUAC is a mandatory measurement for pregnant women (Photo by Rakhi Ghosh)

A poshan sakhi checks the mid upper arm circumference (MUAC) of an expectant mother. MUAC is a mandatory measurement for pregnant women (Photo by Rakhi Ghosh)

Nutritional deficiency

Findings of the new Global Nutrition Report 2017 places 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% 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 taking 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 Swabhimaan program with the support of developmental organizations 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.

Growing vegetables in kitchen garden and millets available in plenty helps women consume a variety of nutritious food (Photo by Rakhi Ghosh)

Growing vegetables in kitchen garden and millets available in plenty helps women consume a variety of nutritious food (Photo by Rakhi Ghosh)

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

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 the 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,” said Jena. “All these are essential for women of all ages.”

Nutrition from 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 program has been piloted, 25 poshan sakhis have undergone training. “We plan to increase the number to 50 by the end of this financial year and next year we plan to implement the program 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.

Rakhi Ghosh is a Bhubaneswar-based journalist. Views are personal.

Rakhi Ghosh
Rakhi Ghosh
Rakhi Ghosh is a Bhubaneswar based journalist.

2 Comments

  1. Debi Prasad Nayak says:

    Nice and informative article. The last paragraph on reduction of premature and low birthweight may be further studied and a comparative figure against baseline situation would clearly speak about the status of these indicators.

  2. Dr Puspashree Nayak says:

    Very good information with an effort to build up confidence to overcome malnutrition. Convergence and coordination is visible

    Through community involvement, many things can be possible