Category: Inspiration,Samvad

Videos Help Fight Misconceptions Around Male Sterilization Procedures

Posted on by Susan Thomas

Malati Sahu, 25, married Sudhir Sahu, 29, resident of Dongargaon Block in Rajnandgaon District in Chhattisgarh, five years ago. “My husband wanted to continue his education, but due to poverty he had to quit schooling when he was in class 9 and started working as a daily wage labourer with his father,” shared Malati who herself was able to complete higher secondary education.

Malati lives with her husband and two children at her in-laws’ home. They do not possess any agricultural land although Sudhir and his father have been working as agricultural labourers. Sudhir’s keen interest in cooking led him into taking it up as a profession after marriage. He is now working as a chef in a restaurant at Rajnandgaon and earning more than INR 10,000 per month. Moreover, Sudhir’s father has leased agricultural land and is earning INR 2,000 to 3, 000 per month from the produce.

Malati’s daughter, Sita is now three-and-a-half-year-old and her son, Shyam is 18 months old. Both of them were born at the government hospital. Malati explained that after the birth of the two children, both she and her husband were happy and didn’t want any more children and were considering adopting some family planning method.

“We were thinking about going for a family planning operation and my husband consulted a doctor for my sterilization. However, in the hamlet meeting, (Digital Green’s) videos shown by the Mitanin Trainer on the family planning changed my perception and I insisted my husband go for male sterilization,” shared Malati.

“Many misconceptions exist around male sterilization among the community. People believe that vasectomy makes males impotent leaves them unable to do any physical work and that it (vasectomy) is painful and that recovery period is long,” she added.

Due to the prevalence of such misconceptions about vasectomy, in India, most men prefer that their wives undergo sterilization rather than use any other contraceptive methods or undergoing a vasectomy themselves. Digital Green’s video-enabled extension approach is helping frontline workers fight such myths and misconceptions in Chhattisgarh, Bihar, Jharkhand, Uttarakhand and Assam through its Project Samvad, supported by USAID.

Malati’s husband was not happy with her suggestion and argued that male sterilization would be painful and would make him weak and unemployable. However, Malati convinced her husband and mother-in-law how male sterilization is safe and medically simpler than female sterilization drawing on the knowledge from the videos about family planning that she had seen.

Sudhir finally consulted with the ANM and the doctor and agreed to go for the ‘No-Scalpel Vasectomy’ (also called keyhole vasectomy or NSV) and after his operation on 27th July 2019, he went to work the same day, four hours after the surgery. Malati shares that her husband is happy and has had no complications since then and has been working with the same efficiency as he had been prior to NSV.

Now, Sudhir is himself a champion of the cause within his village and encouraging other men in his community to go for family planning, improve communication between husbands and wives as well to address the myths and misconceptions related to vasectomy and other contraceptive methods. He is happy that Malati made him aware of this simple, safe and highly effective permanent contraceptive method.

 

Names in this story have been changed to protect the identity of the individuals. The photographs used are also representative.

Combating Malnutrition Through Agri-Nutrition Gardens

Posted on by Susan Thomas

In spite of the steady decline observed in maternal, infant and child mortality, much work remains to be done to tackle undernutrition among women of child-bearing age, adolescents and children under 5 years.

National Family Health Survey 2015-16 (NFHS-4) cites that in Jharkhand, 70% of children between the ages of 6 months and 5 years, and 65% of women ages 15-49 years are anaemic. These high rates of anaemia are attributable to the low iron content in women’s diets from early childhood into adulthood, which has consequences for children’s physical growth, mental development and performance in school. The NFHS-4 further notes that nearly half (45%) of children under age 5 in Jharkhand are stunted and 29% are wasted.

Undernutrition in rural communities can be traced to a dearth of information about nutrition, as well as the unaffordability of nutritious food. The introduction of mono-cropping and the shift in agriculture to a market-driven economy brought in with the Green Revolution in the 1960s in India, drastically reduced crop diversity. With cash crops taking precedence, households shifted from producing a range of cereals, pulses and vegetables themselves, to purchasing them from the market. Although vegetables help combat malnutrition by providing essential vitamins and minerals essential for children’s development and overall good health, India’s present vegetable production level permits a per capita consumption of only 120g per day, against the recommended daily intake 300g.

Background

In Jharkhand, Digital Green is working with Mahila Kisan Sashktikaran Pariyojana (MKSP) and the state Livelihood Promotion Society (JSLPS) on an integrated approach to address the immediate determinants of undernutrition, particularly consumption of adequate food and nutrition. The work is part of the Samvad  project funded by the US Agency for International Development, which is working with state Rural Livelihood Missions, state-level agencies of the National Health Mission, and multiple non-governmental organizations to employ video- and other ICT-enabled approaches to increase adoption of optimal maternal, infant and child health and nutrition and family planning practices in Jharkhand, Bihar, Odisha, Chhattisgarh and Uttarakhand.

Through community videos they watch and discuss together, facilitated by the frontline workers (FLWs) trained through Samvad, the women farmers learn about health and nutrition practices, initially focusing on the first 1000 days (which start at the identification of pregnancy and last until the child is 2 years old) for both mother and child. The videos focus on dietary diversity during pregnancy, exclusive breastfeeding, complementary feeding, and so on. Once the groups understand health and nutritional requirements for healthy development, the FLWs guide them in discussions on options for bridging dietary diversity gaps, including backyard agriculture or kitchen gardens. MKSP and JSLPS are successfully promoting agri-nutrition gardens as a year-round source of fruits and vegetables.

I never thought of maintaining this kind of garden. Now I am harvesting fresh vegetables daily, by just collecting and using the household wastewater.

The Agri-nutrition Garden

After discussions with stakeholders on field conditions and land and water availability, Digital Green developed a model for an agri-nutrition garden, which details the size (about 50 square meters), layout, and options for maintaining a  diverse selection of vegetables and fruits by season. The garden boundary and rooftop can be used for climbing plants. The model advocates organic, non-pesticide management practices and compost production. Households use a Jalkund, a pit lined with a polyethene sheet to store household wastewater for irrigation. Establishment of community nurseries ensures timely availability of saplings.

During the last kharif and rabi seasons (2018-19), more than 12,000 community members planted agri-nutrition gardens in Jharkhand. Almost every garden developed during Kharif season was continued through the next (Rabi) cropping season, showing their importance to the women who plant them.

Many women farmers from the Tilaiya village mentioned that maintaining the small gardens, which they call a ‘poshan bagicha’ or nutri-garden, allows them to diversify their families’ daily diets to an extent not possible when they had to purchase vegetables from the market. In addition to this, they are also saving the money they used to spend purchasing vegetables (an average of Rs. 200-300 weekly).

I developed my nutrition garden during Kharif with 8 different kinds of vegetables and continued it in the rabi season by incorporating season specific vegetables. I have used organic manures only and maintained the garden using wastewater from the household. I consume the vegetables and also share the surplus with neighbours who don’t have enough.

Community Level Convergence

While interacting with community members in the Tilaiya village of Ramgarh, I realized that the extent of adoption of the practice of growing and tending agri-nutrition gardens, and the communities’ ownership of them, is attributable to the informal convergence in the villages of frontline workers from different domains and departments. MKSP FLWs, known as Community Resource Person or Aajeevika Krishak Mitra, screen the health and nutrition videos and talk about dietary diversity and other issues using platforms such as Anganwadi Centres (AWCs) and Village Health and Nutrition Days, where Anganwadi workers and/or Sahiya are present to discuss the issue with further clarity and details.

Anganwadi Centres have planted model agri-nutrition gardens (either at the centre or nearby) so that women can visualise how a small garden in their backyards could meet their families’ year-round dietary requirements for fresh fruits and vegetables. FLWs from the National Health Mission, the Department of Women and Child Development and NRLM share this common Anganwadi Centre platform for meeting and discussing household health and nutrition issues, and how to meet nutrition needs by developing a small agri-nutrition garden.

Empowerment of Women

This intervention has empowered women socially as well as economically. Each month, they save up to Rs. 1,000-1,200 by growing their own vegetables,  which they use for household needs that were previously difficult to meet. They also share or exchange the surplus vegetables from their gardens with needy community members and neighbouring farmers.

 

This concept even received an award in the state – see our Facebook update here!

Breaking barriers around IFA supplementation for pregnant women through videos

Posted on by Susan Thomas

 

Sohini Banjare, a Mitanin Trainer in Ambargarh Chowki block, Rajnandgaon, Chhattisgarh has been advocating regular consumption of Iron Folic Acid (IFA) tablets by pregnant women for years. “The side-effects of the iron supplement and the stigma related to having any medicine during pregnancy has been a big barrier to my work,” shared Sohini.

 

She recalls one particular case from 2017 to demonstrate this. “Sangeeta Mandavi belonged to a loving and supportive family in Thetwar Lanjhiya and was expecting her first child. When I came to know about Sangeeta’s pregnancy, I visited Sangeeta’s house,” recalled Sohini.

 

A Mitanin’s visit to a pregnant woman typically involves counselling the woman about her health, update her on the government schemes and entitlements and remind her of the check-ups she must get. These visits are also meant to keep a check if everything is alright in this delicate stage; ensure she is getting adequate rest and optimum diet but most importantly, to ensure she is consuming the IFA tablet regularly, which goes a long way in ensuring the health of the mother and her child.

Sangeeta’s husband and in-laws were very supportive and assured that they would take good care of her and Sangeeta herself assured Sohini that she’s taking the IFA tablets regularly.

 

“One tends to think that it’s easy to pop a pill which ensures good health for the mother and child. However, women often discontinue it due to the side effects such as vomiting which accompany it in the initial days until the body gets used to it,” shared Sohini.

 

 

“Closer to her baby’s delivery, a neighbour’s child playing in Sangeeta’s room was seen with some tablets. Soon her family discovered a heap of IFA tablets discarded under her bed,” shared Sohini. “It turned out that Sangeeta had been throwing away the tablets under her bed as she could not bear the side effects when she initially started taking the tablets,” she added. Sangeeta had hidden this from her family fearing that they may insist on her having the medicine. A week later, Sangeeta delivered a low birth weight baby (2 Kgs) and faced a lot of weakness herself.

 

In January 2018, Digital Green entered into a partnership with the State Health Mission in Chhattisgarh under its USAID funded Samvad project. The project seeks to address Family Planning, Maternal Child Health and Nutritional goals through a participatory approach, using locally relevant content created by, of and for the communities. The program is being implemented on a pilot basis across 2 districts of Chhattisgarh, namely Rajnandgaon and Kawardha, through the State Health Resource Centre. Digital Green trained Mitanin Trainers (MTs) to produce and disseminate the videos using pico projectors. These MTs have reached nearly 41,000 women (up till Dec 2018) with community videos on themes such as IFA supplementation, Complementary feeding, Diarrhea management and Family planning messages.

 

 

In March 2018 Sohini received training on video-based approach from Digital Green. The Mitanin Trainers were also given a pico projector to disseminate videos on various health topics to improve awareness of the community. The Mitanin Trainers would use these new tools to bring all pregnant women and new mothers together to disseminate these videos.

 

In April 2018, Sangeeta was pregnant the second time and Sohini made it point to invite her to the dissemination of video titled – Importance of IFA tablet. The video illustrated in great detail a woman’s hesitation in eating the supplementary iron tablets due to the side effects in a dramatic and emotional manner. After the video was shown, Sohini invited Sangeeta to talk about her experience of taking the tablet and then discontinuing it. Sangeeta shared her struggle with the side effects and hesitation in taking the medicine and the consequent problems of having a low birth weight baby. Sangeeta resolved, “I will not make the same mistake again with my second pregnancy. I will follow all the suggestions as shown in the video to combat the side effects.” Sangeeta’s second child was born a healthy baby of 3 kgs.

Videos Boost the Efforts of Chhattisgarh’s Frontline Health Workers

Posted on by Susan Thomas

“I am motivated by the thought that my work can bring a positive change in the lives of my community,” shares Anju Sahu, 38, a Mitanin trainer in Barccha tola, Rajnandgaon, Chhattisgarh. ‘Mitanin’ in Chhattisgarhi means a female friend, traditionally a female friend who helps out in times of need or illness. This organic concept was adopted in a state-wide attempt to create a cadre of health extension workers or ‘Swasthya Mitanin’ (friend of the village for health care needs).

Digital Green entered into a partnership with the State Health Mission in Chhattisgarh in January 2018 under its USAID funded Samvad project. This project is an effort to address Family Planning, Maternal Child Health and Nutritional goals through a participatory approach, using locally relevant content created by, of and for the communities. The program is being implemented on a pilot basis across 2 districts of Chhattisgarh, namely Rajnandgaon and Kawardha, through the State Health Resource Centre. Digital Green trained Mitanin Trainers (MTs) to produce and disseminate the videos using pico projectors. These MTs have reached nearly 35,000 women (up till 30th Nov 2018) with community videos on themes such as IFA supplementation, complementary feeding, Diarrhea management and family planning messages.

Happy about the introduction of Digital Green’s video-based approach Anju shares, “It’s difficult to gather people or keep their attention when we try to disseminate information, but videos help us garner their interest.” “I asked the two Mitanins in my area to gather everyone at the village ground in the late evening for video dissemination and it was heartening to see so many people turned up. There were women, men and children of all ages,” shares a happy and excited Anju.

Anju chose to show a video about diarrhoea. “The children were spell-bound and watched the video in complete silence,” she adds. “A few days later the principal of the primary school invited me to the school. He asked me what video I had shown in the village,” shares Anju. The students had shared with him how good and useful the information about diarrhoea had been. Anju asked the students on the key points of the video and was glad to see that they were able to recall that to avoid diarrhoea one should always drink clean water and wash hands with soap after using the toilet, before cooking and eating.

“The video is a great medium for reaching out to all age groups – even small children can easily understand the information shared through it,” shares Anju.

Anju is happy to report that when the Mitanins go for home visits now parents share with pride that there is a great change, especially among the children as they never fail to wash their hands with soap after defecation and before eating.

“Even the Mitanins are happy as they are able to convey these health messages in a more convincing manner and disseminate them among larger groups at once,” adds Anju.

Discovering Empowerment and Knowledge in Rural Jharkhand

Posted on by Susan Thomas

Upon my return from my first field visit after joining Digital Green, I was frequently confronted by curious colleagues and friends asking “How was it? What did you see? What did you learn?” These simple questions left me thinking. The truth is, what I saw and felt is not easily explained with a “Good or Great”.

I spent almost a week visiting villages and interviewing health workers and beneficiaries in various districts of Jharkhand to understand Digital Green’s approach and impact to capture how this is being used to achieve the goals and objectives of the USAID supported project Samvad.

In Jharkhand, we work in partnership with Jharkhand State Livelihood Promotion Society (JSLPS) who have a cadre of community resource persons called Cluster Convergence Coordinators (CCCs). They are trained in various government initiatives. Digital Green leverages these resource persons to disseminate best practices on health and nutrition among Self-help Groups and Anganwadi Centres. They use Digital Green’s videos to share information with beneficiaries and other health workers.

This was my first visit to Jharkhand and I was completely mesmerized by the beauty around me. We had to drive through the dense Saranda forest (frequently in the news for internal conflict) to reach our destination, Manoharpur block in West Singhbhum district.

It is here that I met Janki Mahto, a fiesty CCC. Conversation between us flowed easily as she described her experience of joining JSLPS and attending Digital Green’s trainings.

Curious to understand the impact of the training, I asked her if she felt empowered after being trained on video dissemination. She said, “I didn’t know what being an empowered woman meant. I used to be at home, cooking and taking care of the children. After getting trained on Health & Nutrition videos, I have resumed my studies and can operate a smartphone and a Pico projector. I can now educate and empower other women to make informed choices for themselves and their families. It is now, I have realized what empowerment means”

I further asked, “How does your husband feel, now that you are earning? Does he allow you to be out for so long?” to which she replied, “In the beginning, my husband didn’t support me. I had to struggle to become a coordinator. Now, when he sees other women coming to me for advice, he feels proud. When I go for trainings, he comes to drop me at different meeting locations. He also stays at home and cooks.”

The discussion was an eye-opener for me, living in Delhi, we easily assume that women in rural areas are unaware and not empowered enough. We imagine ourselves as their ‘knights in shining armours’ who would magically appear to improve their lives but little did I know a training on video dissemination is itself an opportunity to invest in their empowerment.

Next day, I attended a dissemination training on immediate breastfeeding in Chiria town of West Singhbhum, attended by the local tribal women. I asked how many of them fed their baby breast milk within the first hour of the birth. I was surprised that most of the women raised their hand. Upon further probing, they related this practice to how the calf is fed its mother’s milk immediately after birth. This simple parallel that they drew with nature around them displayed such wealth of knowledge that I felt ashamed to have doubted their apparent simplicity.

The next day I travelled to Patratu, a town in Ramgarh district of Jharkhand where I attended a video dissemination training and met the beneficiaries. When I asked them about why they adopted specific practices, the beneficiaries said that there are certain practices that they understand and are easy to adopt in their daily life. And if they personally benefit from that practice, they tell their friends and neighbours and aspire to better services.

This first visit to the areas where Digital Green is working in left me hopeful and optimistic about the future of these women living in the difficult to reach areas. It might be difficult to hear their voices, but the stories they tell are poignant and worth listening to.