Date Published: January 22, 2019
Publisher: Public Library of Science
Author(s): Reshmi R. S., Konsam Dinachandra, Arti Bhanot, Sayeed Unisa, Gopinath T. Menon, Neeraj Agrawal, Vikas Bhatia, Manisha Ruikar, Abner Daniel, Sourav Bhattacharjee, Rabi N. Parhi, H. P. S. Sachdev, Raj Kumar Gope, Arjan De Wagt, Vani Sethi, Vijayaprasad Gopichandran.
Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women’s empowerment and nutrition outcomes. National Rural Livelihoods Mission’s poverty alleviation and livelihoods generation initiative is an opportune platform to layer women’s nutrition interventions being tapped by project Swabhimaan in three eastern Indian states—Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women’s empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women’s access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women’s nutrition interventions as stipulated under Swabhimaan may yield better results for women’s empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.
India had an estimated 71 million undernourished women of reproductive age and an estimated 30 million pregnancies [1, 2]. Majority of these pregnancies were expectedly among undernourished women and a quarter among adolescent girls . The long term, intergenerational and irreversible consequences of pre-pregnancy and maternal undernutrition, manifesting as intra-uterine growth retardation, prematurity, low birth weight and childhood stunting as well as increased susceptibility to chronic diseases later in life are established . A five year initiative titled Swabhimaan (Lit. Pride) was launched in 2016, layering essential women’s nutrition interventions on an ongoing nation-wide government livelihoods promotion and economic empowerment initiative- The National Rural Livelihoods Mission (NRLM). Swabhimaan covers over 600 000 population in three states of eastern India- Bihar, Chhattisgarh and Odisha, with the highest rates of women’s undernutriton and fertility. It covers all the stages of a woman’s life-cycle with hightened nutritional vulnerability that is adolesence, pre-pregnancy (newlyweds), pregnancy and lactation (mothers of children under-two). Its design was informed by a scoping study that concluded that mature women’s Self- Help Groups (SHGs) and their federations also known as Village Organizations (VOs) and Cluster Level Federations (CLFs) have the potential to manage grants for improving last mile delivery of essential nutrition services for women, provided they are enabled, supervised and provided protection against domestic violence and exploitation . The concept of layering nutrition interventions on economic empowerment programs for women is not new in the Indian context with programs like Kudumbashree and Andhra Pradesh Rural Poverty Reduction Program providing nearly two decades of learnings [6, 7]. However, Swabhimaan is a pioneering women’s nutrition focused initiative covering direct or nutrition-specific interventions impacting quality and quantity of food intake and nutrition-sensitive interventions pertaining to planned fertility, access to basic health, water, sanitation and hygiene (WASH) services and improved household food security.
We found that at least one in four mothers were members of SHGs in Bihar, Chhattisgarh and Odisha; there may be more who came from households that had an SHG member as NRLM aims to have at least one woman member from each family linked to the SHGs. Our survey did not capture the latter. However, the context in which Swabhimaan operates is marked by social and gender inequalities. In all Swabhimaan intervention states, that is Bihar, Chhattisgarh and Odisha, sampled population belonged to government enlisted vulnerable communities of SC, ST or OBC. Over a third of mothers in Odisha were married before legal age and nearly one in ten were adolescent mothers. Schooling rates were low for mothers in all three states, one of the known drivers for early marriages and childbearing .
NRLM’s poverty reduction program has some gains in improving women’s empowerment, particularly on increasing women’s control over financial resources and community leadership. Women’s tolerance to domestic violence in Odisha was a concern and needs to be addressed through NRLM or other social welfare platforms. Along with increasing SHG membership, need for improving reach of food security schemes or nutri-sensitive livelihoods is needed across all states. The gains in women’s financial control are yet to translate in improving their nutritional status across all states. SHG membership has varying influence in use of antenatal, partum and family planning services across Bihar, Chhattisgarh and Odisha. Services that require increased attention across all states include pregnancy registration in first trimester, height measurement of pregnant women, increased information and access to family planning methods and participation in VHSNDs. In Bihar, reach of all ANC services excluding TT vaccination need to be reviewed. The need for layering essential women’s nutrition interventions that is access to health services and care to nutritionally “at risk”, access to family planning services, improving dietary diversity, preventing micronutrient deficiencies and anemia and access to water, sanitation and hygiene services is immense. The context supports an inititaivet like Swabhimaan to layer these nutrition interventions on the NRLM platforms. This may be more effective in a state like Bihar where nearly half the SHGs have federated to VOs.