Sure Start for moms and babies in India

Group of women and their children sitting cross-legged on ground.
Mothers and their children take part in a mothers’ group meeting. Photo: PATH/Gabe Bienczycki.

We’re celebrating results from PATH’s Sure Start project, which reached 24.5 million people in India with information and support to make childbirth safer. To learn more, see our special feature on the project. W. Sita Shankar, our director of Maternal and Child Health and Nutrition in India, spoke to us in advance of a visit to Seattle, where she’ll be sharing the Sure Start story at our Breakfast for Global Health on May 22.

Q. Sure Start relied almost entirely on people working within their communities. Why did you take this approach?

A. About a million babies in India die each year during childbirth or before they’re a month old. To address this huge number of unnecessary deaths, the transformation really needs to begin at the individual, family, and community levels. Simple acts can save the lives of many babies, but people have to know about them, and they have to be convinced to change traditional practices. We saw an imperative need for a community-based behavior change intervention.

To inspire this transformation, Sure Start developed champions for safe childbirth in villages and slums that are barely reached by the health system. We mentored around 7,800 front-line health workers and equipped them with the skills to overcome deep-seated social norms and to convince people to adopt best practices for healthy pregnancy and childbirth.

Mothers’ group meetings conducted by these health workers were particularly effective. Women who participated were significantly more likely to plan for deliveries, receive prenatal services, opt for delivery in health facilities, and seek care from a health care provider when they had complications. Once a woman sees that her baby turns out healthy, you can rest assured that her daughters and daughters-in-law will get the message, too.

Q. What stands out to you as a signature success of this project?

A. The most remarkable change that I’ve seen is the increase in participation of men in issues related to maternal and newborn health. In India, this is considered to be the women’s domain, yet men are often the key decision-makers in the home and hold the purse strings. To engage fathers, we gave them letters that were supposedly written by their unborn children. The baby is basically saying, “Hey, I really want to meet you, but I want to come out healthy. That can only happen if my mom is healthy, so take care of her in these specific ways.” This emotional appeal—from a baby the father is really excited about—is very effective.

We also mentored village health committees. These groups, which are mostly made of up of men, are now championing better conditions for pregnant women. They are making sure there is transportation to the health center, that a weighing machine is available to weigh the babies, that vaccines are brought to the village on time. People realized that there were things they could do for themselves and their communities that could save many lives.

Q. What does Sure Start tell us about simple interventions?

A. We now know that there are simple and cost-effective things we can do to make a difference in the lives of mothers and infants. In the places where PATH works, it’s like a parched land. A few drops of water in terms of better information and giving people hope, and you can have a substantial impact.

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