When Anita Devi, 19, went into labor, she was terrified. She felt she would deliver her baby on the road, in the dark of that winter night. Anita was aware that the nearest hospital was six km away from her village and feared that no rickshawwala would agree to take her to hospital in such cold weather.
Anita's fears were confirmed. Conveyance was not available; she would have to walk to the hospital. Fortunately, just as Anita and her husband were setting out, a neighbor suggested they head to Jachcha Bachcha Ghar, the informal childbirth delivery centre that was just two kilometers away and that had a trained birth attendant (TBA).
"If my neighbor had not told me about Jachcha Bachcha Ghar (JBG), I don't think my daughter would have been born alive. I was very frightened - it was my first baby and I was in great pain. I thought I would die. But the dai (trained birth attendant) there calmed me down and gave me confidence. I am thinking of naming my 15-day-old daughter after her," said Anita.
JBG was established in Nargada village, Danapur, in 1996, by the Danapur-based NGO, Shaktivardhini, with support from the National Foundation of India (NFI). Catering to a population of around 8, 000 people spread across 12 villages, JBG has facilitated the delivery of 1,000 babies in the past decade.
Ever since the centre has opened, there has been a decline in both maternal mortality rates (MMR) and infant mortality rates (IMR) in the area. Before JBG was established, the IMR was 9.5 per cent. The figures have been slowly declining, with the IMR at 9.2 per cent in 2006; and the MMR, which was 9.3 per cent pre-JBG, fell to 8.8 per cent in 2006 (Source: Shaktivardhini).
"Our research showed that 25 per cent of the mothers and 10 per cent of newborns died because the child was born outside home - primarily in the field or on the roadside - as the expectant mother was unable to reach the hospital in time. A lack of government health delivery systems and the practice of midwives not being allowed to visit villages outside her domain exacerbated the situation. Thus, it was essential to establish a centre where the antenatal and post-natal status of rural pregnant women could be improved. Furthermore, JBG would allow us to interact with adolescent girls as well," said Vandana Kumari, field supervisor, Shaktivardhini.
JBG thus aims to improve the health and social status of women in 12 villages of the Danapur block, Patna district. Using a multi-pronged approach, JBG reaches out to the entire community and focuses on an integrated reproductive and sexual health programme and on proper nutrition, and antenatal and postnatal health.
Pregnant women who visit JBG are monitored at both pre- and post-natal stages in order to ensure the survival of the girl child and the expectant mother. They are also given information on personal hygiene, breast-feeding, nutrition and diet and on gender equality.
As part of the JBG initiative, mothers-in-law in the area are invited to the Shaktivardhini office to join in on discussions on adolescent reproductive and sexual health (ARSH). Through such interaction, the older women are able to learn about ARSH topics and clear misconceptions.
The rapport established with the older women helps the JBG team organize activities for adolescent boys and girls. Over the years, youngsters have been encouraged to participate in discussions on the physical and behavioral changes that occur during adolescence. They are also encouraged to voice their thoughts on the importance of the right age of marriage and parenthood; on the reproductive cycle; and on HIV/AIDS.
The Shaktivardhini team has even reached out to fathers-in-law and newly married men, in an effort to improve the low social status of women and to reiterate the importance of gender equality in society. Men have been invited to meetings at the Shaktivardhini office where gender equality, and the need to stop female feticide (practiced under the garb of family planning) have been discussed.
In addition to such activities, JBG managed to widen its reach even further when it organized a baby show in the year 2000. The show attracted a sizeable number of families and around 110 children - between the ages of six months to three years - participated and brought a smile to many a face. Of course, the organizers used the occasion to assess the health of the children and inform the parents of the same. The baby show also provided a platform to disseminate knowledge about reproductive health and family planning; the importance of breastfeeding; maternal and child nutrition; and personal hygiene.
Over the past decade, JBG has thus become an integral part of the lives of the women in Danapur. "Before JBG was established, the women didn't know anything about personal hygiene. Having worked here for the past 10 years, I have seen the difference JBG has made to the women's lives. They have become more informed and aware. JBG is like a lifeline for countless women in the surrounding villages," said Lakhpatu Devi, a TBA at JBG.
In fact, women prefer to come to JBG instead of the local hospital because of the personal care and moral support offered there. "I have been coming here for the past six years. I have delivered two sons here. The TBAs take good care and always help us even if we need them at night," explained Sunaina Devi.
NFI has stopped supporting the project since December 2006; but the local women are determined to keep JBG open, even if it means having to generate the requisite financial resources themselves.
JBG plans to meet the monthly expense of Rs 2,000 (US$1=Rs 46) - comprising rent and the salary of the two TBAs - through delivery fees; contributions from the women; and assistance from the Village Advisory Committee (VAC).
Incidentally, women are charged Rs 50 in the case of a delivery occurring during the day and Rs 100 if the baby is born at night. In addition, women registered with JBG during the past 10 years will be asked to contribute a minimum of Rs 10 each. JBG officials also plan to raise funds through the local panchayat (village council).
Lakhpatu Devi, in addition to being a TBA, is also a panchayat ward member. Being politically savvy, she understands that unless everyone has a stake in JBG, it cannot be sustained. So along with a group of women, she has already sounded out all the stakeholders - including the parents of adolescent girls and the other local panchayat leaders.
She also has an ace up her sleeve: She is confident that in the event of any financial shortfall, the pradhan (village head) will step in. The reason being that the pradhan is also a mother - and motherhood, Lakhpatu Devi feels, is what will keep JBG going as a community initiative.