Lessons in nutrition for pregnant and lactating women

She ate what we ate. Some dal, rice and vegetables whenever we could afford it,” says Mahalakshmi, mother of 18-month-old Varsha. “I had no idea she was not receiving enough nutrition until she had diarrhoea and we had to rush her to the hospital. My daughter weighed five kilos, while doctors said that she should weigh at least seven kilos.” Mahalakshmi’s family could not afford three meals a day and “buying fruits and vegetables was out of the question.”

She was introduced to the First 1000 Days programme, an integrated nutrition project of RC Bengaluru Platinum City (RCBPC), RID 3190, handled by a social worker from Surdenpura village in Rajanakunte, 28 km from Bengaluru. The comprehensive, household-based initiative aims to improve the nutritional status of pregnant and lactating women and children under two years of age. After 12 months of enrolling in the programme “Varsha looks healthy and active now and is gaining weight steadily,” smiles Mahalakshmi.

“The term ‘acute malnutrition’ or ‘severe wasting’ sounds alien to mothers from underprivileged and rural backgrounds in India. They not only lack nutritional knowledge, but have zero idea about how a mother’s malnutrition during pregnancy adversely affects her child’s survival, growth and development, and her access to nutrition,” says Dr Shobha G, a nutritionist, and member of RCBPC. When it comes to the health of mothers and infants, particularly in rural areas, “we must do beyond what PHCs and ASHA workers do.”

As a professor of Human Development at the VHD College of Home Science, Shobha came across the increasing issues of acute malnutrition in young mothers through a research programme carried out by her students. “I approached my club with the statistics and we began work on the project immediately.” The club launched the two-year initiative at Surdenpura with sponsorship support from MCKS Trust, a city-based charitable trust.

But women from the village weren’t convinced to join the programme. “This concerned their baby and they weren’t willing to risk anything,” says club president Nisha Bellare. With the help of People’s Trust, a local NGO, the club gained the trust of the rural community. To ensure the project’s sustainability, “we had to make sure that all the women participated in the classes regularly. So, we allowed the families of the pregnant women to attend the programme. They could bring their children, mother-in-law, or any family member to the classes. Sometimes we had the entire family of a participant come and see what we were doing.” she adds.

Shobha explained to them that the first 1,000 days of life provide a unique opportunity to establish the foundation for lifelong nutrition, health and development of their soon to-be-born babies. “My students created brochures about the programme in the regional language with a chart to measure neonatal milestones.” A food pyramid was also displayed to show how much of what should be eaten to achieve a healthy, balanced diet.

Shobha says that “50–55 per cent of both rural and urban women enter pregnancy in an anaemic state.” To address this issue the club partnered with Aspirar Sphere, an NGO that is addressing iron deficiency through its iron-rich chocolates. “I tested the efficiency of the chocolate myself,” quips Shobha who took a pre and post-chocolate consumption blood test to determine her iron level. “My iron level went up by 2 per cent in just one month. So, we began distributing the bite-sized chocolates to the mothers-to-be at Surdenpura.”

50–55 per cent of pregnant women in both rural and urban areas are anaemic.

Next, the club partnered with the University of Agricultural Sciences, Bengaluru, to provide the women with monthly supply of nutritional ladoos made with ghee, wheat flour, dried fruits and nuts. The university also gave them seeds and saplings (drumstick, guava, papaya, curry leaves, etc) of food that can be grown in the backyard of their homes. In association with the Mitu Foundation, Bengaluru, the club distributed woollen sweaters to the pregnant woman. A special awareness programme on breastfeeding was also conducted. A healthy recipe contest was held for these women and “we were surprised to see the number of things that can be made with something as simple as ragi,” says Shobha.

The programme includes complimentary nutritious meals for both mother and child, nutri-milk for the infants, sanitation and hygiene education, nutrition assessment, counselling, and support through a WhatsApp mothers’ group.

After the initial hesitancy the village women are now opening up to the team from RCBPC about various other issues they face at home. In a one-to-one session Shobha was shocked to know that “a girl as young as 19 was going to deliver her third baby, while another woman was forced by her husband to ask the doctor how soon after her delivery will she be able to have sex with her husband. She wept saying even in pain she had to oblige him. Although I advised her to voice her feelings strongly to her husband, I realised that more than counselling the women, we have to educate men to look beyond a woman’s body,” she added.