The theme of this year's International Development Week is the empowerment of women and girls. Read on to learn more about the development work that CRWRC is doing in maternal and child health, and watch the videos linked to on the right side of the page for a full and moving picture of what community development means in communities like Bangladesh.

CRWRC Scales Up Mother and Child Health in Bangladesh and India

The quality of first 1,000 days of a child’s life is essential to their survival. In places where the young are extraordinarily vulnerable, birthdays often go unrecognized and children remain unnamed until their fifth year when they are more likely to stay alive until adulthood.

In 2010, nearly 7.7 million young children around the world died. The most common causes of death among these children are preventable—respiratory infections, diarrhea, measles, and malaria. The roots of their vulnerability to these diseases are complex, but chief among them are hunger—and resulting malnutrition—and lack of access to medical care.

“Children suffer the worst long-term consequences if they are deprived of proper nutrition in the first two years of life,” says Alan Talens, Health Advisor for the Christian Reformed World Relief Committee (CRWRC). “Malnutrition affects the immune system, creating vulnerability to common illnesses, stunting, decreased mental capacity, and a poor prognosis for productive adulthood.”

CRWRC is addressing the needs of poor women and their children in Bangladesh and India through two innovative, five-year programs that improve nutrition for mothers who are pregnant or breastfeeding and facilitate access to health care opportunities. The programs are funded by grants from the U.S. Agency for International Development (USAID). In India, where CRWRC partners with the Christian organization EFICOR, this work is improving the lives of nearly one million people who are mostly from marginalized tribal groups living in a remote area of Jharkhand, India. The participating communities were selected due to the tremendous disease, poor services, remoteness, and minority ethnic population present.

“These projects focus on nutrition interventions like exclusive breast feeding and vitamin A supplements that can reduce the global child mortality rate by one-third each year,” Talens says. “But in impoverished rural areas, there is often no operational health delivery system available, so establishing sustainable strategies that give people access to health care equitably and affordably must be part of our response.”

By working in collaboration with existing government health facilities in poor communities, CRWRC can improve the quality and accessibility of critical health services like ante- and post-natal care for pregnant women, immunizations, and treatment for common childhood illnesses. And, by training community volunteers to make appropriate referrals to health facilities and providing opportunities for regular contact with public health workers, community representatives can improve the services available to them.

By making these quality health services accessible to mothers and babies in poor communities, CRWRC is providing interventions and resources to those who are most in need, and that means saving lives.

“CRWRC’s community-directed health programs in India and Bangladesh are an effective way to provide universal coverage equitably,” Talens says. “These programs make affordable health care available to everyone, and among the poor and hard to reach groups it’s vital to improve the health and nutrition of mothers and their children in the first 1,000 days of a child’s life.”

Case Study: Netrokona, Bangladesh

Rural Netrokona District in northern Bangladesh has a high ethnic minority population, a high disease rate, and cultural differences that create barriers to accessing health services. In addition, environmental conditions like flooding can cut off women from health facilities for months each year. In these complex and often desperate circumstances, the health needs of women and children, especially those who are poor, are often neglected or misunderstood.

“Families often ignore very simple health practices or reject them because they clash with traditional practices,” Talens says. “There is very little understanding of the need for rest and nutritious food during pregnancy in these communities, or concern for pregnancy and infant care.”

CRWRC organizes community members in Netrokona into village groups that elect representatives to a higher governing body called Peoples’ Institutions (PIs). Village groups engage in local projects like literacy training, income generation, and health activities, while PIs organize health services and link with outside health systems for advocacy and referrals.

PIs also select, teach, and support volunteers who are trained as traditional birth attendants and community health volunteers. These volunteers:

• identify low birth weight infants and anemic mothers, and make referrals to health facilities.
• provide counseling in family nutrition, breastfeeding, complementary feeding, nutritional care during illness and recuperation, and vitamin A supplementation.
• provide ante-natal care and essential newborn care such as maternal nutrition counseling, iron and folic acid supplements, and delayed cord clamping.
• strengthen the referral system by building partnerships with local government agencies and related health facilities. These relationships create regular opportunities for communities to make their voice heard throughout the health structure.

Case Study: Jharkhand, India

Nearly one million people are crowded into the Sahibganj district of Jharkhand, India, where disease and poor health are prevalent. Inadequate nutrition, poor breastfeeding practices and low immunization rates contribute to the high child mortality rate. In addition, three-quarters of women of child-bearing age are anemic and nearly half are underweight.

Among tribal groups, it is common for pregnant women to reduce their food intake to control nausea and ease delivery by giving birth to a smaller baby. Almost all women in this area continue their regular activities throughout pregnancy, including hard labor. Harmful practices also include superstitions and taboos around breastfeeding such as discarding colostrum and substituting pre-lactal feeding.

CRWRC works in Jharkhand with two goals: to mobilize communities and educate for behavior change. At the community level, women’s groups participate in savings and credit, recordkeeping, literacy, and health activities. Together these groups form a federation that is a nationally recognized, community-based organization. The members of the federation make up village health committees that provide governance to the community health system.

“Village health committees improve the quality of health services and increase access to them,” Talens says. “They create a health network and links to government health services and facilities.”

CRWRC health workers are trained to emphasize nutrition in the first 1.000 days of a child’s life through:

• improved diet and adequate rest during pregnancy.
• antenatal checkups including treatment and counseling.
• post-natal care including education for mothers and fathers.
• immediate and exclusive breastfeeding.
• growth monitoring for children under three.
• long-term follow up is built into local health services through regular community meetings where growth monitoring and early detection of children whose growth falters, as well as instruction in healthy feeding practices and counseling with mothers whose children are malnourished measured.

We are thankful that these projects are resulting in outstanding improvements in women and children’s health in many areas, indicating that children are eating nutritionally sufficient diets, being immunized, and recovering well from childhood illnesses.

• 31 percent more pregnant women had three or more ante-natal visits
• 17 percent more women received the tetanus vaccine
• 11 percent more mothers were assisted by trained birth attendants
• 15 percent more women had postpartum visits from health workers
• the complete childhood immunization rate rose by 13 percent.
• the early initiation of breastfeeding increased 19 percent.
• vitamin A intake improved by 31 percent.
• underweight children decreased by four percent