The consistently low rates of exclusive breastfeeding, complimentary feeding and the consumption of IFA tablets shatters the long perceived notion that undernutrition is an outcome of poverty, food insecurity and poor access to health services. There is more to it which is basic but critical – the compromised CARE PRACTICES. It might sound simple but is bit complex as the care practices are influenced not only by knowledge and attitude but also by social norms. It requires unwavering effort to amend the practices.
It’s heartening to see the paradigm shift in the approach to address the issue of undernutrition – going beyond service delivery the emphasis is now also on the utilization of services through improved health-seeking behaviours. The focus of National Nutrition Mission (NNM), on community engagement through community events, platforms for awareness generation which is a first and a welcoming step towards behaviour change. However, it is important to recognize that behaviour change is NOT a separate or autonomous activity that has to be “added” to the programs. It is a functional approach that accentuates impact and needs to be mainstreamed within all interventions to enhance the program’s effectiveness.
At the same time, we need to realize that knowledge, attitude and behaviours are not necessarily linearly linked and the dissemination of information does not on its own lead to behaviour change. And therefore it is essential to promote a bottom-up approach to behaviour change where individual or groups in the community are actors of change and not just passive targets of behavioural change interventions delivered from the top down.
Thus helping the target population to increase its perceived self-efficacy towards a situation or issue is an important factor in behaviour change and this role to encourage, support and facilitate the process can be played by FHWs. And this can well be achieved by including activities that recognize the influence of peer groups like a mother to mother support groups, men support groups, adolescent groups, faith healers and community and family members. These groups can initiate the process of community engagement and keep the process going which is more sustainable and can also facilitate the community events envisaged under NNM.
Community engagement is much more than belonging to something; it’s about doing something together that makes belonging matter. Brian Solis.
Our experience with the following groups has shown promising results.
Mother-to-Mother Support Groups:
Apart from delivering health education around care during pregnancy and lactation and IYCF, mother support groups are monitoring child growth and development on their own. There has been an increase in early identification and referral of malnourished children. This task-shifting from government community health workers to mothers has substantially reduced the FHW workload of travelling miles, foraging homes for identification and screening of malnutrition.
Men Support Groups:
Engagement with men as heads-of-households is vitally important to steer-in their partnership with mother for continued child care. There is a range of social-cultural norms around the household division of labour that subjugate mother’s role in child care and expose them to dual burden of income generation for the family while managing household chores. Our men’s groups have substantially helped change these family dynamics and community equations. By targeting specific behaviours in child care, our programs are able to receive men’s holistic participation and partnership.
In the majority of rural & tribal communities, health-seeking behaviours contort to the preference of faith-healers over trained medical practitioners. It is more of a matter of trust and family-social practices due to superstitions that families prefer to receive inhumane prescriptions from faith-healers than difficulty accessing quality health services. Our field teams have strategically targeted faith-healers and sensitized them to malnutrition causes and consequences. There are umpteen instances now that faith-healers have avoided maltreatment and instead recommended families to seek medical advice through ASHA and anganwadi workers.
Realizing adolescence is period of a growth spurt and the phase-in life-span where malnutrition sets-in and impacts intergenerational cascade of deficits and disease. We have designed Health and Nutrition Toolkit for Adolescents sensitivities around sexual and reproductive health rights, delivered to school-going adolescents, while dropped out youth are targeted at the community level through adolescent clubs. The adolescents are trained and empowered to become change agents in the community. We have stories of change wherein the adolescents have mobilized their families for constructing toilets in the household, encouraged and accompanied pregnant women in the family for antenatal care and ensured timely immunization in the neighborhood.
Head of the Department, Nutrition & Health
Action Against Hunger