The project named "Preventive and Promotive Primary Health Care Services for Mother and Child". This project was implemented in 17 villages of Bawal Block, District-Rewari Haryana and was Funded by ASAHI INDIA GLASS LIMITED (BAWAL) and YOUTH REACH (N DELHI). MAMTA was the implementing partner in this. Here are some case studies under the project..

CASE STUDY NO.-1
Name : Surashta
Age : 30
Sex : Female
Education : Primary
Marital Status : Married
Nativity : Patuhera, Bawal, Rewari (Haryana)
Family Size : 06
Occupation : Tailoring & House keeping
Family Monthly Income : Rs. 1800

Surashta is a resident of Patuhera Village. She was 7 months pregnant when she came in contact with MAMTA’s workers. Before MAMTA’s intervention she had already been registered with the local Anganwadi of that village. In the initial phase of the intervention, it was noticed by the workers that she did not take the proper medical and nutritional precautionary measures, which is essentially required for any pregnant women and her baby in the womb. The following were the lapses discovered:
·TT injections were not administered
· No diagnosis by the doctor was done at any stage
· Iron supplements (IFA) were not taken
· Intake of prescribed diet was not done
· Exhaustive activities like fetching water from long distances was done
· Expecting her fourth child despite her weak physical health

In the wake of these discoveries, the MAMTA’s staff came to help the woman and at the earliest possible sensitised her about the significance of the medical as well as the nutritional requirements needed for a safe delivery. During the intervention, the woman was motivated to undergo at least two medical check-ups, to take 100 IFA tablets, get administered with two TT injections in the seventh and eighth month, to adhere by the prescribed diet for a pregnant woman, not indulge into heavy physical activities which may be dangerous for the lady and her baby and last but not the least to never go for pregnancy for the desperate need of a male child (male child being considered as an economically productive sex).

After several interviews, it was brought out that the pregnant woman was being held responsible for delivering three girl children, hence she was pressurised by her in-laws and her husband as well to go for the fourth child who should possibly be a male child.
Looking at the contemporary situation, it was determined by the staff of MAMTA to motivate the people around Surashta who were her in-laws, parents, husband and other relatives. Consequently, all the above-mentioned people were sensitised and motivated to create a congenial environment wherein the expecting mother can have the mental and physical peace for the delivery of a healthy child. They were also sensitised to change their inclination towards the preference to a male child. Thereafter, the pregnant woman and her in-laws were sensitised to take her for an institutional delivery in CHC or district hospital for which they disagreed on the grounds of their financial status and non-accessibility to the health services to a common man and therefore for them the only viable alternative left was to have a delivery under the supervision of a dai. Here it was informed to them that if they had to take the service of a traditional birth-attendant TBA (dai) then they should make it a point that the dai must be a trained one who can take care of the most significant aspect in delivery i.e. 5 cleans. Apart from this they were also advised to take care of the hygienic situation of the room and not to use cow dung on the walls and floors that they follow as a ritual in their lives.
In the subsequent visits, the staff of MAMTA explained them (pregnant woman and her family members) to start breast feeding after an hour of the delivery and not wait for the sister-in-law to come and follow the ritual of cleaning the breasts first and then start feeding the new born. Besides this, they were also told not to give any kind of supplement in the form of ghutti (honey) or milk from the cattle and adhere by the essential prescription of exclusive breast-feeding for 6 months and then start giving semi-solid food such as dal and rice water, etc.

After following each of the measures illustrated by MAMTA’s staff, it was observed that Surashta delivered a healthy baby and she was herself keeping good health even after the critical period of the delivery. The baby incidentally happened to be a male child, which brought much delight to the faces of Surashta’s family members.

In recognition to MAMTA’s endeavour, Surashta and her family came forward to express thanks for the timely guidance and support extended by its staff and invited them for the well-known local ceremony called kuan pujan (worshipping well).

CASE STUDY NO.-2
Name : Suman
Age : 24
Sex : Female
Education : Primary
Marital Status : Married
Nativity : Sulkha, Bawal, Rewari (Haryana)
Family Size : 06
Occupation : House keeping
Family Monthly Income : Rs. 2800

Suman is a resident of Sulkha village and her husband is working in a private company, who is the only breadwinner of the family. She was 7 months pregnant when she came in contact with MAMTA’s staff, before that she was staying at her maternal home. After attending the group meetings conducted by MAMTA, Suman started realising the significance of the inputs, which are to be adhered by at the time of pregnancy. Slowly and gradually she started taking interest and she understood that it was important to attend these meetings for the benefit of her baby and her own self. Once it happened that Suman could not attend the meeting to which the staff of the MAMTA promptly responded by paying a visit to her home where they came to know that she was keeping unwell due to acute headache and fever. During this visit, the workers came to know that Suman was of the impression that her sickness was due to the intake of IFA tablets. Here, it was pointed to Suman that generally the prescribed intake of IFA tablets does not cause any serious side effects or such ailments mentioned by her. Following which it was advised to her to get herself medically examined in order to find the real cause of her sickness.

Suman had a history miscarriage when she was 6 months pregnant and it was ascertained that it happened due to various reasons such as her indulgence in heavy physical activities like fetching water and having not undergone proper diagnosis. A point was made to her that she avoid doing heavy work and take appropriate rest and at the same time must get herself checked at CHC or a district hospital. Suman, was also informed that they (MAMTA) would escort her to the CHC for her medical examination if needed. On which, she responded that she would speak to her husband about the same. After speaking to her husband, it was agreed upon by them to go to a private doctor in Rewari city and not to CHC or district as they found the services at public health system offering poor quality. Thereafter, Suman and her sister-in-law arranged money and vehicle to visit Rewari for meeting a private medical practitioner (Dr. Sachdeva Hospital). After the treatment process, she is now fine and sticking to the prescriptions illustrated by MAMTA’s staff.

The key factor in all the exercises involving Suman’s treatment was the motivation built by MAMTA wherein the focus was laid upon accessing the quality health services no matter it was a private hospital or a government one and also following the precautionary norms for a safe delivery.

CASE STUDY NO.-3
Name : Chand Singh
Age : 65
Sex : Male
Education : nil
Marital Status : Unmarried
Nativity : Rajgarh, Bawal, Rewari (Haryana)
Family Size : No family
Occupation : Unemployed

Chand Singh is a resident Rajgarh village. He has been living alone for a long time since he was disserted by his family long before when he was considered to be physically and mentally unfit. During a health camp organised by MAMTA dated 09-11-04, it was found by the MAMTA’s Director, Dr. Goswami and his team that Chand Singh had been affected by a serious infection in his right leg which led to the formation of worms around the infected area. After looking at this, Dr. Goswami advised him to get himself treated at the district hospital at the earliest as it can lead to further complication of amputating his leg. He also advised the workers to take care of this case and motivate the rural inhabitants and panchayat in kick-starting his treatment process.

It took several meetings with the village people and panchayat when they at last realised and decided to escort him to the district hospital as he could not bear the expenses and also there was no one to look after him. With the treatment on, Chand Singh got gradually recovered and has now become a productive person, as he is fully involved into labour intensive activities. Above all, his community members started accepting him as rightful inhabitant of the village, which he deserves in the first place immaterial of his physical or mental health.

What we can draw from this case is that the endeavour made by MAMTA in developing the sensitivity of the community members paid dividends in the form of total cure of the neglected individual and also transforming him into an economically productive entity. It also exemplifies the MAMTA’s stance in bringing about a health seeking behaviour and creating a conducive environment wherein a person can substantially contribute towards his/her personal and overall development of the village.

CASE STUDY NO.-4
Name : Santra
Age : 35
Sex : Female
Education : nil
Marital Status : Married
Nativity : Sukh Teri, Bawal, Rewari (Haryana)
Family Size : 07
Occupation : Housekeeping & agricultural activity
Monthly Income : Rs. 2000

Santra is a resident of Sukh Teri village and her husband is the only breadwinner in the family. She came in contact with MAMTA’s staff when she was four months pregnant. Santra used to visit Anganwadi centre in the afternoon to fetch the set quota of food guaranteed by the government for the pregnant and lactating women. There in the meeting organised by MAMTA’s workers she came to know about the essentially required information for an expecting woman. But she did not follow the set basic norms and eventually became sick. After getting to know about her health, the workers paid a visit to her home and discovered from the interaction with her that she is not sticking to the above-said norms such as she was not getting checked, not following the diet pattern, involved into physically tiring activities. Slowly and gradually she realised the significance of information being disseminated by MAMTA for the health of her baby and herself.

With the constant visits paid to Santra’s home, it came to the notice of MAMTA’s staff that now she is recovering from acute anemic problem as her hemoglobin level has risen from 7 to 11.5 due to intake of iron-contained diet and IFA tablets. Apart from this, she is also following the other norms like taking 3 to 4 hours of rest in the afternoon and not getting involved into the physically exhaustive activities. Now she is into her eighth month of pregnancy and she and her family is being motivated by MAMTA to opt for the institutional delivery for the safety of her baby and her own self. They advised her to either access the health services offered by the government machinery or visit the private practitioner.

This case suggests that the efforts made by MAMTA were resulting in the change of the mindsets of the families associated with a pregnant woman with regard to their age-old practices such as giving a diet full of fats (desi ghee) and not giving the iron rich diet which is very significant for the safe health of an expecting woman. Moreover, they realised the importance of an institutional delivery under the supervision of a qualified medical practitioners and not to the RMPs (Registered Medical Proferssionals) who are most of the time quacks.

CASE STUDY NO.-5
Name : Bimla
Age : 25
Sex : Female
Education : Primary
Marital Status : Married
Nativity : Naichana, Bawal, Rewari (Haryana)
Family Size : 08
Occupation : Housekeeping & Agricultural activity
Monthly Income : Rs. 2800

Bimla is a resident of Naichana village and her husband is involved in agricultural activities with a small land holding. Her financial condition is weak as she belongs from the weaker sections (Dalit) and hence she and her family are forced to stay at the periphery of the village. Within the social milieu of the village they have to face whole lot of problems of fetching water from long distances as their community well has dried up and they are barred to fetch water from the tube well of upper castes in the village. Therefore, Bimla and many other persons from the periphery have to struggle for fetching water from outside which particularly is very dangerous for the pregnant and lactating women and hence they are becoming the victims of the perennial Indian caste system.

She was 3 months pregnant when she came in contact with MAMTA in the group meeting being organised by them where she was sensitised about the issues of great significance for the pregnant and lactating women at the Anganwadi centre situated at the periphery of the village. Since then she and her family is keeping a close watch in the form of providing the nutritional supplements, medical assistance, psychological support, etc. which are essentially needed for the well-being of herself and her foetus in the womb. Apart from that, the workers also tried to change the attitude of village panchayat and the people from upper caste in the series of meetings being conducted at their premises. The issues discussed over there were regarding health of the mother and child which is the area of specialisation and focus of MAMTA and also how to change the casteist mindsets of the village people.

However, the outcome of these efforts was not very satisfying as the phenomena of caste-based practices are deep-rooted and discrimination is done in every walk of village life.