The Sure Start ripple effect

Kamraj Nagar is a small, poor urban settlement in Mumbai, Maharashtra where Sure Start operates. For the past three years, in ever-increasing numbers, the residents here have been working together with the project to ensure that mothers and their babies survive and stay healthy. In the process of doing so, they have seen a change for the better not only with regard to maternal and newborn health in their community, but also within themselves.

Take Ms. Madhavi Dewale for instance. She is a tiny lady with a big moon-like face and an ever-ready smile. Madhavi is a community-based health worker who was trained by Sure Start to be one of the “foot soldiers” of the project, working in the field to keep a pulse on her community’s concerns and needs as well as building one-on-one relationships with the residents. She loves her job and is very good at it.

On a typical day, Madhavi along with her fellow health workers makes home visits to pregnant women and new mothers in the community, offering them support and guidance on lifesaving maternal and newborn health behaviors and practices. Madhavi’s job doesn’t just stop with the women; she also counsels the men to take care of their pregnant wives and to stop any domestic violence. On more than one occasion, she’s exchanged sharp words with husbands who have mistreated their wives. “I never used to be so confident,” says Madhavi. “I found it difficult to talk to people. But now I can talk to anybody. I have made so many friends. Working with Sure Start has filled my soul with hope.”

In her three years as a field worker with the project, Madhavi has certainly collected many stories of hope along the way. She recalls how during one of her field visits, she found out that a pregnant woman was bleeding. “She was so scared—she thought she was going to die. Nobody knew what to do,” recalls Madhavi, who went with the woman to the hospital and stayed there with her all night, making sure that she received proper care from the doctors and nurses. The woman survived and gave birth to a healthy baby. Till this day, she calls Madhavi her angel. Another time, a pregnant woman went into labor while her husband was away at work. Madhavi quickly banded together other residents to help the woman get to the hospital safely, and to ensure that her children were taken care of while she was away.

Seeing such acts of community togetherness and dedication has turned Mr. Ratnam Devandra, a long-time resident of Kamraj Nagar, from being a cynic to being a believer. He explains that years ago Kamraj Nagar had been at the center of a major caste riot. Since then, he has seen many organizations come and go, with hopes of creating community cohesion and offering various services. So when Sure Start first came to his community three years ago, he thought it would be more of the same thing. “I thought they would just put up a banner, hold a few meetings, and that’s it. But then I saw how much good they have done. So I thought I’d help too.” Mr. Devandra offered his small, centrally located office space as a community resource center (CRC) for the project. In this space, Sure Start staff and volunteers hold mothers’ group meetings for pregnant women and their mothers-in-law. The meetings are lively affairs with music and games to help create awareness about positive maternal and newborn health behaviors and practices.

Ms. Savita Dubey, who is 41 years old, lives in a small one-room hut located opposite to the place, where these mothers’ group meetings are held. She proudly mentions that her son Ashok, an auto-rickshaw driver, has volunteered with Sure Start for the emergency transport system for pregnant women. His number and name are neatly written on a small piece of paper and displayed on the CRC’s wall, along with those of 13 other auto-rickshaw drivers from the community. Savita says that her older son was also inspired by the project. He has just completed a training session for driving four-wheelers, so that pregnant women in his community are better able to get to the hospital.

The young boys in Kamraj Nagar are also doing their bit. They are on call to run into the narrow gulleys of the settlement and carefully carry pregnant women out in case of an emergency, as stretchers don’t fit in the tiny lanes.

And what do all these efforts by so many different members of the community add up to? “Peace of mind,” says Ms. Sonam Sachin Pawar, who is 26 years old and a new mom to a healthy baby boy. She recalls how with her first pregnancy she was scared all the time; she felt unprepared, unaware of what to expect and how to cope. After her delivery, Sonam was in the hospital for many months due to complications. She says that her second pregnancy was an entirely different experience due to Sure Start. She is particularly thankful for the home visits by Ashwini didi (“sister” in Hindi), a health worker like Madhavi. Thanks to a birth-preparation calendar she gave to Sonam, who still has it taped up on her kitchen wall beside a rack of steel utensils, Sonam was fully prepared for her delivery—with the doctor’s number, her transportation to the hospital arranged for, and her tetanus toxoid vaccinations all neatly recorded on the colorful chart. She was also much more aware about monitoring danger signs and ensuring proper nutrition for herself during her pregnancy. She is convinced that these simple practices are responsible for her safe and complication-free pregnancy this second time around. “We women in this community don’t feel scared anymore. We feel relaxed,” says Sonam with a smile as she cradles her newborn in her lap while hugging her three-year-old daughter beside her. “We know there’s somebody there for us who cares about our babies, just as much as we do.”