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Four women in patterned saris, one holding a toddler.

Savita Rai (left) makes sure daughters-in-law Anjani and Prinyanka follow the steps for safe pregnancy and childbirth.

Mother-in-law changes ancient practices to protect her grandchildren

The women in the Indian village of Amkoil are hanging hand-washed saris out to dry. In the fields, they are bent over, beating sheaves of rice against the ground to free the grains. But when it’s time for the mothers’ group meeting, the pregnant women stop their work to gather in the courtyard of the local community health worker, known as the ASHA (for Accredited Social Health Activist).

They sit in a wide circle accompanied by the family members who will support them through their pregnancy and childbirth. Anjani, 27, is there with her mother-in-law, Savita Rai.

Changing dangerous traditions

Like so many villages where doctors are far away, Amkoil has had high rates of infant deaths. Knowing that simple acts could save many of these babies, PATH launched the Sure Start project to bring education and support to villages. One of the most successful venues for information-sharing has been mothers’ groups meetings, where PATH-mentored ASHAs share sound health advice with pregnant women—and key family members.

At this meeting, Savita squats just outside the circle of women, playing with her grandson. Anjani, who is nine months pregnant, sits beside the ASHA, listening to an instructive story. She peers shyly out from a red and black sari that is pulled over her face.

“If she comes to the meetings and learns the good practices, she will follow them.”
—Anjani Rai

Like most Indian women, Anjani moved in with her husband’s family when she married. She knows well how important it is that Savita is at the mothers’ group meeting. “The mother-in-law makes the decisions in the house,” she says.

The decisions her mother-in-law makes include where Anjani will give birth and how she’ll care for her baby. Women like Savita are often midwives to their grandchildren, using practices they learned from their own mothers-in-law. They don’t realize that many of these practices put infants and mothers at risk. Changing centuries of tradition requires engaging the keepers of these traditions.

“I didn’t know”

So when Anjani was pregnant, the local health worker invited her and Savita to a mothers’ group meeting. Savita went first to make sure Anjani wouldn’t be exposed to “any destructive teachings.”

What Savita found instead was lifesaving information—how to make sure mothers and newborns survive childbirth and the critical days that follow. Years before, Savita lost a baby of her own, a son who died after only 14 days.

“We used a dirty blade to cut the cord,” she says. “We gave the babies cow’s milk—we thought it was god’s milk. I didn’t know about covering the child to keep it warm. I didn’t know about giving birth at the health center or vaccinations. I didn’t know about any of it.”

Savita brought Anjani to the next mother’s group meeting, and she made sure that her grandson was born in a health center.

Born in the health center

“Before Sure Start intervened,” says Dr. Rajendra Kumar, the chief medical officer for the district, “there was no public awareness about the healthy practices that the ASHAs teach or the need to give birth in a health facility or routine immunizations or family planning. That has been changed by Sure Start.”

Particularly significant is increase in the number of women giving birth in health centers where medical care is available if complications arise. In 2007, just 4,000 women in the district used a health center. By 2011, that number had increased to 41,000. And the number of newborn deaths is declining.

For Anjani, Savita’s support remains crucial to ensuring a safe birth for the child she is now expecting. “If she comes to the meetings and learns the good practices, she will follow them,” Anjani says. “And then my husband won’t resist doing the birth preparations or going to the health center.”

“I’ve learned how to take care of the mother and child,” Savita says. “Now I’m not so worried about my daughters-in-law or my grandchildren.”

Photo: PATH/Gabe Bienczycki.