I was excited when I found out I’d be attending the MANSI Thematic Conference in Jamshedpur, Jharkhand. MANSI, the Maternal and Neonatal Survival Initiative, is one of AIF’s flagship programs. Their work—building the capacity of community health workers, or ASHAs (Accredited Social Health Activists) with additional training in newborn care—is something I was particularly interested in, given that my work at BEMPU Health supports research around our innovative products to address infant mortality. Through my work at BEMPU I’ve come to understand how important community health workers can be in identifying health concerns, serving on the front line in providing initial care, and encouraging care-seeking behavior, and was thrilled to have the opportunity to witness firsthand the important work of ASHAs in rural communities.
Our conference kicked off with a presentation by Anupam, State Program Manager of MANSI’s programs in the state of Jharkhand, who gave us an overview of how the organization equips ASHAs with strong training in newborn care, something that is especially crucial in a state like Jharkhand, with a high infant mortality rate of 29 deaths per 1,000 live births (1). It was particularly interesting for me to learn more about MANSI’s work, as a lot of BEMPU’s programs where we deploy our products also engage ASHA workers in supporting newborn care. We were able to directly hear from one of MANSI’s field staff members about the training ASHAs receive, and see some of the tools these women use in their work.
The ASHA system is a program of the Indian Government’s National Rural Health Mission. The program provides every village in India with a trained community health worker—a literate and usually married woman from the community where she will be working—who promotes immunization, gives referrals and accompanies patients for higher care, offers health education, provides essential medications, and much more (2). MANSI provides ASHAs with extra training in newborn care so they can specifically support families with babies who have experienced complications like premature birth. As participants in the MANSI conference, the fellows of CFP had the privilege of traveling to some of the villages around Jamshedpur, Jharkhand where MANSI-trained ASHAs work to meet some of the mothers and families they support, and to hear their stories.
A typical home in the villages we visited
We traveled to different villages for three days and stopped at a few homes to meet various mothers who, for vastly different reasons, required their local ASHA’s support after delivery. We heard stories ranging from heartwarming to downright heartbreaking. One mother, who was still grappling with the post-delivery loss of one of her twins shortly after delivery, was raising three other children in addition to her new baby. One mom, who had previously given birth at home to twins who had not survived, had recently given birth in the hospital to another set of twins and was caring for her new babies with the support of an attentive ASHA, who the family stayed well-connected with to monitor the babies’ health. One young, first-time mom, whose baby was preterm and low birthweight, had no other woman in her life to guide her on newborn care, and appreciated the ASHA’s support and help from Kangaroo Mother Care (skin-to-skin care). Another more experienced mom, caring for a low birth weight baby for the first time, relied on the ASHA to provide care at home when her baby became septic, and the ASHA’s provision of antibiotics kept the baby from experiencing further complications.
Most of the mothers we met with seemed timid, unsurprising given the situation: We, a large group of foreign strangers accompanied by MANSI team members, were showing up in conservative villages and asking these women personal questions about their pregnancy and delivery experiences. Some mothers we spoke with were young, in their late teens or early twenties. In every case, a crowd of onlookers formed as we spoke with the mother and local ASHA.
One of the things I found most striking were the relationships present between the moms we visited and the ASHAs who had previously worked or were continuing to work with them. While many of the mothers were initially very shy and the ASHAs relatively more chatty, as the narratives unfolded—often including stories of ASHAs supporting mothers through their infants’ very critical situations—many mothers seemed increasingly confident in telling their own stories. The strength of the mothers we spoke to shone through as the ASHAs helped them recount experiences in which they — both mother and ASHA—took painstaking care of supporting a new baby through highly adverse situations. Through the stories they told I could visualize the partnership that must have taken place between these women, many of them first-time moms, and the older, more experienced ASHAs to rally around a sick newborn and get the baby the care it needed. It was clear on the face of every ASHA just how proud they were of these mothers and their babies, and easy to envision the teamwork necessary to keep a premature baby healthy in a place where medical facilities are far away and resources are scarce.
Fellows with an ASHA and supervisor, with a mother and baby they cared for
Reflecting in the weeks after the conference about the relationships I witnessed between ASHAs and the communities they support, the phrase that’s stuck with me is one I’ve seen recently on t-shirts and posters: “Empowered Women Empower Women.” The ASHA system itself empowers women—by taking local community members and training them to recognize and respond to basic health needs—and MANSI’s program carries that empowerment even further by providing ASHAs with in-depth knowledge and hands-on training in newborn care. The ASHAs we met, when discussing what motivates them to engage in this work, spoke of how fulfilling it is to know that they are actively contributing to saving infants in their communities. Seeing ASHAs interact with mothers made it clear that this empowerment is contagious. For mothers caring for very ill babies—many living in their husband’s hometowns after delivering their babies, as per tradition, without their own families as a support system—the guidance and encouragement the ASHAs offer seems to be a vital part in promoting healthy outcomes for babies in the community, and helping mothers tackle overwhelming challenges. It was obvious that by the support they offer, ASHAs empower mothers to recognize their own strength and to provide the best care possible for their newborns.
It was empowering for me personally to see such an incredible system of women being champions for other women. I knew when I learned I’d be attending this conference that I would be getting a great public health experience, but I was so pleasantly surprised to also be able to see the female empowerment side of this program. I’m excited to be using my learnings from MANSI in my position at Bempu, and hope to work more with community health worker programs in the future.
1) Govt. of India, Sample Registration System. “Infant Mortality Rate.” NITI Ayaog. niti.gov.in/content/infant-mortality-rate-imr-1000-live-births.
2)“About ASHA – Governnment of India.” National Rural Health Mission, Government of India, nhm.gov.in/communitisation/asha/about-asha.html.