Sijo John, Shipra Prakash & Gajinder Kalia
A slightly revised version of this article was originally published in Outlook Poshan
Mohini Sutar, ASHA Sahayogini, Badgaon block in Udaipur, visits pregnant women to counsel them as part of her work. Often, she meets resistance from mothers in-law. “They believe that some food items can make the birth difficult”, she shares, standing near her Anganwadi, flanked by the images of bathua patta, sarso ka patta, mooli ka patta, gur, channa, gooseberry and lemons, among other food items. “Convincing them is not very easy and can get frustrating. But these days, when we go on home visits and refer to these new paintings”- pointing to her backdrop- “our work is made easier as everyone has seen these messages.
“There are times when women are reluctant to eat peanuts, but slowly, I manage to convince them that it is good for them, using these paintings for recall. Older women also refer to these images and can understand, even if they cannot read. These days, it is easier to assure women and their mothers in-law that chaas, peanuts and bananas are good for them during pregnancy”, she says, with pride in her eyes. Durga Patel, ANM, working in Karanpur village shared how the newly done up walls improve the aesthetics of her workplace, “I have 5 Anganwadis in my service area. All of them have been recently painted. It’s not only village residents, even we feel good now when we visit newly painted Anganwadis”.
An Anganwadi Centre is an ubiquitous part of the community landscape, alongside Panchayat bhawans, village commons, and chabutras in our country. It is a site of action, where deliberations and policy designs transform into services provided through the cadres of Anganwadi Workers, ASHAs and ANMs. Through a simple set of rooms and home visits, a formidable trio of pink, blue and white-clad frontline workers, strives to ensure that mothers receive adequate care, food and advisory throughout their pregnancy and early motherhood, provide their children disease-free and well-fed childhood through immunization and nutrition services, and strengthen cognitive growth of children through non-formal, early education.
POSHAN Abhiyan was launched by the Prime Minister as a clarion call for holistic nutrition across the country from a pulpit in Jhunjhunu, Rajasthan in March 2018. Government of Rajasthan was early in recognizing the crucial importance of including facets of Social Behaviour Change Strategy to break cyclical under-nutrition. Through the SBC framework, the State focuses on inter-personal counselling by frontline workers, supported by mid and mass media engagement to achieve this goal. While mass media campaigns make inroads into every living room through televisions, there are still significant media-dark pockets in our country, making it essential to have “leave-behind” souvenirs that the community sees and ponders upon. Mid-media interventions such as wall paintings, serve this purpose.
A wall painting is not a new idea for a Rajasthani village. No marriage ceremony is complete without freshly done up walls, displaying names of the bride and groom, along with camels, horses, and elephants, assembled in an auspicious montage. RajPusht, a project for reducing instances of low birth weight, used the walls of Anganwadi Centres as a canvas for aspirations and messages for the community. Walls of the Anganwadi and high footfall community locations were used to publicize messages on nutrition. Design elements and motifs were drawn from local customs, foods, preferred practices etc and were based on robust studies undertaken in Rajasthan, commissioned by Children’s Investment Fund Foundation and Bill & Melinda Gates Foundation. This was done in Bhinder, Sarada, Badgaon and Kherwada blocks of Udaipur, covering more than 1,000 Anganwadi Centres in the four geographical corners of the district.
There are two parts of the design: the first gives a face lift to the Anganwadi Centres, through a fresh coat of vibrant blue, along with a customized logo of “Anganwadi champions”. These champions are a bright-eyed pair of a girl and boy, carrying aloft a trophy, a slate and a laddoo, skipping on their way to the Anganwadi Centre, under a rainbow. The second part shows messages on diet, IFA and calcium consumption and pregnancy care, with the image of a pregnant woman, dressed in traditional attire, looking over from the side.
Preliminary reactions from the community have been positive, if lagged due to the lockdown and resultant social distancing. Repainting of the Anganwadi walls and the logos have drawn comparison with private play schools, with delight over the fresh, clean look. These have also merited a closer look from women and their families in the catchment area. Says Lali, a 25-year-old expectant mother from Mehro Ka Gurha, Badgaon Block, “After seeing the food messages on Anganwadi walls, I started consuming peanuts”. Such pregnancy care messages also resonate with young fathers, who are often not privy to conversations between the frontline workers and their wives. “Whenever I cross this wall, the messages written on this painting get my attention. It helps me understand what my wife should eat”, says Vani Ram, a young father.
The paintings bolster interpersonal counseling undertaken by the ANM, ASHA Sahoyogini, and Anganwadi Workers. These have found their way into conversations with expecting mothers and families. Since the message on the walls stay long after the conversation is over, it acts as a memento and reinforces the messages. Reaffirming this, Kailash Saini, Anganwadi Worker at Bhatra Khurd Village in Bhinder block, says, “Human memory is shortlived, so we tend to forget many things. Since the walls have counselling messages, my community can see these messages over and over again. Gradually, I believe all of this will become a part of their routine.” Says Pyari, a long time resident of Bhatra Khurd village, “I have spent almost my entire life in this village. But this is the first time I am seeing wall painting explaining what a pregnant woman should eat. This is a good initiative and I am sure many are learning from it.”
An image overhaul and behaviour change is a journey of many incremental steps. Our work suggests that branding activities and customized messages in the heart of well identified community spaces, is a good way to reiterate messages and start, if not steer, important conversations on nutrition and well being of pregnant women. It also reaches their families and envelopes the community in a collective sense of responsibility. As the popular adage goes, it takes a village to raise a child.