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Poster sure start isofi300610


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Poster sure start isofi300610

  1. 1. ISOFI Integration to Sure Start Project (an initiative to improve maternal & newborn) CARE International India, Uttar Pradesh <ul><li>Project Goal: To catalyze sustainable improvement of maternal & newborn health status through effective community actions in two districts of Uttar Pradesh namely Raebareli & Barabanki. ISOFI Hypothesis: Gender and Sexuality are underlined causes of poverty that remain hidden. Systematic integration of G&S can bring incremental change in maternal and neo health uptake </li></ul><ul><li>Objective1 : To significantly increase individual, household and community actions that directly and indirectly improves maternal & newborn health. ISOFI aimed to create enabling environment for women in the household and the community </li></ul><ul><li>Objective2: To enhance the systems and institutional capabilities for sustained improvement in maternal & newborn health status. Service providers and project staff address their own biases around gender and sexuality before addressing it in the communities. </li></ul>Abstract: Integration of Gender and Sexuality in a maternal health program can bring incremental change in the health behaviours. Not only does this require intensive work with the communities but it requires to work with ourselves, our attitudes and our beliefs. Sure Start anchored a project on Maternal and Neo Natal Health and Inner Spaces Outer Faces Initiatives (ISOFI) integrated gender and sexuality in the case district in Sure Start coverage area. Background Maternal mortality is the highest burden for any country. For India, it is the biggest challenge as over 25% of all maternal and newborn deaths in the world take place in India, a burden far exceeding the country’s share of the global population. Sure Start was launched to catalyze sustainable improvements in maternal and newborn health through effective community action in two districts (Raebareli & Barabanki districts by CARE) of Uttar Pradesh, covering 5.5 million people living in 2 districts, 36 blocks and 1500 villages. ISOFI layered on Sure Start as case control operation research project. The case district received intervention through ISOFI in 100 villages covering 57, 000 population in 4 blocks of case district Barabanki <ul><li>Challenges: </li></ul><ul><li>Donor pressures and targets as both the projects have different donor </li></ul><ul><li>Capacity building and regular reflection on gender and sexuality for entire NGO and government staff </li></ul><ul><li>Taking the interventions to scale </li></ul>Project Duration Sure Start: Project Duration ISOFI June 2006 to September 2011. May 2007- April 2009 for intervention May 2009- April 2010 for dissemination Strategy: Capacity Building, Reflective sessions with service providers and community, BCC strategy to address social norms around Gender and Sexuality, System Strengthening. Activities: Community Focused Approaches such as mothers committee meetings, Local governance meetings, Tweaking tools of Sure Start : mother’s committee meetings and VHSC to address Gender and Sexuality addressing social norms, couples meetings, new parents meetings, community theatre, puppet shows, magic shows, innovative games such as beads game, <ul><li>Results: </li></ul><ul><li>ISOFI intervention has strong association with two of the MNH project’s primary health behaviour goals: preparation for childbirth and skilled attendance at delivery </li></ul><ul><li>Women in the intervention community were 2.68 times more likely to report receiving help with household chores during pregnancy and 1.87 times more likely to discuss the number and timing of children with their spouses. </li></ul><ul><li>Lessons learnt : </li></ul><ul><li>Community engagement is a key to address maternal and neo natal health </li></ul><ul><li>Needs a buy in from the top managers/ directors </li></ul><ul><li>Integrating strategies on addressing social norms on gender and sexuality in maternal health programs is possible: </li></ul><ul><li>a) It requires sustainable efforts </li></ul><ul><li>b) It works best when integrated right from the beginning </li></ul><ul><li>c) It requires the right skills </li></ul>Conclusion ………. Achieving more equitable gender attitudes and behaviors is, of course, a desirable outcome as a step toward the goal of gender equality. In addition, layering simple, community-based gender-transformative interventions into a community health intervention can also provide incremental benefits with respect to desired MNH behaviors. By addressing gender inequalities through change in gender attitudes and behaviors, health programmes may be able to improve the quality of health outcomes and the efficiency by which those outcomes are achieved. Drying & Wrapping of newborn-a demo by MG member Engaging males- a letter from unborn child to expectant father Snakes & Ladders Game-a tool for educating mothers on Birth Preparedness Flash cards used during Mothers Committee meetings, couples meets and new parents meets A husband shares: “When my wife asked me to get her something, I would bring it separately for her. I would fill the water, wash my own vest and underwear, and she washed my pants and shirts. Even if I asked her not to wash them, she would not listen. Of course, I used to feel shy, as other members in the family would say that not only does he wash his own clothes, he washes his wife’s clothes, too!” According to One ANM , “I am touched by my own unequal treatment of the girl child. We prefer the boy child [over the girl child], even though men drink and treat us badly while girls take care of us. We need to appreciate our daughters.” Beads game to reduce stigma for women who give birth to girls children <ul><li>Key factors identified by Sure Start that impact MNH: </li></ul><ul><li>Cord Care </li></ul><ul><li>Thermal care </li></ul><ul><li>Immediate breastfeeding </li></ul><ul><li>Danger signs recognition </li></ul><ul><li>Birth Preparedness </li></ul><ul><li>Key factors identified by ISOFI : </li></ul><ul><li>Lack of Agency or decision making power. </li></ul><ul><li>Restricted access and control of women over resources. </li></ul><ul><li>Restricted mobility of women. </li></ul><ul><li>Gendered division of labour. </li></ul><ul><li>Violence, both physical (from beating to forced sex during pregnancy) as well as emotional and psychological violence </li></ul><ul><li>Son preference or pressure to give birth to a male child. </li></ul><ul><li>Spousal Communication </li></ul><ul><li>Contacts: </li></ul><ul><li>Mousumi Kundu </li></ul><ul><li>Suniti Neogy </li></ul><ul><li>Sanjay Tripathi </li></ul><ul><li>Devendra Tripathi </li></ul>District Barabanki District Raebareli Communication Household Empowerment IPC & Postpartum care 15% Level-3 Awareness & Advocacy 60% Level-1 Community Mobilization 40% Level-2 ASHA ANM AWW <ul><li> </li></ul><ul><li>Village Health & Sanitation Committee (ensuring quality & regularity of services, supportive supervision) </li></ul>Checkups & Immunization Counseling & Nutrition Referral & Counseling <ul><li>  </li></ul><ul><li>CBOs </li></ul><ul><li>(Checks & </li></ul><ul><li>Balances) </li></ul>Families of Pregnant Women & Newborns <ul><li>  </li></ul><ul><li>SHGs </li></ul><ul><li>(Checks & Balances) </li></ul>System Strengthening