Maternal and Child Health

Improving the health and nutritional status for women and
children in urban informal settlements through Continuum of Care approach

Mumbai (Dharavi, Wadala, Govandi, Mankhurd, Malwani),
Thane (Bhiwandi)

The Problem

Nearly 41% of the population of the Mumbai Metropolitan Region (MMR) of Brihanmumbai Municipal Corporation in Maharashtra, India dwells in urban informal settlements (slums). These slums are faced with a multitude of health problems such as increased risk of maternal and infant morbidity and mortality, prevalence of child malnutrition, high incidence of domestic violence and poor access to health facilities.

Women of reproductive age (15-49 years) are estimated to be anaemic

Children under the age of 5 in India are stunted

Children are in the category of wasting

The urban informal settlements are faced with a multitude of health problems such as the increased risk of maternal morbidity and mortality, low birth weight babies, and poor access to health facilities. The period from the start of a mother’s pregnancy through her child’s second birthday, is a critical window for addressing the long-term consequences of childhood undernutrition.

Source: National Family Health Survey-5

How can we empower communities to improve health and nutrition outcomes for mothers and children in a holistic manner?

Our Work

We believe in developing local, context specific and sustainable solutions which can be gradually taken over by the systems (Health and Nutrition) and community stakeholders. Health and Nutritional status of women and children can be substantially improved if both supply and demand focused interventions are implemented hand in hand.

Aahar Programme

The Aahar programme helped create an evidence-based model for addressing malnutrition of children upto 2 years of age in the urban slums of Dharavi and later scaled to Wadala in Mumbai. The goal of the project is to improve maternal and child health and nutrition, in informal settlements through a partnership with the community and public system. The programme also strives to build community ownership by developing a cadre of trained volunteers and empowering them to negotiate and avail services.

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Healthy Cities Programme

The Healthy Cities Programme (HCP) in Malwani (Mumbai), invests in the first three years of a child’s life (0-3 years) to improve maternal and child health, responsive care and nutrition outcomes. The programme aims for integrated delivery of health and nutrition interventions across the life-cycle, with specific emphasis on the first 1000 days of life, addressing preconception care, planned parenthood, maternal nutrition and mental health, appropriate inter pregnancy spacing intervals, early childhood growth and development and prevention of violence against women and children.

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SNEHA Centre Programme

The SNEHA Centre programme is aimed at improving the health and nutritional status of married women in reproductive age, children less than six years of age and adolescents in vulnerable slum communities of M East ward of Mumbai (Mankhurd, Govandi). The programme delivers integrated health and nutrition interventions across the life-cycle, with specific emphasis on the first 1000 days of life, addressing planned parenthood, maternal-child-adolescents health and nutrition, and prevention of violence against women and children.

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Building Bridges Programme

The Building Bridges programme works in the selected vunerable urban slums of the Bhiwandi-Nizampur Municipal Corporation along with public health and nutrition systems and in tandem with the community to improve the health and nutrition indicators of women and children.

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Reach

4,00,928+

Households
(2016-2024)

2,08,365+

Women in reproductive age
(2016-2024)

1,13,553+

Children
(2016-2024)

Impact

4%

Reduction in stunting among children aged 0-5 years
down from 34% to 30% in 2021 - 2024

13%

Reduction in maternal anaemia:
decrease from 52% in 2021 to 39% in 2024

9%

increase in children (12-23 months old)
who received full immunization for vaccine-preventable diseases from 78% in 2021 to 87% in 2024

24%

Improvement in children covered by ICDS for anthropometry
up from 71% in 2021 to 94% in 2024

Notes from the field
Changing behaviours for positive health outcomes

In the highly gendered society that we exist in, women’s health is often neglected. Hence it becomes imperative to work with their family members including husbands and male figures who are the decision-makers. Long-term behaviour change interventions require a multi-pronged approach targeted towards different stakeholders in the woman’s life to build a support system for her to make healthier choices.

Saba’s* husband Amjad was wary of organisations like SNEHA influencing his wife and family. With the limited interaction that SNEHA’s Community Organiser (CO) was allowed, it was revealed during Menstrual Surveillance that Saba was three months pregnant.

Saba delivered prematurely, in the seventh month of pregnancy, which the SNEHA CO came to know through a neighbour. The baby weighed 900 grams at birth and was kept in an incubator. When discharged after 10 days, he weighed 1.3 kg.

The SNEHA CO visited when the child was brought home. Saba was feeding breastmilk to him through a tube as he was unable to suck milk. The CO educated her about feeding , health and nutrition practices such as kangaroo mother care, exclusive breastfeeding and maintaining hygiene to ensure better health of both, the mother and child. SNEHA continued with anthropometry of the baby which indicated improvement in height (45cm) and weight (1.650 kg) measurements. Saba continued following the care as suggested by the CO.

The continued efforts resulting in positive change in the health of the baby and the mother, also helped increase engagement with husband Amjad. The child is now in the normal category and the parents are responding positively to the health education imparted by SNEHA.

*Name changed

Scaling Our Model

Our partnerships help us scale our models in different contexts and also allows exchange of best
practices with other organisations operating in the Maternal and Child Health sector.

Learn more about how we work.

Our experience in implementing the effective community based interventions to reduce malnutrition are being used to support the Village Child Development Centers (VCDCs) in Kasara. The project is supporting 64 Anganwadi centers in Kasara. It will work to build the capacity of ICDS staff and provide on-field mentoring support in the management of Severely Acute Malnourished (SAM) and Moderately Acute Malnourished (MAM) children and support in establishing referral linkages for child health and nutrition services by bringing about convergence between health and nutrition services departments.