Sure Start works to educate women in India on maternal and neonatal health. Sure Start, an initiative by PATH, supported by the Bill & Melinda Gates Foundation works to promote safe childbirth practices in India. Visit Sure Start! Facebook: http://www.facebook.com/pages/Sure-Start-Project-by- Path/178629192101 Twitter: http://twitter.com/pathsurestart/

1. Neonatal Care in India: Celebrating a different kind of
success
Sixty years after India’s independence,
despite a “booming” urban economy, 300
million Indians (roughly the size of the
USA) still live in abject povertyand one
could argue that the biggest price they pay
for being poor is their health. While health
services in India are generally designed to
be inclusive of all people regardless of caste,
gender, geographic location, socio-
economic status, or any other basis of
exclusion, this doesn’t always hold true in
practice. One area where lack of
inclusiveness can have especially dire
consequences is that of newborn and child
health. The country has the unfortunate
distinction of claiming 30 percent of the
total neonatal deaths in the world. Every
year, 1.2 million of the 27 million babies
born in India die within the first month of
life, according to the latest National Family
Health Survey (NFHS-III).
Part of the problem is limited access to hospital and institutional support. In India, 65
percent of all births occur at home, often without the assistance of a skilled birth
practitioner. When something goes wrong, there is no one to help and often no plan to get
the woman to the local medical center. In rural areas, women often die because transport
is not available.
The Indian government has come up with schemes such as the National Rural Health
Mission (NRHM) and the soon-to-be-launched National Urban Health Mission (NUHM).
Both schemes give high priority to the issue of maternal and newborn health for
marginalized communities, and seek to improve the availability of and access to quality
health care for those at the lowest rung of the socio-economic ladder. Additionally,
government programs such as the Janani Suraksha Yojana incentivize delivery in
hospitals by encouraging mothers to opt for institutional deliveries.
Unfortunately, in a country of India’s size, many local communities are unaware of these
schemes. Those that are aware of the schemes are often confused about the details and
how to go about accessing the services. Even more common is the lack of awareness

2. about why these schemes are important in the first place. In many Indian households,
where the basic issues of survival take center stage, the health of mothers and their
newborns is often sidelined.
Not so in Sabji village in Uttar Pradesh where Ms. Ramvati works. She is a government-
sponsored trained Accredited Social Health Activist (ASHA). ASHAs are part of an
initiative that falls under the NRHM with the aim of bringing communities and health
services closer. Ms. Ramvati makes home visits to pregnant women in the village,
educating them about safe birthing practices.
She explains that the process of bringing about change has not been easy, but using
materials and training provided by a project called Sure Start has eased the way a lot. The
projecta five-year initiative based at PATH, an international not-for-profit organization
supported by the Bill & Melinda Gates Foundationis working with rural communities
in Uttar Pradesh and marginalized urban settlements in Maharashtra to help mothers and
children survive and stay healthy.
Projects such as these work on the premise of community action and involvement. They
work in tandem with the Indian government’s efforts to develop community-level
systems for improved services. The goal is to actively engage with the community to
bring about change from the inside out.

3. “Earlier, people were somewhat suspicious and some even forbade me from coming into
their houses, but I now receive a lot of respect,” says Ms. Ramvati. “People ask me to sit,
offer me tea, and actually listen to what I say.”
Ms. Sudama, a mother of three who is expecting her fourth child, says, “Didi [Ms.
Ramvati] comes to our house, and therefore I know how to access a four-wheel vehicle
when I need to go to the hospital. I have also kept the telephone number of the doctor
handy.” Ms. Sudama’s birth preparation calendar—a gift from Ms. Ramvati—is
displayed prominently on her wall.
On another of Ms. Ramvati’s visits, Ms. Sudama was given a tiffin box. While the
expectant mother cannot break with the Indian custom of feeding her family first, she
now uses the tiffin box to put aside some cooked food for herself and consumes it after
everyone else. “I already have three children,” Ms. Sudama says, “but this time around I
will do some things differently.”
At a time when India’s heroes and success stories are often about economic titans or big
business ventures, it is important for us to remember and strive for another, more
fundamental kind of success—we must celebrate, encourage, and support the numerous
people who are working tirelessly to create tangible change from village to village, city to
city, and life to life. Together they are doing something sacred… nurturing India’s future
and the people who carry it for nine months.

4. Sure Start works to educate women in India on maternal and neonatal health. Sure Start, an
initiative by PATH, supported by the Bill & Melinda Gates Foundation works to promote safe
childbirth practices in India.
Visit Sure Start!
Facebook: http://www.facebook.com/pages/Sure-Start-Project-by-Path/178629192101
Twitter: http://twitter.com/pathsurestart/