Raipur, August 7, 2019: Surguja district of the central Indian state of Chhattisgarh has recorded the world’s highest breastfeeding rate.
The land of iridescent forests, dazzling waterfalls and sweeping tablelands, tucked away in the foothills of the mighty Vindhyas, has overtaken the central African country of Rwanda that has 87 percent breastfeeding rate.
Surguja supersedes it with 87.5 percent, although it continues to suffer from poverty, unbridled mining, deforestation and man-animal confrontations.
The World Breastfeeding Week (WBW) is held August 1-7 every year since 1992. More than 120 countries, including India, celebrate the week.
The goal of the week is to promote exclusive breastfeeding for the first six months of life which yields many health benefits, providing critical nutrients, protection from deadly diseases such as pneumonia and fostering growth and development for the first time in 1991.
Breastfeeding should ideally start within one hour of birth, to benefit both the baby and the mother, says the World Health Organisation (WHO). Exclusive breastfeeding reduces neonatal and infant mortality, if followed for the first six months.
Like most Indian village communities, Surguja had no clue about adequate breastfeeding. Colostrum, the first yellowish milk considered the first immunization for infants, was kept away. There was no focus on breastfeeding children within an hour of birth, while most children were given water, sugar drinks, animal milk, herbal water, or tea after birth.
Nearly 100,000 children die every year in India due to diseases that can be prevented through adequate and exclusive breastfeeding, according to a UN report, Global Breastfeeding Scorecard. Not just India, worldwide, breastfeeding rates are falling: a mere 23 percent in the US, while the UK lags behind at just 1 percent.
The change in Surguja started in the summer of 2002, two years after the formation of Chhattisgarh state. The new state faced several social and developmental challenges, the gravest being public health. In rural areas such as Surguja, infant mortality rates were as high as 95 per 1000, compared to 68 per 1000 nationally.
Out of desperation, the state health department initiated a partnership with civil society. The outcome was India’s largest community health volunteer program, the mitanin program.
Mitanin in Chhattisgarhi means a female friend. According to traditional customs of female bonding, mitanin was a girl’s friend, philosopher and guide for life. It is this custom that was built on, to create a new type mitanin, a trained healthcare friend of the village, selected by the community and approved by the panchayat.
“The main beneficiaries of this innovation were children and mothers living in rural habitations,” says Basanta Kumar Kar, a pioneer of the movement who was also the first member secretary of the newly-formed State Advisory Body on Nutrition, Chhattisgarh in 2002.
As the mitanins were volunteers from the community, they brought health awareness, care, counsel, support and services at the doorstep of all rural families. Soon, surveys started revealing how malnutrition fell in Chhattisgarh by 20 percent, a record in the country.
“In tribal areas, breastfeeding is not a taboo, but a sacred practice,” says Kar. “The intense home contact and inter-personal counseling by the hamlet-level nutrition warriors led to proactive change in people’s behavior. I recall recruiting almost 60,000 such change-agents in 20,000-plus villages of Chhattisgarh.”
He had also introduced the concept of “dharam dai,” or lactating foster mothers who would voluntarily feed community children, whenever needed. Meetings of daughters in law with mothers in law and wives and husbands helped demystify breastfeeding facts while healthy baby shows often worked to encourage mothers to breastfeed their children well.
From 2012, yet another innovation transformed Surguja. It was prompted by the realization that the highest percentage of children died before one year of birth in Surguja among all the districts. To tackle the crisis, a community-led, panchayat-supported program, the Surguja Suposhan Abhiyan, was launched—involving volunteer mothers.
With technical and implementation support from State Health Resource Centre (SHRC), village mothers started running community crèches for children under three years, called Fulwari.
Each Fulwari ran from space voluntarily given by a community member. Each got a grant of around 4,000 rupees for utensils, bed nets, toys. Each made three hot-cooked meals for children and two for pregnant women. Eggs, per child per week, apart from oil and vegetables were emphasised in the menu, finalised by the mothers. Mothers volunteering to work in a Fulwari also got food for that day.
And the result was there for all to see. A study in association with UNICEF showed commendable success within one year of enrolling at Phulwari Centres, with a fall in malnutrition levels among children, from 45 percent to 30 percent. The National Family Health Survey-4 of 2015-2016 showed a steep rise in breastfeeding rates, not just in Surguja, but nearby districts like Rajnandgaon (84.6 percent) and Kabirdham (84.9 percent).
Despite having one in five people steeped in extreme poverty, Surguja now has child malnutrition parameters that are well below the national in every possible way.
Accolades are rolling in for the first-of-its-kind scheme at Surguja. It has been recognized as the Best Innovative Activity by the federal government’s Centre for Innovation in Public Systems. The European Union has also endorsed the initiative.
“We need to learn and replicate such best practices,” says Kar. More than the awards, the word needs to spread. Fulwari schemes have spread to all the 85 tribal blocks in 19 districts.
Surguja has become the gold standard for radical, out-of-the-box weapon to fight India’s war on malnutrition, across all villages, districts and states.