Asha Maternal and New-born Health Care for Delhi Slum Dwellers
Asha believes that every child deserves a healthy start in life, and every mother access to quality healthcare during pregnancy and childbirth.
The Problem in Delhi Slums
The urban population is increasing rapidly in India, with more than 81 million residents living below the poverty line. Cities are marked by inequitable distribution of healthcare services and utilization among the settled urban population and marginalized slum dwellers. Of these, pregnant females and children constitute are at high risk for poor neonatal care, neonatal tetanus, diarrhea, and respiratory infections.
In 2015, The State of the World Mothers reported that only 19% of women in Delhi slums were attended by skilled birth attendants, and only 27% completed their pre-natal visits. Home deliveries have been the norm (80%), and hazardous practices common. Post-natal check-ups have been rare. Studies have shown that only 40% of infants receive breast feeding within one hour of birth and that the rate of exclusive breastfeeding is about 66%, far lower than the optimal practice. 58% of urban poor women suffer from anemia, which is a major cause of maternal mortality.
Asha’s Interventions for Women and Newborn Delhi Slum Dwellers
Asha’s antenatal clinics register expectant mothers and provide them at least 3 antenatal check-ups for fetal health using ultrasounds, screening for infections, vaccination against tetanus toxoid, in addition to iron, calcium and folic acid tablets. These antenatal services, as well as education on nutrition, personal hygiene, breastfeeding, and family planning are also given the expectant mothers and their families.
When Asha team members identify cases of pregnancies at high-risk due to maternal age, hypertension, lung, kidney, heart problems, diabetes or sexually transmitted diseases, they take care to regularly monitor their progress, and encourage them to register in the nearby government hospitals to ensure safe delivery. CHVs visit their home every week and conduct check-ups. When required, they accompany them to the appropriate health facility.
Pregnant mothers are encouraged to deliver at certified healthcare facilities or at home attended by trained nurse-midwives. The Asha staff and CHVs intercede when unregistered medical practitioners attempt to provide potentially dangerous services to women in labour, and provide expectant mothers with free birth kits in the last trimester of the pregnancy.
The Asha team encourages new mothers to breastfeed within 6 hours of delivery, to use handwashing and hygienic umbilical cord and skin care, and to take iron, folic acid, vitamin and calcium supplements. Their progress is followed with regular postnatal visits up for to six weeks after birth.
Impact of Asha’s Interventions in Women and New-borns in Delhi Slums
- 100% pregnant women across Asha’s slums undergo 3 ante natal check-ups;
- All pregnant women in Asha-supported slums receive basic laboratory investigations;
- All pregnant women receive two doses of tetanus toxoid vaccination to immunize both the expectant mother and her child, preventing neonatal tetanus;
- 99% of deliveries take place either in hospitals or by trained birth attendants;
- No maternal deaths were reported in the last 5 years;
- Fewer than 5% of newborns in Asha slums have low birth weight (< 2.5kgs or 5.5 lbs);
- 99% of new-borns breastfeed within the first six hours of birth;
- 99% of children between the ages of 0-1 years receive the BCG vaccination;
- Asha slum neonatal mortality rate is only 19.2 per 1000 live births in comparison to 23 per 1000 live births in India as a whole.
Reena’s successful journey towards Motherhood
Reena and her husband Mukesh are residents of Zakhira slum colony. They were married for more than eight years but did not have a baby. They came to the Asha center for treatment and were immediately referred to the Asha Polyclinic and Diagnostic Center. The doctor after conducting some tests diagnosed that Reena with a thyroid problem and started treatment. After a few months of treatment, Reena conceived in August, 2019. The Asha team began providing Antenatal care and Community Health Volunteers (CHV) made regular home visits to monitor her health and provided her with dietary supplements including iron, folic acid and calcium. Reena’s pregnancy was high risk due to her medical condition The CHV accompanied her to the nearest government hospital to register for delivery.
When Reena completed her gestation, her family insisted on home delivery because of the ongoing Covid-19 crisis. However, Asha team members explained the complications of her pregnancy to the family and had her admitted to the public hospital. The doctor found that the umbilical cord was entangled around the neck, and after a successful caesarean operation, Reena delivered a baby girl weighing 5.9 pounds. After delivery, she received postnatal care first at the hospital and then by the Asha team at her home. Both the mother and daughter are healthy and progressing well.