From 24-26 September, I was visiting one of the poverty prone Upazila (sub-districts) in Bangladesh named Karimganj, surrounded by low lying areas and located 140 kilometers north-east of the capital, Dhaka. People have limited options for livelihood, often depending heavily on nature and rain water. For most of the year, the areas are water logged which causes lower production of vegetables and fruits. Rice is the major food but imported milk powder and low quality junk foods come from neighboring town. The literacy rate of this sub district is only 20.3% (for those above 7 years of age).
My interactions with the villagers, especially with the women, of this sub district amazed me due to their concern with nutrition, both for the mothers and babies, during pregnancy and during lactation. It is worth noting that Bangladeshi children suffer from high rates of micronutrient deficiencies, particularly vitamin A, iron, iodine and zinc deficiency. Malnutrition among women is also extremely prevalent in Bangladesh and more than 50 percent of women suffer from chronic energy deficiency. Studies suggest that there has been little improvement in women's nutritional status over the past 20 years. However, in this sub district, women are now aware of malnutrition and its impact. They would like to improve nutritional status for their babies and themselves. CARE Bangladesh has been implementing a project named Akhoni Shomay (Window of Opportunity) since July 2009, as a part of a CARE global initiative funded by CARE USA, that focuses on improving the nutritional status of children under two years old from extremely poor households and communities in Karimganj Upazila in the Kishoreganj district.
CARE Bangladesh ensures the participation of people in implementing this project. It therefore helps each of the first level of local government units (Union Parishad) to organize monthly coordination meetings at the local level. This type of monthly meeting analyses the health situation of each village in terms of pregnant and lactating mothers, breastfeeding, immunizations, family planning and other related issues. Antenatal care, exclusive breastfeeding for babies during their first six months, proper weaning food during the seventh month, immunizations and family planning services are critically reviewed for women and babies. In addition, necessary support and technical directions are provided to implementing organizations both for government and NGOs through these meetings. The Union Parishad takes a lead role in improving maternal and child nutrition status in their respective villages. Further, CARE Bangladesh created pool of community counselors who visit house to house to reach out to pregnant women and lactating mothers. These counselors do one-to-one interpersonal counseling to ensuring the proper nutrition of pregnant and lactating women and their babies. The counseling session varies on a monthly basis, depending on where a woman is in her pregnancy and lactating period. At the later part of pregnancy, it focuses on early initiation of breast feeding and exclusive breast feeding for first six months and on-time vaccinations. Immediately after delivery it re-counsels the same issues and provides mental and technical support. The community counselors are assigned specific households to support on a daily/weekly/monthly basis to ensure early initiation of breast feeding, maternal nutrition with iron folic acid supplementation, immunizations, exclusive breast feeding, and weaning at seven months. Micronutrient supplementation is provided from the seventh month onward for the babies. The counselors and their supervisors also take care of post partum depression and refer to appropriate resources for its management.
Mothers, guardians, community and religious leaders, school teachers, adolescents’ boys and girls and concerned males are all brought under the umbrella of Akhoni Shomay (Window of Opportunity) to build each one’s capacity to understand the importance of nutrition and micronutrients for mothers, children and the future of the nation. The project has partnered with the government and with other NGOs not only for health and family planning but also for education, agriculture and rural development to treat nutrition as a cross cutting issue. From my field visit, I found it to be taking the form of a social movement to improve the nutrition status, with villagers and mothers taking the lead in the movement. CARE Bangladesh and its local partner POPI facilitate the process with technical and financial supports.