India: How CARE helps women get better healthcare

Laurie Lee
Kanti (left), a young woman expecting her second child, listens to advice from a doctor via a free mobile phone service

Last week I went to India where CARE is working with the UK Government (DFID) and the Bill & Melinda Gates Foundation to improve health in Bihar. Bihar is the third largest and one of the poorest states in India. Improving the health of mothers and children in Bihar depends quite a lot on addressing issues around gender equality, women’s empowerment and domestic violence.

Women who have had no education, have little or no money, who rarely leave the house, and do not know their rights or about the facts of hygiene, nutrition and family planning, find it understandably difficult to look after their own and their children’s health. By empowering women, we can make a big impact on health for women and their families. In Bihar, CARE uses several ways to support women to access health services.

Community voting cards

Cards used by a women's group to vote on which issues they want to discuss

One way is through so-called Women’s Self-Help Groups. These are similar to the Village Savings and Loan Associations I saw in Rwanda in September. Millions of women across Bihar are members of these groups. We saw how they vote by placing stones on different pictures, to decide which problems they most want to discuss and solve at each meeting.

Sometimes they concentrate on savings and loans. Sometimes they focus on electricity and roads. Kalnaur village in Jehanabad now has an all-weather road linking it to town. And sometimes they talk about hygiene, nutrition and health. 70% of the village now have indoor latrines.

Street theatre performance

Actors performing a short drama about domestic violence

Another way is through community mobilisation to change attitudes to domestic violence. We saw some amazingly good local actors from Sebana village performing a short drama. After the show, volunteers engage with women who want help. They will try to resolve matters locally but there is now a help-line they can contact if that doesn’t work.

In Fatuha, we visited a small Primary Health Clinic which serves a population of 200,000 people. They have 300-500 outpatients every day – between four doctors! The Medical Officer in Charge, Dr Prasad, explained that the Government of Bihar had resources available for health, but that CARE was helping them to identify the right problems, so they could use that money on the right priorities.

Labour ward in Bihar

The labour ward at Fatuha Primary Health Clinic

One example was the labour ward, which has been cleaned up, well stocked and now has a basic intensive care room. They now deliver up to 10 babies each day. This is double what it was just four years ago. Two-thirds of mothers are now delivering in the clinic, and this means they and their babies are much safer and healthier.

With only one clinic for 200,000 people, most health services are provided at the community level. Accredited social health activists (‘Ashas’) encourage women to attend local health sub-clinics, where their babies are vaccinated and checked for nutrition, and where mothers are offered family planning advice and given ante- and post-natal medical care. In the picture at the top of the page, an Asha called Nirmala is giving birth preparedness advice to Kanti, a young woman expecting her second child. Nirmala has some training, but Kanti is also able to listen to advice from a doctor via a free mobile phone recorded message.

As a result of these and other interventions in Bihar, child vaccination is up from 25% to 65%. Ante-natal care is up from 65% to 96%. Post-natal health visits in the first week have gone up from 6% to 29%.

CARE puts gender equality and women’s empowerment at the centre of all its work, as explained in our new global programme strategy. CARE’s work in Bihar shows how this is not just the right thing to do, but also makes a huge positive impact on other goals – in this case mother and child health.

Laurie Lee's picture

Laurie Lee is Chief Executive of CARE International UK – Read his blog posts on our Insights policy and practice website