With 2015 UN goals lagging, Asian parents learn better practices to save children's lives

BANGKOK, Thailand (PLAN INTERNATIONAL): With only three years until the 2015 deadline to achieve the Millennium Development Goals, the lives of the poor have improved markedly in some ways: a recent World Bank assessment found that targets related to extreme poverty and access to safe water have been reached, while there have been strides in education.

However, two health-related goals – to save more lives of mothers and children – remain significantly off-track.

For instance, in Vietnam, mothers haul infants around while toiling in rice paddies, potentially causing illness, malnutrition and impaired development.

Women in Nepal lose their babies because of lack of knowledge about taking care of themselves while pregnant and of their newborns.

In Kudagama village in Sri Lanka, nearly half the children under age five were underweight, in part because lower-caste residents did not have decent health care.

These children – from rural areas and poor, less educated families – are among those most likely to succumb to illness and death.

An estimated 7.6 million children under the age of five die every year, more than 70% of them in Africa and Southeast Asia. Two-thirds of these deaths are caused by preventable diseases, while more than a third of all child deaths are linked to malnutrition.

For 75 years, Plan International has been working in impoverished and remote communities around the world to tackle these problems, with a focus on improving children’s lives.

Teaming up with local NGOs and health workers, Plan helps raise awareness among parents and caregivers about nutrition and better practices to keep their children healthy, happy and alive.

Nepal: Care before and at birth

In Piprahawa village in Nepal’s Mid-Western region bordering India, Ramawati Kori has been pregnant five times, but lost her four first babies. Her first was a stillbirth, and the following three died within a few days after birth.

“All my babies were delivered at home without the support of a health worker. My family did not opt for a hospital delivery since they did not know about it,” the 24-year-old said, adding that she and her family knew nothing about antenatal care or the causes of neonatal death.

Key to saving children’s lives is safe childbirth and good neonatal care, especially during the most vulnerable first 28 days of life. Nearly 40% of child deaths under the age of five take place during the neonatal period.

According to the latest national demographic survey, Nepal’s neonatal mortality rate is 33 per 1,000 live births, compared with 32 in India and 4 in the United States.

To boost babies’ chances of survival, educating expectant mothers and their families is essential.

Ramawati first learned by radio of support for her pregnancy, including free delivery services at health institutions. A local NGO, Geruwa Rural Awareness Association, and Plan were organising pregnant women's groups, so Ramawati joined the monthly meetings in the third month of her fifth pregnancy.

She received her first lessons in health education, learning about the importance of institutional delivery and physiological changes, as well as danger signs during pregnancy, labour and after giving birth. She also became aware of antenatal measures such as iron consumption, de-worming and nutrition for herself, as well as care of the newborn.

She gave birth by caesarian section to a healthy 2.8kg girl on 18 February 2011, her due date.

“I had her immunised against measles when she was nine months old. I breastfed her and feed her [a high-protein porridge], bananas and vegetable soup,” Ramawati said, expressing hope that Plan and Geruwa would continue their awareness programme for pregnant women. “It helps save the lives of the mothers and newborn babies in our community.”

Vietnam: Breastfeeding and care for newborns

Regardless of the weather, Vang Thi May would strap her first-born daughter on her back and head to work in the rice paddies in northwest Vietnam near the Chinese border. The baby cried incessantly.

“We are lucky that my first child survived though she suffered from malnutrition and frequently got sick because of the harsh weather when she stayed on the terraces with me,” 27-year-old May recalled.

One in 10 Vietnamese children under the age of five weighs less than a child of their  height should, indicating acute food shortage or disease. Nearly a third of Vietnamese children under the age of five are smaller than the average child of the same age, pointing to insufficient nutrient intake and frequent infections, and accompanied by delayed motor development and impaired cognitive function.

When May became pregnant with a second child, she and her husband worried again, but that October, Plan began a group to raise awareness and promote positive practices in childcare and development for parents in remote mountainous areas.

May learned about symptoms and prevention of common childhood diseases. She was trained to collect her own milk by hand and store the bottled fresh breastmilk in cool water or on ice so her baby could be fed by her grandmother at home while May worked in the paddies. She now makes nutritious meals from locally available foods.

“My second daughter is growing well these months,” she said. “I feel relieved.”

Sri Lanka: A village of underweight children

In Kudagama village of Sri Lanka’s North Central province, 47% of children under the age of five were underweight. Because villagers were from a lower caste, they received lower quality health services than neighbouring villages and dared not complain to officials.

With Plan, facilitators from the Foundation for Health Promotion and Rajarata University began work to train public health midwives on issues of excluded communities. Through role playing, peer feedback, case studies and home visits, the midwives devised a strategy to help such communities address issues such as malnutrition.

Eventually, villagers came to trust their midwife – boosting confidence among the mothers.

“We learned that if children are stimulated well during their early childhood, they will grow with enough strength and intelligence to achieve their dreams. We realised that our small world can improve immensely by simple changes that we can make happen,” several mothers shared after a community gathering with the midwife and facilitator from the Foundation for Health Promotion.

They began collective feeding sessions for the girls and boys, which helped children to socialize and eased the burden on each poor household to provide a good variety of food to their children.

The mothers monitored the variety of their children’s diets, and within three months, the average monthly weight gain of their children, aged 2-5, increased from a meagre 57 grams per month to 261 grams per month. For the 0-5 age group, the figure shot up from 52 grams to 305 grams.

“We used to hide when the public health midwife came for home visits. We did not like her to make bad comments about our children’s weight because of the belief that it would bring bad luck to our children,” the mothers shared at a symposium with public health officials, NGOs and community members. “Now, we eagerly look forward to the next weighing session to share our progress with our closest friend in our changed world – our public health midwife.”