Stories of Prabal Yatra: Self-care helps older persons to regain mobility
Seventy five year old Pyari Gameti, lived with family in a small mud and cement house in Majawari village of southern Rajasthan. She received a monthly government pension and would walk to the local PDS outlet to collect her 5 kg wheat allowance each month. A few months ago one day, she suddenly felt dizzy, vomited and then collapsed. Her son found that she had fever and immediately rushed her to a private hospital nearby, where she received treatment for a week. During this time she could not recognise her family members. A day after returning from the hospital, she lost sensation in her legs and could not walk. She had to drag herself on the floor to use the bathroom. After a few days, Rekha, Block Health Care Coordinator of ARTH’s programme for older persons, met her on a round of the village. She advised Pyari and her family members to apply hot compresses to her legs and slowly stretch them from time to time during the day. Pyari began to do this diligently, while sitting on her bed. She started to feel a change after 3-4 days – although her legs would barely move in the beginning, she was determined to get better and continued applying hot compresses and moving her legs as well as she could. Over the next two months, her legs began to stretch and she was able to rise up and stand, first with the support of a stick and then on her own. Rekha additionally conducted a home assessment to gauge the risk of falls and general convenience for an older person. She found that the flooring at entrance of the house was very uneven – this was later levelled by her family. With some more guidance and encouragement, Pyari was ultimately able to start walking slowly. Her story tells us that simple manoeuvres combined with will-power can enable an older person to mobilise after illness, thereby improving health outcomes without requiring complex facility-based visits for treatment. According to a study by Devi and co-workers, women engage in self-care practices more than men, but this tends to decrease in both, with advancing age1. With more of India’s population ageing due to demographic transition, health issues are increasingly expected to impact older persons. It is necessary to enable older persons to pursue a path of healthy ageing to prevent health issues in the first place, and to use appropriate self-care to recover from illness. A wellness focus on one’s health would eventually lead to fewer clinic visits and reduction in the cost of health care. – Snehal Sinha (ssinha@ccr.arth.in) 1Devi RS, Pandian S, et al. (May 15, 2025) Assessment of Self-Care in Promoting Healthy Aging Among the Elderly in Rural Areas of Kancheepuram, Tamil Nadu. Cureus 17(5): e84171. DOI 10.7759/cureus.84171
During quiet struggles, a gentler shade of support…
Over the past year, ARTH has implemented Navneet, a postpartum maternal-infant care intervention in rural-tribal villages of southern Rajasthan. During this time, our team has provided services to 3,252 women in the year after their delivery. On a field visit to Dhoya village, I met Jhamli, mother of four, who currently lives alone because her husband has migrated to the city for work. Jhamli feels exhausted by daily chores that stretch from morning to evening, while also caring for her newborn son. We have observed that in households in which the husband has migrated for work, the wife’s burden intensifies for almost everything, encompassing childcare, cooking, cleaning, fetching water and firewood, and tending to goats and cattle. In the same village, Rekha, who lives in a family of six, described a similar experience. She said that her daily routine leaves her exhausted – her arms and legs ache and she feels listless. A 2023 review of motherhood and mental health indicates that a sense of emotional and physical overload can evolve into anxiety and mood disturbances, which if unsupported, might tip women into postpartum depression (https://doi.org/10.7759/cureus.46209). Research shows that around 15-21% of women experience some form of postpartum mood and anxiety disorder (PMAD) (https://doi.org/10.1016/j.nurpra.2018.03.010). Against this backdrop, Preraks — trained outreach educators recruited from within the same communities, meet women at home during the year after delivery. On each visit, the Prerak engages in a friendly, informal conversation while discussing key aspects of maternal and infant health, such as nutrition, contraception, health concerns and immunization. She also encourages women to visit the clinic for a routine check-up by nurse-midwives or a doctor. While we were sitting outside her house, Rekha began talking about the Prerak’s recent visit. She smiled and said, “Didi (sister) came to check on how I was doing. Talking to her made my mind lighter”. Later that day, Jhamli shared, “my sisters-in-law got a sterilisation, but I was scared, so I didn’t get it done. When Didi (Prerak) explained about Mukti (hormonal IUD), I felt relieved. Next month, when my husband comes home, I will go to get Mukti”. Thus, Preraks build a relationship of trust, transforming into a friend who sincerely cares. For their part, Preraks see their role as going well beyond delivering information. One of them said, “Most women talk to me about family matters – about husband, mother-in-law, household, money, everything. They feel good that someone has come to meet them”. Another Prerak added that women often call them up later, if they have questions or need advice. Preraks are backed by counsellors of ARTH’s telephone helpline located at Udaipur, who speak the same dialect and provide additional guidance when women call. They also proactively schedule check-in calls to enrolled women. Although we might not be able to reduce the physical workload that women have to endure, we hope that by creating a trusted relationship through home‐visits and telephonic follow-up, the Navneet intervention will help to prevent postpartum depression (PPD). Simultaneously, addressing anaemia and debility, enabling contraceptive choice and treating infections also should help, by meeting the major health needs of this period. Recently, the World Health Organization has emphasized that maternal well-being depends on supportive care, strong social relationships, health care, and the ability to make decisions for oneself. Meanwhile, we are working to strengthen the circle of support around new mothers so that they may return to their daily routine and restore the relationship with their husbands, and are able to enjoy rather than merely endure motherhood. – Himani Sharma (pa.hs@arth.in)
Tackling undernutrition among older persons in rural Rajasthan
The Longitudinal Ageing Survey of India (LASI)1 reports that 26% of older persons (60+ years) in Rajasthan have a body mass index less than 18.5 – a sign that they are significantly underweight. We were curious to know the situation in our field area in tribal southern Rajasthan. While screening 2,460 older persons, we found that a much higher proportion, 43% were underweight. We conducted a separate qualitative review of food intake among 15 older persons and found that they were consuming just 51% of calories and 53% of protein, compared to their daily requirement. Older persons progressively lose muscle mass as they age, and require a wide array of nutrients to maintain their health and muscle strength2. Southern Rajasthan, located along the Aravallis, has less fertile soil and agriculture is mainly rain-fed, leading to low productivity. Small scattered villages and hamlets mean that one has to travel a significant distance to buy even simple grocery items. With low levels of education, most people depend on NREGA and other wage-labour to supplement farm output. Beyond the age of 70, this income reduces to the amount of pension and any financial support they might receive from their families. Those living below the poverty line do receive 5kg of wheat from the Public Distribution System. Over time, food insecurity in conjunction with the ageing process leads to reduction in appetite, with resultant frailty and poor health outcomes3. During National Nutrition Week (1-7 Sep 2025), ARTH organised group-cooking sessions in 100 villages as a part of its Prabal Yatra intervention, to initiate a conversation on maintaining nutrition with age. On the menu were simple, easy to chew meals like laapsi (sweetened broken wheat), kheer (rice pudding) and khichdi (rice, pulses and a few vegetables).These dishes provided protein and energy along with some vitamins and minerals. We demonstrated that nutritious meals could be made from locally available ingredients. Cooking and eating a meal together additionally increased social connect among older persons who tend to become isolated. While some older persons enthusiastically cooked the meal, others sang songs, played games and discussed locally available food items that could be consumed to improve health – in the words of one participant, “This way we found a reason to meet each other”. Ensuring older persons’ access to better nutrition will require efforts by multiple stakeholders, including the government. Currently, Anganwadis and schools provide meals for pre-school and school-going children. With an ageing population, should India consider a similar arrangement for older persons living in vulnerable areas? We have begun to understand the issue of undernutrition among older persons, and will continue to work with the community to learn more. Meanwhile, even as individuals, we can do our bit to secure good nutrition for older persons in our own families and neighbourhood. We can begin by asking them what they ate, through the previous day. – Snehal Sinha (ssinha@ccr.arth.in) References: 1 International Institute for Population Sciences (IIPS), National Programme for Health Care of Elderly (NPHCE), MoHFW, Harvard T. H. Chan School of Public Health (HSPH) and the University of Southern California (USC) 2020. Longitudinal Ageing Study in India (LASI) Wave 1, 2017-18. 2 Rani, P.M.S. (2024). Nutritional Status of Elderly in India: A Review. In: Soletti, A.B. (eds) Contemporary Issues in Late Adulthood. Asian Perspectives on Public Health. Springer, Singapore. https://doi.org/10.1007/978-981-97-4449-7_11 3 Chaudhary, M. (2018). Association of food insecurity with frailty among older adults in India. Journal of Public Health, 26(3), 321–330. https://doi.org/10.1007/s10389-017-0866-4
Menstrual Health: a missing link in primary care
I met Vimala (20 years) at home, where she lived with her parents in a village of Udaipur district. She looked weak and exhausted — it was visibly difficult for her to even get up, so I went and sat beside her. Speaking softly, she told me about her last period that had lasted 13 days. Bleeding was very heavy from the first week — she’d used up to two 6-pad packs of sanitary napkins per day. At night she would keep waking up to change pads. With abdominal pain and backache adding to this, some nights left her in tears. “Didi (sister), I kept bleeding continuously. One night I used three packets of pads.”. In the first week her mother took her to an informal provider who ran a saline drip and gave her some tablets. The family spent Rs 2000, but there was little improvement. By the eighth day she noticed clots and panicked. At the government health centre 8 km away, tests showed that her hemoglobin was down to 4.7 g/dL. Medication reduced the bleeding, but she still feels weak, enduring pain, headache and dizziness. A day later, 50 km away in a village of adjacent Rajsamand district, I met 20 year old Kanku. Her periods had earlier been regular, but two years later there was pain that progressively became severe. She endured it over months, resting to cope, unable to cook, fetch water, or carry out daily chores. With downcast eyes, she said, “The pain becomes so severe that I cannot stand. I just lie down the whole day.” I asked her how she had endured it for so long. She said, “I told my husband and mother-in-law. She said it was normal to have pain during periods and nothing to worry about, so I remained quiet”. A few months later, the pain became unbearable and one day, Kanku fainted. The family rushed her to the district hospital, where hemoglobin was found to be very low – she was admitted there for 8-10 days. After discharge, her family additionally took her to a traditional healer. Perusing ARTH’s call-centre records, I realized that such stories are not rare. In the above instances, one girl bled for days till she could barely stand, another collapsed from pain dismissed as “normal” by the family. Both reached a health facility only when their condition became severe. What they faced, is part of a larger reality: menstrual disorders are widely prevalent among adolescents and young women in India. A national survey of 6,715 adolescent girls across 16 states shows that 62% reported menstrual problems, of whom 90% had abdominal or back pain, 26% experienced distress and 21% had heavy bleeding (https://doi.org/10.1515/ijamh-2024-0101). A systematic review covering rural and tribal India found dysmenorrhea (55%), irregular menstruation (26.2%), and premenstrual syndrome (47.8%) to be the commonest menstrual disorders among adolescent girls (https://doi.org/10.18778/1898-6773.87.4.01). Going beyond pain and discomfort, heavy menstrual bleeding (HMB) is a leading trigger of cellular iron-deficiency and iron-deficiency anemia, with the latter affecting 57% of women (https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf). FIGO has highlighted that despite high prevalence, HMB is frequently normalised by women and health care providers, leading to a lack of care (http://www.figo.org/resources/figo-statements/iron-deficiency-and-anaemia-women-and-girls). Clearly, menstrual disorders do have a larger public health impact. However, the competence for treating them is currently concentrated among medical specialists who tend to be located far from women living in villages. At the primary care level, where women like Vimala and Kanku first seek help, doctors, nurse-midwives and frontline staff are inadequately trained and equipped to address menstrual disorders. And yet, while medical treatment is important for severe cases, menstrual health should not be seen solely from a clinical lens. Given that it spans across from well-being to potential illness, young women, their families and first responders (frontline health workers, teachers) need to be aware of the normality of menses and be able to practice or advise self-care as a preventive measure. Isn’t it time we moved beyond prioritizing women’s health only in the context of pregnancy, to include menstrual health as part of primary care? Gunjan Khorgade (gk@ccr.arth.in) (photographs with consent)
When motherhood brings on the blues…
Valki, a young woman living in a remote village near Kumbhalgarh fort, Rajasthan, delivered a boy at home about a month ago. The walk to her house took a half an hour beyond the tourist trail, to a hamlet of around 25–30 families. When we met her, she was stirring chhaachh (buttermilk) and fresh corn on a chulha (clay stove) to make raab gruel, in a smoke-filled, dimly-lit room while breastfeeding her baby. As part of the Navneet intervention for maternal and infant care in the year after delivery, an ARTH field worker assessed Valki’s mental health using the Edinburgh Postnatal Depression Scale (EPDS), adapted and translated into Mewari dialect. Valki scored 23, well above the cut-off of 13, suggesting severe depression. As she spoke, she began to open up about the struggles weighing her down. At the end of her first pregnancy, her husband, who struggles with substance abuse, had ignored her labour pains. She was taken late next day to the hospital by her in-laws. The experience of her first delivery was so isolating and traumatic, that this time she chose to give birth at home. She told us that she had been taking contraceptive injections from ARTH’s health centre to avoid another pregnancy. But some months down the line, her husband refused to give her money to travel to get them. A year after her first delivery, she again became pregnant. “Baacha re vaate, maro iccha hi ni viyo. Phir bhi ek saal mein maaro dan chadhi gyo. Maane laagirio ki muh baccha ne chodi pihar chaali jau”, she said bitterly (I had no will or desire for this pregnancy. Even then, I missed a period. I felt like leaving the (older) child and going back to my parents). A prospective cohort study from this very area by ARTH in 2012 reported 20% as the incidence of postpartum depression (https://doi.org/10.3329/jhpn.v30i2.11318). A larger systematic review of Indian studies similarly suggests that about one in five mothers (19%) experience depression within the first few months after delivery (https://doi.org/10.2471/BLT.17.192237). Atif et al. (2015) from Pakistan, have found that depressed mothers struggle to bond with their infants in the first year, showing reduced emotional involvement and less positive communication. Maternal depression increases the risk of poor child health including developmental delay and behavioural problems, contributing to intergenerational disadvantage (http://dx.doi.org/10.1053/j.semperi.2015.06.007). We also know that depressed mothers are less able to breastfeed successfully, thereby increasing the chances of infant malnutrition (https://doi.org/10.1590/1518-8345.2110.3035). While maternal and child health programs often stress physical health, the mental health needs of mothers remain overlooked. A situational analysis of five low- and middle-income countries including India (2016) showed that maternal mental health (MMH) was not a priority – MMH services were largely absent, primary care workers were not trained to identify or manage MMH conditions, while mental health specialists were available only in distant referral facilities (https://doi.org/10.1186/s12913-016-1291-z). What Valki needs most right now, is not conventional medical care – she needs counselling and supportive care, apart from a partner and family that could share her responsibilities. Her story highlights a wider reality: maternal-infant health care in India and similar countries continues to focus on physical health while mental health remains neglected. Addressing this challenge will require a systemic response that combines trained frontline workers, family support and community awareness, to ensure that postpartum care moves beyond mere survival, so that mothers and their children can truly thrive. – Himani Sharma (pa.hs@arth.in)
Does maternal health care need male involvement?
Badami, 28, had delivered a boy on 8th October 2024. I met her at home during a field visit to Vardara village in southern Rajasthan. When I asked about the newborn, she whispered “Baccho off veyi gayo”, (the baby passed away). Her husband sitting nearby told me that at the time of delivery, fluid had accumulated in the newborn’s lungs which led to its asphyxiating and dying shortly after. Badami said “After getting home, I felt like I couldn’t live anymore. I couldn’t do anything. My husband cooked, looked after our three year-old daughter, took care of his parents and cared for me as well”. Her husband, shared that since then she has been feeling extremely weak with continuing abdominal and back pain. He added, “When Badami was unwell, it became my responsibility to manage the household. There’s always work at home. However, I thought if she gets some rest, she’ll recover sooner”. An ARTH field worker had earlier met Badami as a part of the Navneet intervention which focuses on maternal and infant care through the year after delivery. She advised Badami to rest adequately, avoid strenuous work, to include nutritious food in her diet and to visit ARTH’s Health Center for a postpartum checkup, which she later did, along with her husband. At the health center, the nurse-midwife found that her haemoglobin level had dropped to 9 g/dL. She advised her to include iron-rich foods, locally available green leafy vegetables, pulses, jaggery, etc. in her diet along with iron supplementation. During our discussion she told me that she has been taking IFA tablets consistently and had discussed with her husband about delaying pregnancy until she recovered her strength. I was struck by the extent to which Badami had regained confidence after what was clearly, a traumatizing delivery experience. Emerging evidence emphasises the importance of male involvement in maternal health, especially during the postpartum period. Maria Rosa et al. (2021) emphasize that emotional support from husbands during the early postpartum phase enables mothers to feel less isolated, more capable, and better equipped to cope with the demands of new motherhood (https://doi.org/10.3889/oamjms.2021.5761). Similarly, a systematic review by Yargawa (2015) of low- and middle-income countries (LMICs) highlights that male involvement in both pregnancy and postpartum care is associated with reduced odds of postpartum depression (http://dx.doi.org/10.1136/jech2014-204784). The author concludes that maternal health must not be viewed solely as the woman’s issue – men must be seen as part of the solution, and not as passive bystanders or barriers. However, a qualitative study conducted in Madhya Pradesh, India (2020), found that lack of male-inclusive infrastructure and gendered expectations at health facilities acted as powerful deterrents to male participation (https://doi.org/10.1007/s10995-020-03029-8). According to a more recent review (2023), “men who accompany pregnant women to health facilities are shunned, stigmatised and or labelled as ‘weak’, ‘controlling’, ‘bewitched’ and ‘women`s rivals’ which acts as a hindrance to male involvement in maternal health” (https://doi.org/10.1016/j.midw.2021.103089). Badami’s example suggests that a husband’s support makes a major difference not only to physical recovery, but also reinforces a woman’s emotional resilience. Meaningful male involvement in postpartum care will require a fundamental shift in how we view gender roles in the context of pregnancy, delivery and the extended postpartum period. Meanwhile, I wished Badami strength and courage as she recuperated physically and mentally, and along with her husband, looked forward to a brighter future. – Himani Sharma
The real fertility crisis: how do young women make a choice?
(World Population Day, 11 July 2025) As I climbed the path leading to her modest house located on a forested hill in Shivdiya village (44 km from Udaipur, Rajasthan), I found Dakudi (26 years) busy cooking a meal. Her four year-old son was playfully splashing water from a bucket outside the house and a four month-old daughter was crying softly inside. While I waited, Dakudi moved back and forth, comforting the baby, making sure the rotis didn’t burn on the pan, and rebuking her son for wasting water that she had fetched from a distance. After feeding and soothing the baby, she finally came outside and sat beside me. She smiled in welcome and said, “No one comes here, Didi. What brought you all the way to meet me?” I told her I wanted to meet her after delivery and see how she and the baby were doing. She looked happy to have someone to talk to. She lives alone in the isolated house on the hill — her husband works in a restaurant at Surat (Gujarat), visits every 3 to 4 months. Her in-laws have passed and a brother-in-law lives 2 km away, in the main village. We spoke about her delivery and how she was doing afterwards. She recalled the event: “My husband was away when I went into labour. There’s no phone network here, so I couldn’t call anyone. I walked down the hill to the main village and somehow made it to my brother-in-law’s place. They took me to hospital.” Soon after delivery, a Copper-T was inserted. “I didn’t want it. but I was scared, so how could I say anything? My husband wasn’t there. So I just kept quiet.” When her husband came home a month later, he accompanied her to a clinic where she got the device removed. “It’s not that I want another child right now” she said, “but I didn’t want the Copper-T. I was worried that it might cause a problem”. A few weeks later, Dakudi came to know about a contraceptive injection from the Anganwadi worker of her village. Two months after delivery, a government auxiliary nurse-midwife (ANM) gave her a DMPA injection at the same anganwadi. She says it feels just right for her. While postpartum contraception plays a critical role in supporting women’s health, their ability to make real choices is often limited. During 2019-21, ARTH surveyed 1,029 women in villages of southern Rajasthan, one year after their delivery. Of these, 33% had initiated contraception, including 114 (11%) that had a Copper-T inserted at the time of delivery. During the year, 56 (49%) of these 114 women got the Copper-T removed, while another 18 (16%) had a spontaneous expulsion. Hence by the end of one year, only 40 (35%) of the postpartum Copper-Ts remained in place. This raises the question of how and why such a large proportion of women discontinue within months, a long acting contraceptive method is effective for as long as 10–15 years. This year’s State of World Population 2025 highlights the lack of reproductive agency among young women and men across the world. In India, 27% of women have experienced situations in which they were unable to use the contraceptive method of their choice.1 Irudaya Rajan and Andrea Wojnar argue that India’s real fertility crisis is not about falling birth rates, but about the overlooked realities of limited choices and missed opportunities that prevent individuals from achieving their desired family size, whether that means pursuing pregnancy or preventing it.2 For women of limited means like Dakudi, who run their homes and rear children alone in the rural interiors of Rajasthan, making decisions on contraception is even more challenging. And yet, her ability to even belatedly exercise choice, represented an act of persevering resilience. Gunjan Khorgade (gk@ccr.arth.in) & Sharad Iyengar 1: https://www.unfpa.org/swp2025 2: https://www.epw.in/journal/2025/26-27/comment/changing-fertility-behaviours.html
The challenge of promoting yoga among older persons in rural Rajasthan
(Yoga Week, 21 – 28 June, 2025) Buzurg to khud kasrat karte hi nahi hain — “older persons just don’t exercise on their own”, said one of ARTH’s field workers during the team’s monthly review meeting. “When we explain the benefits of exercise, older persons understand and readily agree, and yet do not make it a part of their daily routine”. With increase in age, regular yoga and exercise help to maintain mobility and muscle mass, while also preserving cognition and mental well-being (https://doi.org/10.1093/geront/gnz022). A 2013 Indian study concludes that yoga has positive impact on cognition, leading to improvement in memory, attention and executive function among older persons (https://doi.org/10.4103/0019-5545.116308). Over the past year and half, we have been training, guiding and motivating older persons to make yoga and exercise a part of their daily routine. Recent inquiries reveal that a mere 4% of older persons, members of ARTH’s Prabal Yatra groups, are exercising regularly. A recent survey by the Ministry of AYUSH corroborates this finding – only 11% people perform yoga regularly, and for older persons, the figure is 17% (https://timesofindia.indiatimes.com/india/nearly-one-in-every-four-persons-in-india-incorporating-yoga-reveals-ayush-ministry-survey/articleshow/121985109.cms). ARTH organised a series of public events this year during Yoga Week commencing on 21 June 2025, in 100 villages of southern Rajasthan. Within each event, older persons performed easy yogasanas guided by community mobilisers and health workers. Panchayat representatives were invited as guests. This was followed by a discussion on making yoga and exercise a part of the daily routine. Research suggests that peer-delivered interventions lead to better adherence to regular physical activity on part of older persons (https://doi.org/10.1080/02640414.2017.1329549). We are disappointed that the numbers of those exercising regularly is currently small, and are exploring ways to motivate and facilitate rural older persons in adopting yoga as a pathway to healthy ageing.
A mother’s first year: all work and no rest
(Postpartum care in rural Rajasthan – 2) “It’s easier said than done, you know”, Nirmala (24 years) said, gently shifting the restless baby in her lap, while talking about how she has managed motherhood. She lives in Seloo village of Udaipur district with her husband and 5-month old son. Her in-laws died several years ago, so it’s just the three of them now. Her husband works as a daily wage labourer in the city, returning late each night, so household work and infant care are her sole responsibility. I met Nirmala through ARTH’s Navneet programme, which supports maternal health, nutrition, contraception and infant care during the year after delivery in southern Rajasthan. Having delivered at the local government Community Health Centre (CHC), she stayed at her mother’s place for just a month. “My husband was alone, so I came back early”. At the time of discharge, CHC staff advised her about exclusive breastfeeding, eating healthy and taking rest. Nirmala said, “When I go out to graze the goats or collect fodder, I leave him with Bhabhiji (a neighbour). If he cries, she gives him water – what to do? If my husband is around and I’m busy, he too gives water. I know we shouldn’t, but it happens”. With a wistful smile, she said it’s near impossible to take rest. “Didi (the home-visiting ARTH health worker) said take care of yourself, but how do I do that? I have to feed the baby, graze the goats, cook, clean, wash and look after everything else. Whereis the time to rest?” Nirmala additionally wants to start working. “Before delivery, I used to do Narega (government scheme)labour or other work. Now only my husband earns, that too on some days. On other days he doesn’t,soit’s difficult”. She’s asked her younger sister to come over and stay with her. “If she’s here, I can go and work. I can’t sit at home.We need the money”. While health workers stress the importance of rest, nutrition, breastfeeding and infant care, several new mothers lack the resources or family support to make it happen. Many mothers spend their post-partum year alone, balancing baby care and household chores with wage labour. Perhaps it’s time to consider some form of maternity benefit for those like Nirmala and her husband, who are employed in the unorganized sector – some way of averting the compelling need for a mother to leave her breastfeeding infant at home, to go out in search of wage labour. So this Mothers’ Day, let us ask ourselves, what does post-partum care truly look like, from the standpoint of mothers themselves? Gunjan Khorgade, (gk@ccr.arth.in)
Midwives: Critical in Every Crisis (theme of International Day of the Midwife, 5 May 2025)
Four months after having established a 24×7 delivery & newborn care service in a rural health centre located 55 km from Udaipur, Rajasthan, two nurse-midwives on duty encountered a woman with severe pre-eclampsia. Following protocol, they treated her, carefully injecting Magnesium Sulfate. Then one of them accompanied her to the hospital in the city, for emergency admission. The doctor on duty was visibly upset that a nurse had administered a dose of Mag-Sulf and harshly reprimanded her for “trying to become a doctor”. It took us some effort to console the visibly shaken nurse-midwife, that she had done right and saved a life. ARTH’s team of nurse-midwives nevertheless carried on undeterred, and over 26 years attended 18,466 deliveries of which 1451 (8%) were referred. The most critical skill required of a professional midwife working in a primary care setting, is to know when to refer a woman or newborn for a complication, and to provide basic emergency care in the interim. This life-saving role has been acknowledged by this year’s theme for International Day of the Midwife. Diploma and degree qualified nurse-midwives who join ARTH receive induction training based on standard guidelines, to perform their roles effectively. Early in 1999, we realised that timely referral of those with complications would be an essential part of our Basic Midwifery Model. Hence we developed a safe-threshold protocol for emergencies, that included simple referral criteria, telephone consultation with a doctor, provision of basic emergency obstetric care, empanelled transport vehicles, detailed referral cards, accompanying critical patients and a helpline worker at the government hospital, to expedite admission and provide daily support until discharge. Results of this model published in 2009 showed that nurse-midwives were able to promptly and accurately detect, stabilize and refer those with complications1. During 2024-25, nurse-midwives referred 113 (12% of deliveries) comprising 96 women and 17 newborns. The commonest maternal complications were non-progression or prolonged labour, pre-eclampsia and fetal distress, major neonatal complications included preterm – low birth weight, and birth asphyxia. India has progressed with midwifery training by starting a course on Nurse Practitioner in Midwifery at national and regional institutes in 20182. This will help to professionalise midwifery and give due stature, even though the training will take several years to generate midwives at scale. Meanwhile, the 1.25 million strong existing cadre of nurse-midwives can effectively be trained to provide basic midwifery care, including emergency care for women and newborns during a crisis.