Sita Shankar Wunnava, the Director of Maternal, Child Health and Nutrition at PATH India, knows about maternal health and women in India. An outspoken leader and NGO director Wunnava has over two decades of international global health experience under her belt and knows that behavioral change in India’s rural areas is what will ultimately save more mothers’ lives.

Each year 78,000 women die in childbirth in India and one million babies die before two months. Those numbers are devastatingly high. To combat this high mortality rate PATH implemented the Sure Start program in Uttar Pradesh and Mahrashtra, Indian’s two most populous states, seven years ago.

The Sure Start program works with women in rural areas to teach them how to stay alive when pregnant and delivering their baby. The Sure Start program was created with the understanding the very first step to reversing maternal and child mortality rates begins with education and behavior change. For instance, Sure Start teaches women that if they have swollen feet it’s not just something that normally happens, but there is a great chance she has high blood pressure which can lead to preeclampsia. They also teach women that colostrum, or a woman’s first milk, is essential for a baby’s health and survival whereas traditionally women in rural areas typically squeeze the colostrum out of their breasts in order to get to the white milk. Also, women are educated about the benefits of exclusive breastfeeding instead of supplementing with water and cow’s milk. Now twice as many women in these two Indian states exclusively breastfeed during their baby’s first week of life. Sure Start  also teaches women to wrap babies when they are first born instead of immediately washing them which can lead to hypothermia.

In order to change cultural practices the Sure Start program encourages women to have institutional births, that is delivering in a health center instead of at home with untrained birth attendants. They also had to change the way rural people view pregnancy. Women and their husbands did not view pregnancy as an illness and believed health centers and hospitals were unnecessary for delivering a baby. However, through education over the past three years births in health centers have doubled in Uttar Pradesh.

PATH’s Sure Start program recognizes that the key to reducing maternal mortality is to encourage communities to take collective actions to work together from mothers’ groups, to mothers-in-law, health workers, towns’ mayors, and the village as a whole.

While the Sure Start program has been implemented for seven years in Uttar Pradesh and Mahrashtra, there is only one more year of the program remaining. Sita Shankar Wunnava says that program administrators are sharing data with government officials so they can implement these changes through a larger scaled effort.

For more information visit www.path.org/surestart.

Photo: PATH/Gabe Bienczycki