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‘Going local’: To improve child nutrition in India, UNICEF begins with mothers

© UNICEF/India/2006
Held by her mother and surrounded by other villagers, Tasmina is the picture of good health.

‘Progress for Children No. 4: A Report Card on Nutrition’ will be launched on 2 May. In the weeks leading up to the launch of this, UNICEF’s latest child-survival progress report, we are featuring a series of stories focusing on successful initiatives that can help counter the many threats to children's nutritional status.

BAGDOLEY VILLAGE, India, April 2006 – Little Tasmina Khatuni is the centre of attention in her village in West Bengal, India. With chubby hands, large kohl-rimmed eyes and plump cheeks, the 18-month-old child is the darling and envy of her neighbours. Children want to kiss her and play with her, and other mothers wonder what makes her more lively and healthy than their own, because the girl’s family is as poor as they are.

Tasmina’s father, the family’s sole breadwinner, works in the field. Their one-room mud hut has an open veranda where her mother, Amina Bibi, cooks and her grandmother plays with the child.

In West Bengal, the statistics related to undernutrition, particularly among children, are alarming. Among children under three, every second child is underweight, more than 4 out of 10 are stunted and 1 in 8 is wasted. Children are at high risk of becoming anaemic.

So what does Amina Bibi feed her daughter to make her so healthy? How, despite her mounting household chores, does Amina find time to take care of her? How does she take care of her child when ill? Does the father devote any time to his daughter?

Grassroots approach

Tasmina’s family, with access to the same scarce resources as the other villagers, identified some new practices and mingled them with traditional ones to produce successful results. The little girl is thriving, largely due to the fact that her family has benefited from Positive Deviance, a programme for early childhood launched in 2001 and based on the premise that solutions to community problems already exist within the community.

Amina started breastfeeding her daughter immediately after her birth, unlike many who do so after a few days in the mistaken belief that colostrum harms the infant, whereas the vitamin-rich liquid actually provides the child with its first immunization.

When Tasmina was six months old, Amina began feeding her semi-solid foods, including fish and vegetables. She also used locally available medicinal herbs to treat the child’s stomach upsets. On his way back from work, the child’s father would bring her a piece of fruit or a toy, and play with her when he got home. Each night he would sing to her as she fell asleep.

Positive Deviance emphasizes behaviour change through participatory learning and community mobilization. In West Bengal, it focuses on feeding practices that lead to child undernutrition and encourages parents to change faulty eating habits. It trains mothers in neonatal and childcare and preventive health-care practices.

To put it simply, Positive Deviance seeks to understand and share the beneficial  feeding and caring patterns of families that are deprived, but whose children are nevertheless well-nourished – families that have healthy children despite living in poverty. The practices and habits of ‘positive deviants’ in the community enable them to beat heavy odds and find solutions, however unconventional, to problems that are common in their lives. This grass-roots approach has mobilized the community, resulting in individual and social change at all levels.

Replicating the programme

While earlier nutrition programmes focused on sick, malnourished children, Positive Deviance looks at healthy children in poor settings as sources of good examples to share with others in the community. Instead of asking ‘How can we help you?’ the programme poses the question, ‘How can you help yourselves?’.

Positive Deviance has taken off in a big way in West Bengal because the behaviour changes are acceptable, affordable and sustainable. In fact, it has been so successful that other departments of the Indian Government are interested in replicating the programme elsewhere.

Currently, the UNICEF-supported programme is being implemented in the districts of Murshidabad, South 24 Paraganas, Dakshin Dinajpur and Purulia, covering 1,015 villages with a combined population of 1 million – including 122,000 children under three years of age.

Now, thanks to Positive Deviance, other families share the happiness of cherubic Tasmina and her family, because their children too are becoming better nourished and more lively and playful.




28 April 2006:
UNICEF correspondent Jane O’Brien reports on UNICEF’s work with mothers in India to prevent underweight births and improve nutrition for them and their children.

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