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USAID and UNICEF Help Communities Fight Stunting

By Adresh Laghari

Khairpur Mirs, Sindh – November 2017: While chopping vegetables to prepare lunch, Gul Jan (27), a mother of four, is also expertly coaxing her youngest two-and-a-half year old daughter into eating a banana. “Baba said he will count the bananas left in Anchhu’s basket,” Gul tells Ansa, nicknamed Anchhu. 

It is almost impossible to deduce from this young mother’s graceful smile that like many girls in her village (Jehan Khan in Kingri tehsil, Khaipur Mirs district), she was deprived of her right to education and was married off as a child at the age of 13 . Jan’s husband Imtiaz, a labourer, was 11 years older than her at the time. At 14, she gave birth to her first son Muhammad Waris (13). She had two more boys, Abdul Malik (8) and Muhammad Muqeem (6). “The love that I feel for my mischievous gang of three boys and my princess Anchhu never gives way to unnecessary thoughts of a different life,” says Gul Jan with eyes gleaming in contentment. Just then, Ansa throws the banana towards her mother – as if she knows that silences need to be broken sometimes.


Ansa (2-and-a-half) finally agreeing to have a banana that her mother Gul Jan (27) wisely coaxed her into having instead of a biscuit. © UNICEF/PAKISTAN/Adresh Laghari

Ansa has not always been a healthy, happy fruit juggler. During her first year of life, she was a weak child with no appetite and showed no signs of improving despite being taken to several doctors. “We almost sold our entire livestock and many other valuables for her treatment,” shares Gul Jan whose early pregnancies and poor nutrition had a toll on her children’s health as well, with Ansa being the most affected. 

Ansa was born premature and had a low birthweight. The community influence that saw Gul Jan being married off at 13, also saw to it that Ansa did not receive the essential colostrum through early initiation of breastfeeding. Colostrum is the mother’s first milk that the baby should receive within the first hour of birth. It helps in laying the foundation of an “The love that I feel for my mischievous gang of three boys and my princess Anchhu never gives way to unnecessary thoughts of a different life,” says Gul Jan with eyes gleaming in contentmentimmune system in the child. Instead, Ansa was fed honey and a mixture of dry fruits. Not only that, but she was also kept bereft of being exclusively breastfed during the first six months of her life. “It was normal for me,” says Gul Jan, adding, “All my children had been raised that way.” But Ansa’s condition was worsening with time. Gul Jan says that every time they brought Ansa back home from a visit to the doctor, they were greeted by women of the family who gathered at their house to comfort the parents. 

Unfortunately, the doctors were also prescribing Ansa formula milk and commercially available cereal supplements instead of breastfeeding. They were also testing her for a new disease every other time – Tuberculosis, Hepatitis A, B and C, and others. 


Ansa (2-and-a-half) and her mother Gul Jan (27) sharing a joyful moment in their house. Ansa suffered from severe acute malnutrition (SAM) and was cured through the UNICEF-supported Outpatient Therapeutic Centre in Kingri Tehsil Hospital, Khairpur, Sindh. The centre was established under the USAID-funded UN Maternal and Child Stunting Reduction Programme. © UNICEF/PAKISTAN/Adresh Laghari

When Ansa was 18 months old, two different teams of social mobilisers from as many local non-governmental organisations (NGOs) came to Gul Jan’s village. They held separate sessions on nutrition and water, sanitation and hygiene (WASH) with men and women of the community. It was there that a social mobiliser identified that Ansa was suffering from severe acute malnutrition (SAM). She was immediately referred to the UNICEF-supported Outpatient Therapeutic Programme (OTP) centre at the local public hospital in Kingri tehsil. 

At the OTP site, Ansa went through various check-ups including mid-upper arm circumference (MUAC), and height and weight measurements. She weighed less than 8 kilograms and had a MUAC under 11.5 centimetres – both dangerous signs of a developing nutrition problem that could eventually lead to death if not treated in a timely manner. Staff from“I devoted myself to make sure Anchhu got every bit of attention she needed to get well,” says Gul Jan UNICEF’s implementing partner ACF International (Action Against Hunger) working for improved Infant and Young Child Feeding practices recommended Gul Jan to breastfeed Ansa for the remaining months along with giving her other semi-solid and solid foods – a practice called complementary feeding. To help Gul Jan and other mothers in the village give their children the right types of food, cooking demonstrations were also organised in the community. “I devoted myself to make sure Anchhu got every bit of attention she needed to get well,” says Gul Jan. Ansa was also given ready-to-use therapeutic food (RUTF).  

In parallel, Gul Jan also attended counselling sessions on hygiene and sanitation by Hands International, another of UNICEF’s partners in the programme. Before this, she was never told what role hygiene and sanitation play in ensuring a child’s healthy life. Their house, like many in her village, did not have a latrine. In fact, hygiene practices were not given any importance by the village residents as majority practiced open defecation. “It was one hurdle after another,” she shares. “The most disappointing factor was that they were all being created by my own people, my kin.” Finally, however, Gul Jan convinced her husband and her brother-in-law, with whom they share the house, to build a latrine. 
 

Gul Jan (27), a mother of four, says that after she has come to know the importance of hygiene, she now washes her hands with soap regularly and strictly asks the family to do so as well. © UNICEF/PAKISTAN/Adresh Laghari

The teams visiting Gul Jan’s village were approaching communities under a UNICEF-supported programme called ‘UN Maternal and Child Stunting Reduction Programme’. Funded generously by the United States Agency for International Development (USAID), the programme has a special focus on the first 1,000 days of a child’s life in three districts of the Sindh province, namely Ghotki, Khairpur and Naushahro Feroze. On one hand, “The programme is a perfect example of an integrated approach at the community level,” says Dr. Umar Khan, Nutrition Specialist, UNICEFit addresses the immediate causes of undernutrition, emphasising actions to improve the nutritional status of children, mothers and pregnant and lactating women. On the other hand, in WASH-related activities, efforts are being made to maintain a safe, clean and secure supply of water, eliminate open defecation, and mobilise the communities to adopt standard hygiene practices, particularly handwashing with soap. The WASH activities in the programme are currently only being piloted in two tehsils of each district.  Together WASH and nutrition activities can prevent stunting. 

“The programme is a perfect example of an integrated approach at the community level,” says Dr. Umar Khan, a Nutrition Specialist with UNICEF in Sindh. “A total of six NGOs are engaged in the community activities, while partners at the top include the Government of Sindh, UNICEF, USAID and others,” he adds. Dr. Khan explains that the programme aims to support the provincial government of Sindh in efforts to reduce stunting, especially in the three target districts. Providing services in nutrition for mothers, children under two years of age, and pregnant and lactating women is the crux of the programme. It also specifically targets communities for an improved understanding of water, hygiene and sanitation as well as nutrition practices. 

WASH interventions are critical for stunting reduction and for improvement of living conditions through creation of social norms around health and hygiene. Mubashara Iram, a Water, Sanitation and “Achieving open defecation free (ODF) status is being seen as a service that communities must provide children,” says Mubashara Iram, WASH Officer, UNICEFHygiene (WASH) Officer at UNICEF in Sindh, says that there is an increase in the demand of toilet construction in the project target areas. “Gradually, communities are becoming more aware of health, hygiene and handwashing with soap. In fact, achieving open defecation free (ODF) status is being seen as a service that communities must provide children,” she adds. 

Gul Jan feels she is developing a relation with her daughter, one far different from before. “It is so pleasant to be able to imagine a different life for Anchhu,” she says. “I have already made it quite clear to her father that she will be going to school and she is not getting married until she wants.” 

Curious little Ansa does not know what her mother has in mind for her at the moment. But if you take a long enough pause and look at her attentively, you will see that the toddler has an earnestness in the way she follows her mother. Not that of a daughter, but of a student waiting to receive a new lesson every now and then.

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