1. Low Birth Weight, Maternal Nutrition and Antenatal Care in Rural Jharkhand: Findings from Ranchi Low Birth Weight Project Dr. Subrato K. Mondal Ronita Chattopadhyay Ranchi, 9 th October 2006

2. Project Partners Krishi Gram Vikas Kendra Child In Need Institute Social Initiatives Group, ICICI Bank In collaboration with: Department of Health, Medical Education and Family Welfare, GoJ Department of Social Welfare, GoJ

3. Intergenerational Cycle of LBW and Malnutrition Child growth failure Low Weight & Height in Adolescence Small adult women (Short stature) Low birth weight baby Early Pregnancy LBW – cause and consequence of malnutrition Need to develop a set of appropriate interventions that address the interrelated issues

4. Life Cycle Approach with LBW as an organising principle Pregnancy Early childhood Adolescence  Improving antenatal care  Reducing maternal mortality  Reducing proportion of lbw babies  Reducing infant mortality  Reducing childhood malnutrition  Increasing awareness about health and nutrition issues  Improving pre-pregnancy nutritional status of girls

5. Reducing the Incidence of Low Birth Weight using a Community based Life Cycle Strategy  Aims to impact key maternal and child health indicators  Focus on community mobilisation processes and enhancing linkages between the communities and the health systems  Action research – Seeking to understand and capture the processes of change (at the community and systemic level) Research Objective : To evaluate the impact of a community level Life Cycle based intervention along with the improvement of primary health care delivery system on maternal and child health outcomes.

6. Study Design Angara & Silli Sonahatu & Mandar Intervention Blocks Comparison Blocks (No intervention) Ensuring Mandated Health Services intervention in 50% SC areas Ensuring Mandated Health Services + Community Mobilisation intervention in 50% SC areas No intervention in 50% SC areas 4 Blocks in Ranchi District

7. Methodology 72 SCs from four blocks 195 villages HH level: Married women having live birth in last 5 year, and head of household ANC Cohort – women in last trimester of pregnancy Young unmarried women (15-24 years) Young unmarried men (15-24 years) Ist stage2nd stage Survey Instruments Married Woman Questionnaire ANC Questionnaire Village Schedule Youth Questionnaire ANM and AWW Questionnaire TBA Questionnaire

8. Study area Religion Hindu Muslims Christians Sarna % 62.3 4.6 2.5 30.1 Average Household size5.7 Household below poverty line48.7 Households having toilets3.6 Households with safe drinking water33.1 Standard of living Low Medium High 49.3 40.6 10.1

9. Birth Weight

10. Details of ANC cohort followed Total number of pregnant women identified during third trimester 996 Information available (Followed)830 Still Births30 Birth weight taken741 Neonatal deaths34 Infant deaths48

11. Birth Weight Distribution Proportion of LBW babies: 41.7% Mean birth weight: 2516.3 gm, S.D. 383.5

12. Place and assistance during delivery

13. Birth Weight: Some more findings

14. Maternal Care

16. Tetanus Toxoid Immunisation and IFA consumption

17. Received at least 3 Antenatal Check ups

18. Maternal Diet and Workload Food pattern during pregnancy Women performing heavy/risky work during pregnancy

19. Women’s decision making

20. Women’s autonomy and dietary practices

21. Poverty and health behaviour

22. Reasons for accessing health care: public and private