The Bond of Care, 1998-1999

The care a mother receives during pregnancy and after delivery determines how well she will be able to feed and care for her child. This includes breastfeeding, psycho-social care, food preparation, hygiene and home health care.

When a woman’s rights are violated, when she is blocked from getting the information she needs, from going to school, from sharing information with her peers or when she is beaten at home, her child is significantly less likely to get the care s/he needs.

Photo: S. Mhatre

This connection between women’s rights and child rights — the bond of care — was explored as a programmatic opportunity to prevent child malnutrition in Pakistanthrough the Community Voice in Planning initiative.

The CIET survey identified what actionable components of care could translate into improved child survival, protection and development in a way that enables planners to compare alternative interventions in terms of their cost-effectiveness. Although suggestions from mothers, fathers, community leaders and health workers varied from place to place, some common themes emerged during comparison and aggregation of local evidence:

The education level of a woman was linked to the nutrition status of her children. In some areas, lack of education of the mother could be linked to the child’s delay in reaching developmental mile-stones, such as sitting. An action plan to increase girls’ enrolment in school was established during the first phase of the Community Voice in Planning initiative. It included measures to educate mothers as well as their daughters.

Domestic violence was found to severely damage the bond of care and could be linked to a higher risk for acute or chronic malnutrition (starvation and hampered growth). Despite the difficulties in reporting on violence, one in six women openly said they had a serious quarrel at home during the previous year, often including physical abuse. It is likely that this is only the tip of the iceberg. Men discussed this finding in focus groups to come up with solutions for local action. For an issue that is rarely discussed, opening up the dialogue on domestic violence was in itself a breakthrough in many areas.

Obstacles for women to attend antenatal care included lack of awareness of its importance, money to pay for it, and limited access to the health facilities. As a result, over half of women interviewed did not attend doctor’s check-ups during their pregnancies. Yet, a woman who did not get this care was more likely to have poor health practices and to have an acutely or chronically malnourished child.

Although almost all women breastfed their infants, many introduced other liquids and solids before completing the recommended four months of exclusive breastfeeding. There was also a widespread mis-understanding that colostrum (the first breast milk) should be discarded while, in fact, it allows the child to get natural immunisation.

The findings were presented by local government planners at district level workshops where they, together with community representatives, NGOs and civil society organisations designed action plans. Detailed local evidence allowed for regional adjustments while, aggregated, it was used to guide provincial planning in three out of the country’s four provinces.

“Earnest, honest discussion and practical steps suggested for improvement of children’s health,” proclaimed the headline in Balochistan Times following the bond of care workshop in Quetta in September, 1999. Journalists were involved throughout the Community Voice in Planning initiative to add transparency to the process, to hold decision-takers accountable for implementation of their plans of action and to inform the public.
Executive summaries of the reports on the bond of care cycle are available from the Library for the BalochistanNorthwest Frontier and Sindh provinces and the Rawalpindi district in Punjab.