Trust the Mothers

My first experience in international development was as a Friedman School student, when I interned for three months with Save the Children in Siraha, Nepal. There I met a woman who worked as a community health facilitator for her village, leading a nutrition program for women and their children. I still remember her face, but not her name. She was 24 years old, the same age I was, and a mother of two. I visited her in her home, where she lived with her husband, who worked in the fields, and her in-laws.

I thought she was an amazing woman. She had so many duties taking care of her children and her home (they had no plumbing, and hauling water from the well was fatiguing). In part-time work with a nongovernmental organization (NGO), she also was educating other mothers, specifically new mothers, about breastfeeding, nutritious foods that help children grow and simple hygiene, such as hand washing.

I wasn’t sure if this soft-spoken woman realized that she was making a difference—she may have seen this job primarily as a way to bring in a little extra income—but I saw it as valuable for her community.

I think of her often. She had not gone to high school. She married at 18. Does she have more kids now? Is she still working with the NGO? Does she have a bathroom in her house yet?

Since that time, I have been evaluating health and education projects in such places as the Gambia, India, Cambodia and Kenya, consulting for NGOs that emphasize maternal and child health. In India, I observed government-trained auxiliary nurse midwives from a tribal community provide prenatal care to women in their homes. Just like the health facilitator in Nepal, these midwives had limited education and resources, and yet chose to do important work, probably unknown to them how important.

But it was not until I became a mother myself and was confronting my own challenges juggling work and motherhood in the United States that I came to understand firsthand the importance of mothers to successful international development—and why we must help them.

Mothers of Progress

Several studies have found that money in the hands of women more often than not goes toward the well-being of their children. When women in developing countries own property or add to the family’s income, or when they have access to development assistance, that money is more likely to be spent on food, medical care and housing. Now I understand why.

After having my first child five years ago, my priorities shifted completely. My children’s needs are always met first, whether it is buying diapers, food, clothes and toys, or enrolling my daughter in an art or dance class. Any money I receive as a gift immediately is spent on my children. They are my number one priority.

It makes sense to me now why development organizations see women as important agents for economic progress. The World Bank has found that providing extra income to women means a greater probability that their children will go to school and enjoy good health. The World Economic Forum has shown that giving women farmers in Kenya the same level of agricultural assistance as men could increase crop yields by more than 20 percent.

For reasons like this, international NGOs have focused on working with women to help pull families and communities out of poverty. Also, the more positive and active a role a healthy and empowered mother has in caring for her family, the better a role model she is for her children, specifically young girls.

Motherhood has given me a better understanding of why it is critical to emphasize maternal health during the baby’s first year of life. According to the United Nations Population Fund, every day approximately 800 women die from causes related to pregnancy and childbirth—most of them preventable—and 99 percent of all maternal deaths occur in developing countries.

The consequences affect generations. In Bangladesh, a study by the International Centre for Diarrheal Disease Research found that when women, particularly the poorest women, become sick after giving birth, it places a heavy financial burden on the family.

But even for mothers who do not suffer complications in childbirth, the first year is a physically challenging time. I was aware how tiring becoming a new mother would be, but did not know how demanding breastfeeding would be. I am amazed that women are able to do labor-intensive farm work and also breastfeed. How do they manage?

Health programs emphasize that breastfeeding is best for the child, but for breastfeeding to bring the ultimate benefits, the mother needs to be fed well to produce enough nutritious breast milk. I remember how my mom, who was born in India, cooked lots of fenugreek and dill so I could produce enough milk; how she made sweet foods so my breast milk would taste sweet.

Articles in U.S. magazines always highlight taking care of oneself as a new mother, but now I wonder about these women in poorer households, taking care of several kids, meeting the needs of a husband, mother-in-law and extended family and also working outside the home. How much milk do these women produce when they have so many responsibilities and live in households where there often isn’t enough food? (Usually the mother eats last, and so there is not enough food for her.) Several times during my travels, I have witnessed women selling something on the roadside while nursing a baby.

The United Nations wants to improve maternal health as part of its Millennium Development Goals. For me now, the words “maternal health” are based on my own experiences and not on just classroom learning and field observations. It has made me reflect in new ways on the importance of community support and maternal instincts. I’ve no doubt that with continued support on all levels, the health facilitator in Nepal, the nurse midwives in India and other women like them will truly make an impact in the world.

This article first appeared in the Winter 2014 issue of Tufts Nutrition magazine.

Deepa Shanadi (Bhat), N02, MPH02, evaluates health and education projects at the Research and Evaluation Bureau at Kent State University in Ohio. She can be reached at deepab121@yahoo.com.