As the impact of the covid-19 pandemic in India worsens, Aastha Kant highlights how community support groups have provided a vital service in the pandemic relief efforts

The covid-19 pandemic has caused widespread disruptions in all walks of life. Over the past few weeks, the situation in India has escalated, causing widespread shock, anger, and grief across the world as the death toll mounts. It has impacted on the capacity of health systems to continue to deliver essential health services. Frontline healthcare workers have been diverted to pandemic mitigation activities, creating a void in services for vulnerable groups including support for pregnant and lactating women, and children. In India, women’s community organisations, through self-help groups (SHGs), have stepped in to help fill the gap.  

The response to and management of the covid-19 pandemic started with the abrupt announcement of a nationwide lockdown from 25 March 2020, creating uncertainties related to livelihoods and food security for vulnerable groups. This led to reverse migration, with thousands of daily wage labourers, their wives, and young children returning to their villages in adverse situations. The lockdown resulted in anganwadi centres (Hindi word for “courtyard shelter” which were started as part of the Integrated Child Development Services to address child malnutrition) being closed as a safety measure or being converted into quarantine centres. Cessation of services led to a 21% reduction in institutional deliveries and a 69% drop in measles, mumps, rubella vaccination for children in March 2020 compared to March 2019. [1] In addition, there was a steep decline in antenatal and postnatal care services.

India has the largest number, network, and outreach of SHGs globally. The central and state governments, along with non-governmental organizations, galvanized 7 million SHGs into action, engaging over 75 million households spread across over 6,500 blocks to complement government response to covid-19. These community networks are helping families through the covid-19 pandemic by providing livelihood support and income-generating activities. In addition to stitching nearly 170 million masks, producing over 513,000 litres hand sanitizer and nearly 530,000 protective gears, SHGs have also established community kitchens. Across 15 states, a little more than 122,000 community kitchens have been set up serving about 558,000 vulnerable people, including women and children. [2] These SHGs include Kudumbashree in Kerala, Didi ki Rasoi in Bihar, and Mukhya Mantri Didi Kitchen in Jharkhand, to name a few. 

SHGs have been instrumental in supporting the nutrition of women and children. They stepped in to promote sustainable and diverse diets and nutrition-based livelihoods through various community initiatives. Since the lockdown has led to restricted mobility and market closure, affecting food supplies, SHGs have been involved in promoting nutri-gardens by encouraging women to produce a variety of vegetables in their backyard. This serves to ensure nutritional security of families throughout the year and add to dietary diversity among children. 

Amid the nationwide lockdown, SHGs in various states, including Jharkhand, Odisha, Uttar Pradesh, and Kerala realized the need for delivering essential goods and services to the community. They started to produce and deliver “ready to eat” take home rations, dry rations, and fresh vegetables to pregnant and lactating women, and children aged six months to three      years. “Vegetables on wheels” was one such platform where vehicles were used for providing doorstep delivery of fresh vegetables.  Kudumbashree—an SHG in Kerala explored an innovative initiative—”floating supermarkets,” where boats were used as floating stores to deliver essential goods in areas accessible through water ways. SHGs have also been supporting frontline healthcare workers by reaching out to pregnant and lactating women for antenatal and postnatal care services, as well as iron folic acid and calcium supplementation. For example, in the states of Bihar, Odisha, and Chhattisgarh, over 2,000 SHG women have contacted more than 4,000 pregnant and lactating mothers suffering from malnutrition. [3] 

The nutrition-related activities assume greater importance when viewed along with the key findings of the National Family Health Survey (NFHS-5, 2019-2020), from 22 states/union territories (UTs). Compared to NFHS-4 (2015-16), the key findings of NFHS-5, which cover the pre-covid-19 era, show a decline in maternal and child nutrition status. There has been an increase in child stunting and wasting in 12 states/UTs, increases in prevalence of under-weight children in 16 states/UTs, and high levels of anaemia in pregnant women across many states. [4] 

Although SHGs have been engaged in maternal child health services during the lockdown, there is little evidence to show how impactful these initiatives have been. There is also limited information about the number of beneficiaries reached by the SHGs and how their reach and impact can be maximised. However, studies have shown that prior to covid-19, SHG platforms have been effective in implementing health behaviour change interventions for maternal and new born health by promoting positive behaviours in two resource-limited states—Uttar Pradesh and Bihar. [5,6] 

SHGs have been the bright spots—unsung changemakers who are shouldering the responsibilities of fighting the disruptions caused by the pandemic in India. They have been addressing development issues, despite limited resources, difficult geographies, and existence of patriarchal structures. The Indian experience of engaging SHGs for providing maternal child health and other services in a pandemic crisis and even thereafter, could serve as a model for other low- and middle-income countries.

Aastha Kant is assistant director of research programmes at the Johns Hopkins Maternal and Child Health Center, India, at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health.

This post was developed as part of the course titled “The COVID-19 Response in India: Impact on Women and Children’s Health and Wellbeing”, which was delivered by the center in December 2020/January 2021. 

Competing interests: none declared. 

References:

1. Cash R, Patel V. Has COVID-19 subverted global health? Lancet 2020;395(10238):1687-1688. https://doi.org/10.1016/S0140-6736(20)31089-8    
2. Ministry of Rural Development, Deendayal Antyodaya Yojana-National Rural Livelihood Mission (DAY-NRLM). COVID-19 response report. April 14, 2021. https://nrlm.gov.in/covidResponseReport.do?methodName=showView 
3. Press Information Bureau. Community Kitchens run by SHG Women provide food to the most poor and vulnerable in rural areas during the COVID-19 lockdown. 13 April 2020. https://pib.gov.in/PressReleasePage.aspx?PRID=1613866
4. International Institute for Population Sciences (IIPS), Macro International. National Family Health Survey-5, 2019-2020.  22 December 2020.http://rchiips.org/nfhs/factsheet_NFHS-5.shtml
5. Walia M, Irani L, Chaudhuri I, Atmavilas Y, Saggurti N. Effect of sharing health messages on antenatal care behavior among women involved in microfinance-based self-help groups in Bihar India. Glob Health Res Policy 2020; 5(3): 1-8. https://doi.org/10.1186/s41256-020-0132-0
6. Hazra A, Atmavilas Y, Hay K et al. Effects of health behaviour change intervention through women’s self-help groups on maternal and newborn health practices and related inequalities in rural India: a quasi-experimental study. EClinicalMedicine 2019; 18: 1-11. https://doi.org/10.1016/j.eclinm.2019.10.011