WITH A bag containing photographs of food items and a chart detailing what a daily menu should have, Priti Kumari sits in the middle of a large plastic mat in a mango orchard, in Kasba block’s Kulla Khas village. It is 11 am, and as the sun climbs high, it is cooler under the thick tree cover. Around Priti sit nearly 30 people, all women or children. Kasba and Jalalpur blocks of Bihar’s Purnea district have been chosen for a three-year-long UNICEF project called Swabhiman, being conducted in collaboration with AIIMS, to study the nutritional status of marrigeable girls, just-married women, women with children below two years, and adolescent girls. UNICEF estimates that over 60 per cent of the adolescent girls and women in the two blocks are malnutrished.
Priti, 27, a ‘Poshan Sakhi (nutrition friend)’, is part of the pilot project, which got underway this year. And aiding her is a simple steel bangle, of circumference 23 cm. One by one, Priti will slide it up the wrist of the group around her. If it goes up to their mid-upper arm, they would be considered malnourished. For the adolescent girls (14-19 years), the pilot project has ‘Kishori Sakhis’, who carry a bangle with 19-cm circumference.
The bangle is a replacement for the mid-upper-arm circumference tape generally used to determine malnourishment. The tape is cumbersome to use, while women are immediately attracted to the bangle, Priti smiles. There are 33 such Poshan Sakhis, including Priti, who are part of the pilot project. It is ultimately expected to help prepare a nutritional profile of adolescent girls and married women in their prime across Bihar, and the findings will be included in the National Rural Health Mission.
Priti works with Jeevika, the Bihar government’s rural livelihood programme that is the implementing agency for the project. The requirement for being a Poshan Sakhi is Class 10 and above. Married, the 27-year-old lives in Kasba and recently got enrolled in a Purnea college for graduation, after giving up studying for six years. Her husband Pawan Kumar Shah is a marginal farmer. As the women settle down in a semi-circle facing her, Priti shows them the steel bangle. “Aaj hum log jaanenge aap kitni tandarust hain. Ye choodi bata degi aapne kitna khaya-piya hai (We will get to know today how healthy you are. This bangle will tell us if you eat properly),” she says, addressing the women as didi. The women gathered around her know Priti well as she frequents the area as part of Jeevika.
As Priti stands up, Roshni Devi is the first to approach her. Priti asks her to hold her left arm out, straight, and slides the bangle in. It goes up to her upper arm easily. Priti asks Roshni, 21, who is married, to sit separately. Priti explains that the test is done on the left arm as the right arm develops strong muscles through more use and hence is a less reliable indicator of malnourishment.
Kalpana Devi, 32-year-old Vina Devi and Soni Devi, 23, are next, and pass the test. The women clap. When her turn comes, a nervous Phulo Devi walks up reluctantly. Priti easily slides the bangle onto her arm, and remarks, “Is didi ko choodi dheeli pad rahi hai (The bangle is loose for this sister).” Phulo, 20 and married, is asked to sit next to Roshni. As the clock inches past noon, some women tell Priti they have to go back home to cook lunch. “Let husbands wait a bit longer for their food today,” Priti replies.
As the measurement process resumes amidst banter, Rani Devi, 21, also fails the test. The tape, which Priti uses in some cases, shows her mid-upper-arm circumference is only 20.5 cm. Eventually, 15 of the 30-odd women who get tested are marked as “under-nourished”. Around 1 pm, Priti starts the second stage of the exercise. She gathers the women who failed the test closer around her and takes out a chart denoting morning, noon, evening and night through various positions of the sun. Then Priti asks them what they eat for breakfast, lunch and dinner. Most tell her they hardly eat any breakfast, except for tea and biscuits. Lunch is largely rice, pulses, mashed potatoes or a green vegetable. Then again there is a long gap till they eat roti-sabzi for dinner.
Priti also discovers that nearly 90 per cent of the women do not eat anything before offering prayers in the morning. She then takes out the chart with photos of food ingredients, and explains the basic rule of “tiranga (tricolour)”. A person’s daily food intake should comprise red (pulses), white (milk and egg) and green (vegetables), she tells them. Priti also shows them photographs of the many local varieties of saag (leafy vegetables) they could have. Since this is more of a feedback programme, the Poshan Sakhis are not meant to suggest a food chart, which will be done after completion of the pilot project.
The women shrug at what Priti tells them. Phulo Devi says her husband, Anand Mahto, who sells ice for a living in the summers and otherwise works as a daily wager, earns only Rs 200-Rs 250 per day. The couple do not have a child yet. Rani says her husband Vimal Mahto is a mason. While he often makes up to Rs 500 a day, the work is irregular. The couple have two children, 5 and 3. While Rani is not part of the target group for the project, no one who turns up for the meeting is turned away.
Priti advises the women to grow seasonal varieties of vegetables on whatever land they have. “Ye routine barkarar rakhne ki baat hai. Aap sabko din mein char baar khana khana hai, jaise aap apne bachchon ko khilati hain. Apna balidan bekar me mat dijiye (It is about sticking to a routine. You must eat four times a day, just as you ask your children to do. Do not sacrifice yourself for nothing).” Around 2.45 pm, Priti starts winding up the meeting. She will return to the 15 women after a fortnight as well as visit some households in between to see what and how they cook. There would be follow-up visits later on to monitor the progress of the women and to analyse reasons for the same.
As Priti is leaving, an intern from a Rajasthan institute who has come for a field study on Jeevika’s rural work, tries the bangle on Priti. She smiles as she passes the test. Priti heads next to Jeevika’s block project implementation unit. Block project officer Rajesh Kumar, block Swabhiman consultant Krishna Mohan Mishra and UNICEF district consultant Naushad Ali explain that the work done by Poshan Sakhis is just part of the exercise.
Kumar says they are covering four panchayats each of Kasba and Jalalpur, with a population of 1.57 lakh and one lakh respectively. “The idea is to prepare a micro plan of nutrition. We look at health, nutrition, cleanliness,” says Mishra, adding that apart from bangle measurement, they would be studying the weight, length and body mass index of the targeted women and adolescents.
It is nearly 6 pm by the time Priti returns home. Her mother-in-law and sister-in-law do most of the cooking, she says, leaving her with enough time to catch up on studies. She can visit the college, where she is doing Geography Honours, only for a fortnight in a month due to her Jeevika work. “I wake up early and study between 3 am and 6 am. My husband also encourages me,” says Priti.
She makes sure she follows the tiranga food chart at home, the 27-year-old adds. “How can I lecture women about the benefits of timely and nutritious food if I do not practise it myself? We grow vegetables in our backyard. Though I do not carry a tiffin, I make it a point to eat on time, at times at a dhaba and sometimes at a villager’s place,” says Priti, adding, “I have never failed the bangle test.”