© K M Asad

Feeding Mothers' Courage

In Bangladesh, women dare to stand up for a healthy pregnancy
TEXT: Franca Roiatti - 31. May 2023
© K M Asad

"Who can tell me why lunch should consist of rice and at least four other food items?" Nusrat Hossain looks around. The young woman holds up a plate full of symbols and pictures of vegetables, pulses, dairy products, meat and fruit. On this cool winter morning, the attention of the women sitting on the orange tarpaulin shifts from the Helvetas volunteer to the children who are laughing and jumping up and down.

We are in Shilbunia Para, a small village in the hills of Bandarban district, in the Chittagong Hill Tracts. south-eastern Bangladesh. May Hla Koi Marma smiles at the sight of her lively and healthy daughter Nua Wong, one year old. Her story is different from that of her brother, Uche Wong, now seven, whose early childhood was much more difficult for both him and his mother.

In the region, 40% of children under 5 do not grow properly because of malnutrition and often get sick. In collaboration with young women like Nusrat, Helvetas is devising solutions to a situation that deprives many children of a normal childhood and a healthy life. This situation is due to a lack of nutritious food, but also to ancestral practices and a fragile health system. Helvetas not only promotes access to basic foodstuffs, but also strengthens women's knowledge and self-confidence - which is just as important for safe pregnancies and healthy babies.

Weak mothers, sick babies

May Hla Koi, the 29-year-old mother, walks towards a group of bamboo houses. She sits on her doorstep and watches the children playing with a swing made of ropes and clothes. Her son Uche Wong is at school and little Nua Wong is crying waiting to be breastfed. A blissful moment for mother and child. "It's so different with her," says May Hla Koi. "Uche Wong was sick all the time. He had a fever, coughs, and diarrhea. My milk wasn't enough, and I didn't know what to do. I was so afraid that my son would always be so weak. If only I'd known then what I know now. I feel guilty for him.

In the Chittagong Hill Tracts, villages are scattered, making it difficult to provide care for pregnant women and nursing mothersIndigenous populations are socially and economically isolated, while a number of traditional beliefs are deeply entrenched. For example, during May Hla Koi's first pregnancy, her mother-in-law and other older women imposed a strict diet on her: she was allowed only very small portions, with no protein. In the afternoon, she couldn't take a break. This was to prevent the baby from getting too big, as it is commonly believed that overly large babies cause complications at birth, especially during home births, which are very common here.

“I often had a headache and fever. My legs were swollen, and I felt dizzy. Moreover, I was constantly in a bad mood because I was hungry", recalls May Hla Koi. After giving birth, she was given only rice for a few weeks, which prevented the production of enough breast milk. "I didn't have the courage to oppose."

«I explained how important it is for expectant mothers to eat well.»

Nusrat Hossain, a volunteer

Resistance takes shape

Courage came two years ago with Nusrat Hossain, the dynamic volunteer who provides advice on childcare and nutrition. Just 19 years old, she began visiting families. She is full of enthusiasm, sharing her knowledge of healthy, diversified nutrition for mothers and children, hygiene, baby care and breastfeeding. She acquired this knowledge in one of the training courses set up by a local partner organization working with Helvetas. "It wasn't easy at first," she admits. "I'm young, I'm Bengali. People here didn't trust me, especially the older ones. They warned me that they'd been running things their own way for a long time and that it worked."

Nusrat visits Jeni Tripura, a friend of May Hla Koi and mother of two little girls. Jeni's story is also one of a difficult pregnancy and a fragile baby. "Giomati was listless for so long that I was ashamed to take her to the doctor," confides the 29-year-old. She was afraid that people in the village would think she was a bad mother. The bamboo walls of her modest home are lined with colorful drawings of rainbows, butterflies, flowers and imaginary animals. In the village, Jeni tutors children after schools, a way of compensating for her unfulfilled dream of becoming a teacher.

© K M Asad
May Hla Koi discusses her garden with Aung Swesa Marma, agricultural advisor trained by Helvetas. © K M Asad

Nusrat smiles at Jeni as she continues: "Despite my difficult beginnings, I didn't want to give up. I organized several meetings with senior members of the community. I explained to them how crucial it is for mothers-to-be to eat properly, and why they need to rest and have regular check-ups. I insisted that women should give birth in a clinic. And I explained why it's important for children to be exclusively breastfed for the first six months of life, if possible." Mothers were giving their babies other foods too early because of their workload, but also "because that's the way it's always been done".

Jeni gave rice to her first-born very early on, and May Hla Koi gave honey to her son when he was just three months old. And both missed out on giving their babies colostrum, the first highly nutritious breast milk produced immediately after childbirth. "Experienced women told me that this first milk was not good and unhealthy for newborns," recalls May Hla Koi. Today, I know that the opposite is true. That's why Nua Wong is a much healthier baby than her brother was at the same age."

But how did Nusrat manage to win the trust of the community? “With facts. She put us in touch with the health center so we could talk to doctors," says May Hla Koi. The new knowledge they gained gave May Hla Koi, Jeni and many other women the courage to stand up for themselves, their unborn children and their newborns. "When I was pregnant with my daughter, I explained to my mother-in-law that I was now going to follow different rules regarding food and rest. She was unhappy. I had to fight." Thanks to her husband's support, she succeeded. "Our marriage was one of love", she confides, and it was celebrated when she was 19: two unusual circumstances in a region where many girls are married far too early, with difficult consequences for their future.

© K M Asad
Jeni Tripura with drawings by the village children she tutors. © K M Asad

Sowing for the family’s future

When little Nua Wong falls asleep, May Hla Koi goes to the family garden. A dense canopy protects the gourds. She carefully examines each fruit and harvests only the ripest - much to the satisfaction of Aung Swesa Marma, the local agricultural advisor trained by Helvetas to promote the cultivation of healthy, nutritious food. Together, they check the contents of a plastic container hanging in the middle of the squash, which contains a natural pest control product. Aung's training courses have taught May Hla Koi how to improve her horticultural production: use the right seeds, produce organic fertilizers and natural phytosanitary products, spare water. "Before, I used to throw seeds around and use chemical fertilizers. Then I'd wait for the vegetables to grow. The success was mixed," admits May Hla Koi. Since then, I've reduced production costs and increased the harvest." Her garden also grows red amaranth, radishes, and beans, for her own consumption and for sale at the market. Success has given her and her husband wings. They rented additional land: "I want to plant papayas. And bananas, my daughter's favorite fruit."

With her basket full of gourds, she makes her way to the collection point, where farmers can deliver their harvest at a fair price. In this way, they avoid the often unfair middleman trade, and save themselves costly transport to a distant market. The development of agriculture not only improves the livelihoods of farming families, but also those of the whole community: there are more vegetables at an affordable price for everyone. "In our village, we stick together," explains May Hla Koi. Surplus vegetables are often offered or traded. During the high season, she is even able to hire helpers for the harvest. But above all, it's an opportunity for her to share her newly-acquired knowledge, so that neighboring families can also improve their cultivation.

© K M Asad
May Hla Koi with her lively daughter Nua Wong, in front of her house © K M Asad

A diverse menu

It's almost time to eat. Before she can cook, May Hla Koi has to fetch water from the other side of the village. There's barely enough water for everyone. In the Chittagong Hill Tracts, it's a scarce resource, and there's hardly enough for the garden. "We farmers have often asked the local authorities to bring water from the nearby river to the village via a pipe. So far, our requests have been ignored", explains May Hla Koi. But the women have no intention of giving up.

May Hla Koi carefully washes the vegetables before cutting them into small pieces. While the meat sizzles on the stove, she heats a bit of oil in another pan for the spinach. “This releases the vitamins," she explains. Before, I just boiled them. But with the oil, it's better." A scent of spices pervades the small kitchen, the bowls full of food are a feast for the eyes. "There were times when we ate only rice." Today, May Hla Koi cooks vegetables, lentils or chickpea soup every day. Eggs and meat are on the menu twice a week.

Her son Uche Wong, who was so often ill as a child, is doing much better thanks to the balanced diet and improved hygiene. He loves going to school and having fun with his friends afterwards. "Now I know that good nutrition is important for my children's health and future," says May Hla Koi.

May Hla Koi has to fetch water for the household on the other side of the village.

Looking straight into the future

She hopes her children will one day go to university and fulfill her ambition to become teachers. In her dreams, Uche Wong and her little sister Nua Wong do their homework in a stone house. "We save up for it," explains May Hla Koi. But that's not all. With the proceeds from the sale of her vegetables, she recently bought a cell phone so she can search for information and advice on childcare. "And a lipstick, that I really like."

"In this village alone, we support at least 200 women," explains Nusrat, the nutrition and childcare advisor. In a small outlet, she sells basic products for women and children: sanitary towels, diapers and soap, as well as oil, flour and other foods. She runs the shop with four village women. A space where mothers can come without an appointment to ask for advice and have their babies weighed. "My dream is to make this space economically sustainable to have the opportunity to empower more women," explains Nusrat. She can certainly count on the active support of May Hla Koi and Jeni.

The LEAN project is implemented by Helvetas and partner organizations and funded by the European Union, donations and SDC programme contribution.

© Franca Roiatti
Mothers can have their children measured and weighed to ensure their healthy development in the small, dedicated store. © Franca Roiatti

The situation in Bangladesh: tangible progress but still a long way to go

Bangladesh is one of the world's most densely populated countries. The economy has grown steadily over the past 20 years, mainly thanks to the export-oriented textile industry and remittances from migrants.

The country has recovered relatively quickly from COVID-19, but rising commodity and energy prices are holding back progress. Nevertheless, the government is committed to its vision of becoming an upper-middle-income country by 2031.

Despite remarkable progress in the fight against poverty, Bangladesh still faces a number of major challenges: the country is highly exposed to the climate crisis, the consequences of which are destroying the livelihoods of many people.

Economic and social inequalities are increasing, and are clearly perceptible in rural and remote areas such as the Chittagong Hills Tracts. This region on the border with Myanmar is home to eleven ethnic groups who were at war with the central government just 25 years ago. Indigenous communities continue to be marginalized and the situation remains tense.

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