In Bhudurubania village in Orissa's Mayurbhanj district, the divide between life and death for a nascent baby is as narrow as the road that separates the habitation and the childcare centre.
Padmavati Behera realised this recently. The centre is just in front of her home but she hardly visited it for any pregnancy related care because she believed in traditional health practices. It was only when her child died of cold and cough, an easily curable ailment, did she realise that the simple steps often suggested by the 'aanganwadi' worker could have saved her child.
Padmavati is among those unfortunate women in the remote areas of Orissa who can never be sure of their children's survival. At least 75 of every 1,000 children in Orissa die before they complete their first year, says Grassroots Features.
"I kept watching helplessly as my child lay dying on my lap," said Padmavati. "We went to the Gunia (the local traditional healer) but the condition did not improve," said Suryamani Behera, Padmavati's mother-in-law.
After continued illness for a few days, the child eventually died. "Ignorance and blind faith took the child away from us," rues Suryamani. The child was about seven months old.
Things, however, looked up when Padmavati got pregnant again. By then, she was part of a new awakening process in Mayurbhanj, aimed at tackling infant deaths.
Her third child, eight months old now, did not suffer the same fate, thanks to the Integrated Management of Neonatal and Childhood Illnesses (IMNCI).
Suryamani had by then attended a training course and Padmavati had been to several meetings of mothers, which helped them come out of the trauma of losing a child.
Suryamani says: "Only a few days ago the child had cold and cough and we got it cured with Didi's (aanganwadi worker) medicine."
With the aanganwaadi worker's advice they went for a hospital delivery. "Earlier, we thought home delivery would save us the cost, now we are sure that hospital delivery saves life," said Suryamani.
Mayurbhanj, a tribal dominated district, was chosen as one of the six pilot districts in the entire country, which have the highest infant mortality rates (IMR), to host IMNCI. Padmavati and thousands of other women have now benefited from this programme, which has achieved tremendous results in just two years.
IMNCI is actually a modified version of the IMCI (Integrated Management of Childhood Illness) strategy developed by the World Health Organisation (WHO) and the UN International Children's Fund (Unicef) to reduce child mortality and morbidity and is currently being implemented in more than 80 countries.
Rabi Narayan Kanungo, a retired chief district medical officer, said: "The IMNCI strategy was adopted in October 2004 with Unicef's support to reduce the neonatal mortality rate (NMR) in India. NMR accounts for at least two-thirds of the Maternal Mortality Rate (MMR) and this programme will automatically bring down the cases of MMR drastically.
"In Mayurbhanj, at least 57 percent of the people belong to Scheduled Tribes. Most of them stay in some of the most remote and inaccessible pockets. It is always a challenge to make the health facilities reach these pockets.
"However, we targeted two of the most crucial blocks and trained the aanganwadi workers, auxiliary nurse-midwifes, doctors and NGO workers in various phases. We have organised trainings through public-private partnership in 26 districts," said Kanungo.
Labanya Sahu, an anganwadi worker with 18 years of experience, has found her involvement in IMNCI to be very beneficial and satisfactory.
"We now visit mothers during pregnancy and prescribe proper food and nutrition practices. We have also succeeded in convincing them to go for hospital delivery. Immediately after delivery, we visit the mother and the child and check the health of both the child and mother," added Labanya.
Mothers are also educated on breast-feeding, including proper positioning of the child during breast feeding and maintaining the required level of warmth. Labanya asserted that this has led to an increase in immunity among children.