Janaki Joshi, 40, lives in a remote village in Kailali District, a Far-Western region of Nepal. She studied till the eighth grade but has years of experience in the field of maternal and child health. She has been working as a midwife for the past sixteen years. At an age where women in rural Nepal are normally confined within the boundaries of their houses or fields, every day Janaki bicycles from home to the local health institution. She is aware of the health needs of the women in her community who still value traditional beliefs and practices.
Janaki shares, 'Women in my village are uneducated and backward. They don’t have a choice to be pregnant. It’s often the decision of the husband and they are always under pressure to give birth to sons. Pregnant women are often without good nutrition, anaemic, forced to work in the fields and rarely visit local health institutions.' She continues, ‘When I got married and came to this village more than fifteen years ago, birthing practices were risky, some women delivered babies hanging on to ropes during times of labour. Women often suffered prolonged labour, excessive bleeding and infection.’
Janaki was trained in midwifery for three and half months before she joined the Sub Health Post as a midwife sixteen years ago. The training was organised by the government for 24 women like her from the same district to serve in different villages. There she was trained to be a birth attendant, carry out antenatal and post natal checkups and family planning procedures, provide vaccinations, and taught the importance of mother and child health during and after pregnancy. Since then she has used her skills to save the lives of newborns and young mothers in her village. She also advocates for the need of checkups during and after pregnancy, and the importance of vaccinations, and right birthing practices in her community.
Nevertheless she still faces challenges due to the prevailing old school of thought. She shares, 'Some elderly people still bang steel plates or sprinkle water when newborn babies don’t cry soon after birth. They are not aware newborns need to be rubbed gently on the back or need artificial oxygen in such cases. Most of the times women are alone or assisted by their mother-in-laws. Many children born at home lose their lives for lack of knowledge among family members or old practices. I have saved two such newborns with artificial respiration which I learnt to give. If there are any complications, like children born underweight or with jaundice, I refer them to the hospital nearby.'
Janaki rarely takes time off from her busy schedule of tending to patients, mostly women and children in the Sub Health Post, a local health institution in Godavari Village Development Committee. The health post supported by World Vision, provides essential service to villagers, between ten and two every day except on Saturdays. She carries out antenatal check-ups and prenatal check-ups for pregnant women and does so using simple instruments like a blood pressure unit, stethoscope, and weighing machine. She provides counselling to women in family planning and assists them as well. Every month, she travels to the field to work in the village outreach clinic and provide vaccinations, iron tablets and vitamins to improve mother and child health. She also provides advice on good nutrition for pregnant and lactating women, and the importance of mother’s milk and right nutrition for children.
World Vision has been working to improve care and support for pregnant and lactating mothers and child care practices. Activities such as training Female Community Health Volunteers (FCHV) and mothers groups in Kailali on birth preparedness, with the involvement of midwives like Janaki, monthly classes for newly married and pregnant women on reproductive health, orienting pregnant and lactating women on services available at local health institutions, including classes on nutrition, care and safe delivery, rewarding FCHVs who send the maximum number of pregnant women to the health post, training parents/caregivers on improved feeding practices for children, promoting growth monitoring, and providing equipment and infrastructure support to local health institutions and outreach clinics are being undertaken.