Phounvah and Manivone love their work. On a humid day in Saravane Province, Lao PDR, they again start walking door to door in a small village to meet new or expectant mothers. As trained volunteers for the Lao Women’s Union (LWU), they have the critical task of delivering potentially lifesaving advice to families.
Saravane province has some of the worst health indicators in the county. One out of every ten infants die before their first birthday and stunting rates are among the highest in the world. For this reason, UNICEF and the EU have teamed up with the LWU to reach out to mothers.
Volunteers from LWU like Phounvah and Manivone have been trained and provided materials to offer breastfeeding advice and support to local mothers – advice that if followed would allow children to survive and thrive.
Their first visit was to Pa, a 20 year old mother of two. She could clearly see the benefits of breastfeeding. “I’m exclusively breastfeeding my 6 month baby,” she said holding her new baby and gesturing to her 2 year old who was almost the same size. “I didn’t do this with my first child.”
It was startling to see the how similar in size the two children were, despite the age gap.
“We see many more mothers breastfeeding now,” says Manivonh after counselling Pa on healthy foods for their children. “They are all seeing the benefits this brings to their children.”
A joint report by UNICEF, ASEAN and WHO shows that nearly half of children under 5 years of age in Laos are stunted, or too short for their age. Poor nutrition, including suboptimal breastfeeding, is one of the key drivers of undernutrition in children. Children in Laos suffer from many problems associated with undernutrition; stunting, wasting and anaemia levels are all high.
After visiting Pa the volunteers stroll through the village to meet other mothers. It’s getting even warmer now and with villagers either working in the fields or laying in the shade, the only discernible sounds are the buffalo-bells and crickets.
Wie and Lounny welcome the volunteers to sit beneath a stilted home. “Thanks to their support I learned how to feed my baby properly,” says Wie. “I also learned how to keep myself healthy, which is also important.”
But, said Lounny, there were still challenges. She said some mothers still give sticky rice to their young babies just to stop them from crying. Next to her home, she told us, a baby was born at 8am. By 11am, it was being fed rice.
In Laos, only 40 per cent of babies are exclusively breastfed until 6 months of age. Exclusive breastfeeding up to 6 months and complementary feeding after 6 months protects against childhood diseases, as well as other diseases in later life.
Lao Women’s Union: critical partners
When UNICEF was looking for a partner to promote and support exclusive breastfeeding and appropriate complementary feeding across Laos, the LWU was the obvious choice.
“To reach as many women and child caregivers as possible, we needed a trusted and active agent in the local community in order to keep broad community support,” says Dr Viorica Berdaga, UNICEF’s Chief of Health and Nutrition in Laos. “It’s a resource that allows you to be present in every community.”
The LWU has 600,000 members and is present in every village in Laos. They have the ability to access women across the multitude of ethnic groups and in the many different languages.
“This contribution from community based workers is very important,” explains Dr Chandavone Phoxay from the Ministry of Health in Laos. “We have two main types: Firstly, the village health volunteers who come from the community level. They are trained for a month in nutrition education as well as behavioural change communication and health promotion. In addition to that, the LWU also plays an important role. Some of the LWU members also became village health volunteers.”
UNICEF supports the LWU with training, communication materials and job aids to promote appropriate infant and young child feeding and nutrition in pregnancy and postpartum. Extra funds were provided for cooking demonstrations to engage women and other child caregivers on how to prepare nutritious food using local ingredients.
Additional communication materials were made into visual aids or “memory cards” in order to circumvent the problem of a lack of written languages and a plethora of spoken languages.
“When you cannot use the written language for training, you need to be innovative,” Dr Berdaga explains. UNICEF has also piloted the use of smart phones to convey health and nutrition messages in the local languages.
Laos is making a good progress in improving infant and child nutrition. With the help of UNICEF and the EU, and working alongside groups such as the Lao Women’s Union, it seems likely that greater improvements can be made.
“Nutrition is very complex,” says Koen Everaert, from the EU Delegation to the Laos. “It requires a multi-sectoral approach, multi-stakeholders, putting in place the correct structures at the national level, at the sub-national level and most importantly at grassroots level. The biggest work to come now is the scaling up and the rolling out of these very good policies.”
For Phounvah and Manivone, it’s another day of gratifying work.