2020 was a challenge!

COVID 19 challenges

A difficult year for very many - personal loss, health issues, insecurities, economic hardship and much more - didn't matter how or where one lived.

At Kushal we had our fair share. COVID catalyzed us to jump start activities in India and we had busy months between March and September despite strict lockdown. However, COVID struck and several colleagues were affected. Additionally, we had to cope with severe floods and new regulatory requirements by the government for #ngos.

Yet, the resolve, determination and passion shown by our frontline #volunteers for what we care for has been remarkable. Our digital presence continued to grow.

There are many who were beside Kushal through these challenges.

I would like to take this opportunity to thank Vasavya Mahila Mandali Bollineni Keerthi Jyoti Lahiri Divya Bajpai Peter Beeby Purba Chatterjee Tom Godfrey. A big shout out for Sophie Hurford and Niti Nadarajah who have been critical with their support. Prof Unithan University of Sussex and ST Prasad have been inspirational.

We now look forward to the New Year with the same determination and without dampened spirit.

Wish all a safe, healthy and joyous 2021!

#seasonsgreeting #hopeforthefuture

Act now – start a conversation

Start a conversation. #endgenderbasedviolence

25 November marked the launch of 16 days of activism for the International Day for the Elimination of Violence against Women concluding on 10 December 2020, which is International Human Rights Day.

Pregnancy is frequently a trigger for domestic abuse, and existing abuse may get worse during pregnancy or after giving birth. A period which should be characterised by joy, shattered by violence. The consequences are severe - increased risk of miscarriage, infection, premature birth, and injury or death to the baby.

In India, at any point of time, there are 7-8 million first time mothers of young children who have been physically abused by their husbands while pregnant.

Though pervasive, it does not have to be inevitable. Unless we stay silent. So, start a conversation to make a difference.

UN Women recommends 10 actions,

Act now - start a conversation

 

1. Listen to and believe survivors

WorldPulse provides such a platform, in which women can speak out, whatever they may have to share to commemorate the 16 Days, because voice matters.

2. Teach the next generation and learn from them

3. Call for responses and services fit for purpose

Our partner organisation  Vasavya Mahila Mandali has recently started a hotline for women in Andhra Pradesh.

4. Understand consent

SheThePeople, a women focused channel which challenges gender stereotypes has come up with clever instagram posts to help explain consent.

5. Learn the signs of abuse and how you can help 

 Saahas.space is a web-based and mobile app, and chatbot that helps survivors across 196 countries access support and informational resources

6. Start a conversation

We at Kushal believe story telling is a powerful way to start conversations.

7. Stand against rape culture

8. Fund women’s organizations

9. Hold each other accountable

10. Know the data and demand more of it

The Mask I Wore To Work…

Share your story

The mask I wore to work

By Niti Nadarajah

Our guest blogger Niti bares her heart out on a very difficult topic. She says, "this is the hardest and most personal thing I have ever written. And I have been writing it in my head for more than 2 years... Today will be a hard day as I shed tears and remember what I have lost. But it is important I share my story. It's important that we share our stories. It's important that we start talking about issues that silently and unknowingly impact so many among us every day." 

This article first appeared in LinkedIn here.


Three years ago, I bought a book and read it to my daughter. Three years ago, I went to have a picture taken. Three years ago, my heart broke into a million pieces and I wore a mask to work…

Two years ago, I took that book out again but I didn’t read it to my daughter. Two years ago, I went to have another picture taken. Two years ago, my heart shattered and again, I wore a mask to work...

But this time, the mask was damaged as I had worn it before. If you looked closely enough, you would have seen the small cracks and through them the real me...If you had asked me if I was OK, the mask would have splintered...

And yet I suffered in silence while grief and depression engulfed me. I operated largely on auto-pilot at work, often escaping to the bathroom to cry silent tears. And when I returned home, my pent-up emotions spilt out in an avalanche.

Losing two babies in two years broke my soul. Having to tell my then 3 year old daughter that we were no longer having a baby and that she should stop kissing my belly broke my heart. Having to act like everything was OK while I felt empty inside, while I still felt and, at least in my own mind, looked pregnant, broke my spirit.

support services

My story is not unique. It's all too common. I discovered this when I finally built up the courage to be able to share my grief - so many of the women I knew had their own stories to tell.

But, for some reason, while we talk openly about atrocities committed around the world, about war and death, we are unable or unwilling to talk about pregnancy loss, infertility and stillbirth, experiences which have most likely impacted the lives of many that we work with.

The second time I miscarried, I had just been promoted to my current role. I was trying to establish relationships with a new peer group and credibility as manager of a team I had previously been a member of. I remember vividly going on a work trip three days after I'd had curate surgery to remove my unborn baby. They say flying heightens your emotions - well, I've never cried so much while watching in-flight movies! And those four days away from family felt like fifty. Each day, I put on a brave smile, I fought to focus in meetings and bumbled my way through role-plays and training, I laughed at dinners and drank way too much. And at night, I collapsed in a heap. It was exhausting and eventually, it all became too much...

When I was at breaking point, someone noticed that I wasn't quite myself and asked me if I was OK. The floodgates opened. I didn't need the other person to tell me everything was going to be OK or that I would move past the loss. All I needed was to talk, to cry and to be listened to. After that conversation, my heart felt lighter, my shoulders relaxed and I felt as if I could breathe again. I would never move on completely, but at least I could let go of some of the pain that was holding me in its grip and start living again.

So why do I share something so deeply personal with you?

    1. Ask the question. All too often when we see someone behaving out-of-character at work or suddenly, the standard of their work-product drops, we brush these signs under the carpet and ignore them. Don't ignore the signs. Ask them if they are OK. Sometimes, all a person needs is those simple words, a light touch to the shoulder, a gentle nudge.
    2. You don't need to be a counsellor. Talking about grief is difficult. We often don't know what to say. That's OK. Sometimes, all the other person needs is a shoulder to lean on, a hand to hold, an ear that listens.
    3. Everyone wears a mask. No-one is immune from personal tragedy, grief, anxiety and/or depression... These issues do not discriminate.
    4. We need to get more comfortable talking about pregnancy loss, infertility and stillbirth. These issues affect so many of us and yet, we experience them in silence. We need to build up circles of trust at workplaces that enable women and their partners to talk about what they are experiencing. When a loved one dies, we tell people what has happened, we take time off and no-one expects us to operate as if nothing had happened. We need to allow grieving parents and those dealing with the heartache of infertility the same space.

Let's share our stories and give voice to experiences that are all too common so that we no longer need to suffer in silence.

Niti Nadarajah (mother of four, including two angel babies and one much-hoped for rainbow baby)

For pregnant women gender injustice is THE obstacle to wellness.

#genderinequality #maternalhealth #storytelling #digitaldivide

United Nations Population Fund (UNFPA) has released its "State of World Population Report 2020" highlighting the scale and pervasiveness of gender injustice and stereotyping in the world today. The statistics are appalling and makes me at times wonder in despair why we continue to be stuck in medieval attitudes, beliefs and practices in the 21st century.

UNFPA advocates for a world where every woman and girl should be free to chart her own future. That’s a no brainer and why not! Yet, as the report highlights the reality is quite different. Causative factors are detailed in the report, and some of these are that we experience in Kushal day to day and work towards. For example, when we speak to family members of pregnant women, we are often told,

“Why does she have to learn what happens to her body in pregnancy? My mother and aunt live with us. They tell her what to do. They are who should make decisions for her and for us as a couple.”

It’s easy to get upset and react angrily. But to change mindsets of those who hold power and deny bodily autonomy demands patience. It can’t be done by sermonising, which is why we rely on story-telling, an effective tool for social change and by engaging male members of the family.

The report also presents data from 57 countries, stating that only 55 per cent of women aged 15 to 49 years who are married or in a union make their own decisions about sexual relations and the use of contraceptives and reproductive health services (UNFPA, 2020). We have some preliminary data to this affect as well, and continue to monitor so that we can come up with innovative ways and approaches to address gender related barriers.

For those who would like to know more about gender-biased sex selection, Female Genital Cutting and child marriage the report is a good read. However, I would have liked for the report to articulate strongly enough how and why it is essential to also address the digital divide in today’s world. To make a better case for leveraging technology effectively in order to facilitate autonomy, decision making and wellness in women.

You can also read Prof. Maya Unnithan's commentary who heads Centre for Cultures of Reproduction, Technologies and Health (CORTH) at Sussex University. She concludes by pointing out,

"Although rights have arrived, justice has not followed!"

"Men as husbands, fathers, policymakers, healthcare providers need to use their privilege to redress gender discrimination for greater social justice."

Training frontline workers on COVID

We have been getting requests for COVID -19 Training for frontline workers nearly everyday. That is not surprising.

Pregnant women in urban slum and rural communities are facing unexpected hardship because of COVID -19. The antenatal support provided through Government of India's Janani Sishu Suraksha Karyakram programme in Andhra Pradesh has come to a standstill as Anganwadi Centres (AWCs) have had to be closed because of the COVID - 19 related lockdown.

The closure has not only meant that services such as routine checkups, educational sessions, peer support and distribution of food has been affected. It has also compounded pregnancy related anxiety. In such circumstances, front line community health workers, that is, ASHA and AWC workers who are from the communities too feel helpless and despondent that they are not able to do more.

Most of these frontline champions have been reassigned to COVID related general awareness raising duties. However, there remains a huge gap in knowledge and information in relation to pregnancy at the time of the COVID-19 pandemic.

We keep getting requests from our frontline colleagues for information and training on pregnancy and COVID - 19. In response, we have developed a one hour training session curriculum which helps community health workers answer questions and give advice on antenatal issues in relation to COVID. The training will equip them to reach out and advice and support pregnant women with wellness and allay anxiety.

To know more about the training curriculum you can view the deck here.

COVID – 19 and pregnancy related anxiety

20 July 2020

Pregnancy related anxiety has shot up because of COVID and needs to be recognised and addressed.

The number of people with COVID – 19 continues to spike in India. The Hindu (www.thehindu.com) reports that the number of people who have tested positive for the coronavirus has been nearly 2000 a day for three days straight. The Health Department has confirmed 408 COVID – 19 related deaths so far in the state. Krishna district where Kushal is present has been hit hardest with a 3.17% death rate. Not surprisingly, COVID - 19 anxiety in pregnancy has sky rocketed in Andhra Pradesh.

Communities in Andhra Pradesh are concerned. In ordinary circumstances, perinatal mood and anxiety disorders are among the most common complications that occur in pregnancy or in the first 12 months after delivery (The American College of Gynaecologists and Obstetricians). And these are unprecedented times.

Our beneficiaries are worried, and there is little recourse to advise and comfort because of strict lockdown being enforced.  Antenatal services have been stripped resulting in limited access to information and education. Kushal India is proactively filling the gap by responding to requests with urgency and using digital technologies to surpass these barriers.

Poorer communities are affected the most. All Anganwadi Centres in the state where women from disadvantaged communities generally access government antenatal services have been shut down. We are supporting the local health department to reach out to 700 pregnant women who are linked to urban health centres on their mobile phones with counselling and befriending sessions.

A difficult question colleagues working in the front line are increasingly facing these days is -

“Amma, if I get infected, can I pass the coronavirus to my unborn baby? Will that lead to my child having problems or deformities in the future? My mother-in-law has suggested that I should terminate my pregnancy.”

Difficulty in accessing reliable information and having to take recourse on attention grabbing headlines in the media has spread misinformation and consequently led to fear and panic in communities. Most of our beneficiaries are first time pregnant and young. To have to be under pressure to resort to termination because of myths and misinformation is unfortunate.

We make sure to advise women –

  • The COVID-19 pandemic is a rapidly evolving situation and each day scientists and researchers are learning more on how to prevent and mitigate the impact of the virus. New information comes out nearly each day and at times can contradict previous knowledge. So, it is important to remain updated on information.
  • However, it is crucial that you seek information from reliable and reputable sources, for e.g. WHO, UNICEF and the National Health Mission.
  • If you come across a piece of information in the media and especially social media such as YouTube that makes you curious or worries you, please verify that information from reliable and authentic sources. Do not act on a single source of information.
  • Do not be hasty in taking actions or decisions. Verify your doubts. Consult your doctor first.

To read more about our activities, please click here.

How to prevent bleeding gums in pregnancy

Good oral hygiene is a must during pregnancy for a healthy baby.

Bleeding gums during pregnancy

It is quite common to hear of bleeding gums in pregnancy. Pregnant women want to know how to prevent and avoid problems in relation to teeth and oral health.

In fact, nearly 60 - 75% of pregnant women have gingivitis, an early stage of periodontal disease (Centres for Disease Control and Prevention, USA). Reports suggest that pregnant women are 7 times at higher risk. In gingivitis, the gums become red and swollen. Changing hormones during pregnancy are responsible for the condition but it gets worse as a result of poor dental hygiene practices that lead to plaque and debris. If untreated, the bone that supports teeth gets brittle and gums get infected. Though we do not know for certain the reasons for adverse pregnancy outcomes, periodontitis is associated with preterm birth and low birth weight.

Another complaint often heard is that of a small rounded tumour like growth in the gums between teeth. Commonly called pregnancy tumour, it can bleed when brushing teeth or eating. A pregnancy tumour usually disappears after the baby is born.If it persists after child birth you must visit a dentist.

Morning sickness especially when severe can erode the enamel in your teeth. That happens because of exposure of teeth to gastric juices and acids as a result of reflux. Increased exposure to acidity is a cause for tooth decay too.

To keep your teeth and gums healthy -

1. Brush your teeth twice day with a floured toothpaste.
2. If you have morning sickness, don't brush straight away after throwing up. Wait for an hour or so and then brush your teeth.
3. Daily salt rinse your mouth - 1 tsp of salt added to a cup of water. Swirl the wash a few times in your mouth and then spit it out. Avoid mouthwashes that contain alcohol.
4. Floss once a day.

X-rays including dental x-rays should be avoided in pregnancy. If unavoidable, an LED apron with coat and neck collar must be worn to prevent radiation exposure to the abdominal region and thyroid glands. However, it is safe to get dental treatment during the second trimester of pregnancy.

Always consult your doctor when in doubt.

Sravani
Vijaywada
10 June 2020

To know more about our work, please click here.

Our family is growing!

We had a very busy start to the week!

56 pregnant women participated in two workshops on COViD-19 awareness and Kushal’s wellbeing programme in Vijaywada on Monday. Leela explained how to stay safe from COVID – 19, and all 56 women downloaded our app. The women also learnt in the workshop what to expect week by week, how their baby-to-be will grow, and received tips on wellbeing. Participants were given confidence to have a conversation with their doctors’ to address questions they had about their pregnancy.

It was an important day, and we proudly welcome Bharadwaj Hospital and Karuna Nursing Home (Hospital) to the Kushal family.

Dr Savitri, Gynecologist at Bharadwaj Nursing Home had to say, “The Kushal concept will be very useful for pregnant women. We will coordinate so that you can attend our OP (outpatient days) to help give knowledge about wellbeing to expecting mothers and help them to access your website and download the Kushal app.”

Dr Radha Madhavi, Gynecologist, Karuna Nursing Home reiterated “I am so impressed with the Kushal initiative. I and my health team will learn from Kushal and even on days the VMM team does not visit we will explain to pregnant women aspects of wellbeing on OP days.”

Can I breastfeed – benefits outweigh potential risks

World Health Organisation (WHO) recommends that all mothers with confirmed or suspected COVID-19 continue to have skin-to-skin contact and to breastfeed. In all socioeconomic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants.The novel Coronavirus has not been detected in the breastmilk of any mother with confirmed and suspected COVID-19 and there is no evidence so far that the virus is transmitted through breastfeeding. For more information please visit WHO.

“Fight the virus, not people”

A call by 24 year old Robbie from Indonesia. It’s one of many calls voiced by young people globally to fight stigma and discrimination arising because of the COVID 19 epidemic.

Voices of Youth ( https://www.voicesofyouth.org/ ) is collating stories from
contributors around the world to spread kindness and support to not allow COVID-19 to serve as a vehicle for racism or xenophobia. The site has excellent illustrations, sparks and stories submitted by young people on the site and you can also share your messages of support, comics or poems against stigma and discrimination through the Voices of Youth website. Voices of Youth is UNICEF’s digital community FOR YOUTH, BY YOUTH.

On the same note I was heartened to see the Ministry of Health and Family Welfare, India ( MOHFW ) produce an awareness video to address stigma. Interviews with doctors from the All India Institute of Medical Sciences (AIIMS) highlight why stigma and discrimination as a result of COVID-19 is misplaced. I was heartened to see that stigma as an issue has featured early on in the Government of India’s efforts against the novel Coronavirus and not as an afterthought.

We at Kushal played our own part, albeit small but important. We stepped up our work with focus on COVID in March 2019. Little was known then. Yet, we thought responding with urgency despite our limitations was warranted. Other stakeholders in Vijaywada, Andhra Pradesh did the same and we joined hands to make as much information as possible available to pregnant women. It was despairing to see the anxiety.

Fight the virus, COVID-19 and pregnancy education session in hospital

Fight the virus, not people!