By Laxmikanta Joshi
Jhabua, Madhya Pradesh: In the villages of Jhabua district, women carry the weight of families across seasons of scarcity and migration. Pregnancy does not slow them down. Neither does illness.
Days begin before sunrise, with fetching water, tending to livestock and household chores, before women head out for daily wage labour. Even during pregnancy, rest is rare. Health, often, comes last.
This routine has led to a public health crisis. According to the National Family Health Survey-5, 58.8% of women in Jhabua are anaemic, while 80.1% of children aged six to 59 months are malnourished.
It is within this landscape that Moti Aai, a community-based initiative centred on women caring for severely malnourished children, took shape in Jhabua. The idea was simple: if nutrition was failing inside homes, care had to return there.
“Women here prioritise daily wages over their own health,” said Priyanka Gamar, a supervisor with the Women and Child Development Department. “Even during pregnancy, work does not stop.”
Many pregnant women remain outside the reach of health systems. “When we find them, we try to ensure check-ups at nearby anganwadi centres and with ANMs,” Gamar said. “But we do not reach everyone.”
The consequences are intergenerational. Women who are undernourished often give birth to undernourished children.
Despite anganwadi centres, subsidised rations and nutrition rehabilitation facilities, malnutrition indicators in Jhabua have remained stubbornly high for years. The gap lies not in the absence of schemes—but in what happens beyond them, inside homes.
In November 2024, district officials organised 294 health and nutrition camps across Jhabua’s six development blocks. Data collected showed that 1,110 of the district’s 2,706 anganwadi centres reported cases of severe malnutrition, affecting 1,950 children.
Children were regularly weighed, monitored using mid-upper arm circumference tapes and, in critical cases, hospitalised. Yet malnutrition persisted.
Joint reviews by the Health Department, Women and Child Development Department and AYUSH officials pointed to three structural reasons.
First, migration. Large numbers of parents migrate seasonally to Rajasthan and Gujarat for labour work, leaving young children in the care of elderly grandparents.
Second, food practices at home. “Anganwadis provide supplementary nutrition,” said Ajay Chauhan, an ICDS official. “But at home, children often eat only roti and chilli. Nutrition is seen as the anganwadi’s responsibility.”
Third, uniform menus. State-wide anganwadi diets do not account for local needs. “Jhabua households have access to kodo and kutki, cheap, nutritious coarse grains,” Chauhan said. “But these are not always used for child feeding.”
It was against this backdrop that the district administration moved to formalise a community-based response.
Soon after taking charge, collector Neha Meena said she realised the problem could not be addressed through schemes alone.
“We had all the systems in place,” she said. “But despite years of effort, the situation was not improving.”
In November 2024, the district launched the Moti Aai Campaign, shifting part of the responsibility for child nutrition from institutions to women within the community.
Moti Aai, meaning “elder mother,” refers to women from the same village who take responsibility for one severely malnourished child alongside existing government systems.
“This is not a replacement for anganwadis or hospitals,” Meena said. “It fills the gap between nutrition on paper and care at home.”
The women selected were economically stable and socially trusted. As of March 2025, 1,325 women were working as Moti Aais across the district. The work is voluntary, with a one-time incentive of Rs 1,000.
Their responsibilities include monitoring daily meals, accompanying children for check-ups, maintaining hygiene and providing massage. “They watch the child the way a mother would,” Meena said.
Ayushi (4) from Moradungra village in Meghnagar block was one of the children identified as severely malnourished. Her parents had migrated to Kota in Rajasthan for labour work. She lived with her grandparents.
“My wife tried her best,” said Ayushi’s grandfather, Hakku Vasuniya. “But old age and lack of proper guidance made it difficult.”
Ramu, a woman from the same village, was assigned as Ayushi’s Moti Aai. She monitored meals, massaged the child, and often cooked food herself and brought it home.
Ayushi’s weight gradually improved. She was later declared free of severe malnutrition. Ramu continues to visit her regularly.
A similar story played out in Kalyanpura village. Two-and-a-half-year-old Sunil’s parents worked as labourers in Rajkot, Gujarat. He lived with his grandmother and was severely malnourished.
Habba, his Moti Aai, took charge alongside the family. “She didn’t replace us,” the grandmother said. “She guided us.”
Sunil is now out of the severe malnutrition category.
According to data shared by the district administration, within five months of the campaign’s launch, 1,163 children were assessed as having recovered from severe malnutrition following repeat measurements at anganwadi centres and nutrition rehabilitation facilities.
As of April 2025, officials said 81 children remained severely malnourished. For these cases, the administration launched Moti Aai–2 in May 2025, involving closer medical supervision.
District programme officer RS Baghel recalled one case that surprised even health workers.
“Yuvraj, aged one year and five months, weighed 6.6 kg when admitted,” Baghel said. “In just four days, his weight increased by 210 grams. Earlier, he had been in a nutrition centre for a week with little improvement. Regular feeding and massage under a Moti Aai made the difference.”
In another case, Lakshmi, a one-year-old from Khardu Badi, weighed 4.25 kg when admitted. Her mother had died. Under Moti Aai–2, her weight increased to 5.21 kg by discharge.
“These are not isolated cases,” Baghel said. “We saw consistent improvement when home care became structured.”
Supervisors from the Women and Child Development Department say the work was not without resistance.
“Many women already work long hours in fields,” said Priyanka Gamar. “Nutrition is still seen as a woman’s responsibility. Men often do not cooperate.”
Money remains a constraint. “Families feed what is available,” Gamar said.
Yet, officials say visible administrative support helped sustain the initiative. “When women see the collector visiting villages and homes, they take the work seriously,” Gamar said.
Moti Aais were issued identity cards and their names were displayed at anganwadi centres. “It made them feel part of the system,” she added.
For many women, the role also reshaped how they saw their place in the community.
Sixty-year-old Sama Vasuniya, a Moti Aai from Dhandhaniya village, said she decided to take responsibility when she learned about Shivani, a severely malnourished child whose mother was unwell. “The grandmother was alone,” she said.
Shivani’s weight rose from 3.1 kg to 9 kg over time. “I fed her supplementary food, massaged her, and followed what doctors taught us,” Sama said.
She receives no payment from the family. “People trust people they know,” she said. “That makes the work easier.”
Public health experts caution that long-term evaluations are still needed, and independent assessments have not yet been conducted.
But for families who had exhausted options, the impact feels immediate.
“Earlier, we didn’t even know our child was malnourished,” said one grandmother. “Now we know what to feed and why.”
For collector Neha Meena, the campaign reflects an acknowledgement of the limits of bureaucracy. “Nutrition doesn’t improve on paper,” she said. “It improves when someone cares every single day.”
Whether Jhabua’s experiment can be replicated elsewhere remains an open question. For now, it stands as a reminder that community care,long carried by women without recognition, can become the most effective intervention of all.
This article was originally published in 101 Reporters under Creative Common license. Read the original article.
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