Tightening the strap across her forehead, Harina adjusted the doko full of grass on her back and walked up the rugged hill. The climb to the top became more challenging as her belly began to grow.

Twice a month a Community Health Worker (CHW) from Possible visits Harina and other expectant mothers in their households to counsel them on antenatal care. The CHWs discuss potential complications with the pregnant mothers and their immediate family and design individual birth plans for them.

Sonu, one of our Community Health Program Associates, manages four such CHWs at Possible. Today, she takes a three-hour jeep ride to Payal — a village nestled high in the mountains— to supervise a group antenatal care session in the health clinic. Ensuring that no woman falls through the cracks of healthcare systems, every quarter, a group of women in the same stage of pregnancy are brought together to receive comprehensive care.

Sonu observes as Radhika, our Community Health Worker runs the Group Antenatal Care session
“I’m here to supervise the session and provide clinical services to the pregnant women,” she says.

It’s been three years since Sonu started working at Possible.

“What we do here is very impactful. We provide them with healthcare, and empower them to give back to the community.”

Mothers gather together in a circle. A mixture of new mothers and experienced mothers; it is clear that this is a safe space. The expectant mothers — some nervously and some excitedly — share their stories and concerns from the previous month. Sonu supervises the Community Health Worker counsel them on what is normal, and what is not.

Sonu is trained to run routine pathology tests on all expectant mothers who attend Group Antenatal Care
“Mothers here are responsible for the well-being of the entire household — raising children, feeding cattle, working in the field. Amid all the day-to-day challenges, caring for one’s own health does not become a priority.”

Harina fidgets nervously as she asks a question.

“I’ve noticed sometimes I get headaches and blurry vision. Is that normal?”

In the routine examination, Sonu diagnoses Harina with hypertension. She counsels her to take medication daily and to reduce exertion from physical activity when possible.

“Eighteen months ago, there was no specialized care for the women. Many of them were unsure about high risk pregnancies and the difficulties they could face during pregnancy or the period following delivery. Many did not seek medical attention, even if they were suffering from obvious signs of complication. Through education in our group ANC sessions, mothers can now differentiate between common symptoms and serious complications in their own health and the health of their children.”

Sonu measuring the blood sugar of an expectant mother at the session.

Now aware of how to better take care of her health, Harina calls on a CHW when she notices changes that could lead to complications.

Sonu counsels a patient on the results of her tests, and answers any questions the expectant mother may have.

“Being a woman in leadership is important to me. Working with women is especially empowering. I think only females can truly empathize with the problems of females. I can better understand the physical changes women go through during menstruation and pregnancy, and I know the societal challenges they are facing. I am grateful that I can help empower these women to be catalysts for societal change. I can be an example for these women — because I grew up here just like them — and show them that they don’t have to live in isolation during their period and that they can advocate for themselves within the household. I am proud of the women I have helped.”

With the goal to achieve a 95% institutional delivery rate, Possible’s network of CHWs go from door to door ensuring a healthy pregnancy and child. So far we have ensured 78% institutional delivery rate within our catchment area.

As the familiar contractions of labor started, Harina felt the group ANC sessions she had attended throughout her pregnancy had provided her with the confidence to proceed with the delivery calmly. With the help of her family, she attended the local health post for delivery. With her hypertension putting her at risk of complications, she was referred to Bayalpata Hospital — Possible’s hospital hub in far-west Nepal. After a short phone call to Sonu, Harina was transferred to Bayalpata Hospital by jeep, and gave birth to a healthy baby boy.