Author: Smile Foundation

In a village meeting hall under the neem tree of Badiya Gena, expectant mothers and new mothers sit eagerly on wooden benches as an Auxiliary Nurse Midwife (ANM) speaks in their dialect about caring for their newborns. For many, this is their first time learning that the yellow, sticky colostrum — once thought to be “dirty milk” — is actually the vital first food for the infant. “Earlier we gave our babies honey and sugar water as a tradition,” recalls one young mother from the crowd. “Now I know that only mother’s milk protects her tiny body, and I saw my little one thrive after I started exclusive breastfeeding.” Such scenes are no longer unusual in rural India.

Across the hinterland, community-led awareness sessions have begun to reshape age-old practices around the cradle. Health educators and local workers respectfully address traditional beliefs (like elixir-giving and early baths) and replace them with science-backed newborn care. The result is a new generation of babies who are fed, kept warm, immunized and watched over for danger signs.

Many of these sessions are organized by government and NGO teams who have learned that change comes fastest when neighbours teach neighbours. Indeed, studies confirm that community education saves lives: a Cochrane review found that group and home-counselling by local health workers significantly improved newborn survival and boosted breastfeeding – mothers who received such education were 56% more likely to initiate breastfeeding immediately. In India, this has translated to rising breastfeeding rates.

Recent analysis of NFHS data shows exclusive breastfeeding for six months climbed from about 46% in 2005–06 to nearly 65% by 2019–21, thanks in part to counselling by ANMs and community volunteers. Local surveys echo this. In Uttar Pradesh, for example, women with repeated contacts (three or more visits) from frontline workers were far more likely to breastfeed within an hour of birth than those with no visits. As one rural woman put it after an ANM’s home-visit, “Before, I bathed my baby right away and gave water; now I dry and wrap her, put her on my chest and feed her first. She’s much healthier.”

Core Newborn Care Practices

Community sessions focus on a short list of proven practices, each one grounded in science but taught through familiar analogies. Key messages include:

• Exclusive Breastfeeding (EBF): Only mother’s milk (no water or animal milk) for the first six months dramatically reduces infections. Mothers are encouraged to give colostrum (the first thick milk) immediately after birth.
• Hygiene and Cord Care: Handwashing before delivery, using clean instruments to cut the cord and keeping the umbilical stump dry or treated with chlorhexidine – these steps prevent life-threatening infections. Educators often use local metaphors (e.g. “to make curd, you wash hands and sterilize utensils; do the same for your newborn so they don’t get spoiled”) to win acceptance.
• Warmth and Thermal Care: Newborns must be kept warm. They are dried immediately, wrapped snugly and held skin-to-skin on the mother or other caregiver. Delaying the first bath by at least 24 hours is emphasized to prevent hypothermia. (“A dry, warm baby grows strong,” goes the slogan in many sessions.)
• Timely Immunization: Ensuring birth-dose vaccines (BCG, Oral Polio Vaccine zero-dose, Hepatitis B) and follow-ups protects babies from deadly diseases. Workers explain each vaccine’s purpose in simple terms, so parents understand why they must return for the next doses.
• Danger Sign Recognition: Mothers learn to watch for any danger sign – poor feeding, high fever, fast breathing, lethargy, convulsions or jaundice – and to seek prompt medical help if any occur. (A recent survey found only 43% of mothers knew even three basic danger signs, so education emphasizes this continually.)

By covering these essentials, sessions leave mothers with practical checklists. As one city caregiver said, “I didn’t know a baby could get polio drops the same day she’s born. At the camp they explained it all, even helped me mark her immunization card.” This mix of knowledge helps mother and child stay safe in the critical neonatal period.

Changing Beliefs and Behaviours Towards Newborn Case

Introducing these practices must be done with cultural sensitivity. Many villages still have strong traditional beliefs. In some areas, people bathe newborns early, fearing the placenta’s dangers; in others, they apply cow dung or ash to the cord for blessings. However, evidence from the field shows a clear shift: modern hygiene is replacing harmful customs. For example, a 2024 study in Odisha found that while grandmotherly remedies (applying ash or herbal pastes to the cord, putting substances in the baby’s eyes) were once common, young mothers were much less likely to use them.

Even rituals to ward off the “evil eye” remain more a comfort than a threat – these harmless chants continue, but the dangerous practices do not. Educators never mock traditions; they acknowledge elders’ intentions and then show the scientific ‘why’. Over time, as mothers see healthier outcomes, trust grows.

Similarly, myths about breastfeeding and nutrition are dispelled through dialogue. In many communities, there was an old belief that newborns needed additional fluids (like honey or water) right away. Health workers patiently explain that these introduce germs and dilute breastmilk’s nutrients. The fact that national surveys now show rising EBF rates suggests these messages are sinking in.

Frontline Workers: Building Trust for Long-term Newborn Care

At the heart of this change are the frontline workers – ANMs, Accredited Social Health Activists (ASHAs), Anganwadi Workers and visiting doctors. These are often local women who speak the mother’s language and understand village life. They build trust one home at a time. As one study noted, mothers in Andhra Pradesh who had antenatal counselling by ASHAs/ANMs were more than twice as likely to recognize danger signs.

Across studies, increased contact with these health workers correlates with better newborn care behaviours: in one UP survey, mothers with three or more worker visits were significantly more likely to breastfeed within an hour and to get tetanus shots, compared to those with none. This isn’t surprising – when a trusted ANM explains why exclusive breastfeeding matters, families listen.

In a Madhya Pradesh community, people resisted polio drops for fear of side effects; it took time, home visits and even treating a sick child to break the ice. As UNICEF reports from Nashik recount, once a health team helped cure a migrant mother’s diarrhoeal baby, she “became an advocate” for vaccination and helped bring the others around. Gradually, scepticism gives way to acceptance – as the ANM Nirmala in Nashik put it, after adjusting timings to suit day laborers, “Now they welcome us warmly!”.

Doctors at primary health centers also join this effort, often visiting villages with outreach clinics. Seeing a white-coat giver of vaccines or a doctor examining a newborn can reassure worried parents. Joint sessions – where an ANM teaches feeding and an MBBS doctor reinforces it – can be very effective. Over time, this consistent presence has helped bridge the gap between rural minds and medical advice. Indeed, an Odisha study found mothers increasingly “seeking healthcare promptly for even minor problems,” a big change from the past. The village worker who was once just a neighbour is now a respected “didi” (elder sister) who brings not just medicine, but compassion.

Grassroots Success: Stories from the Field

These combined efforts are translating into stories of real change. In Chhattisgarh, a mother in the Bastar region remarked with pride, “On the first night, I kept my baby on my chest instead of beside the stove. He slept warmer.” In Jharkhand’s Khunti district, after ASHAs taught mothers to delay bathing and give colostrum, hospital referrals for sick newborns rose (in this case, a good thing – once people recognized danger signs, more babies got the urgent care they needed). In urban slums, too, migrants take note: “I came from Bihar thinking bottle-feeding was modern,” says a Mumbai woman who attended an awareness fair. “But in the session I learned about exclusive breastfeeding and even kangaroo care. I adjusted and my baby’s doctor commented on her good weight gain.” An office in Delhi tells of male volunteers running neighborhood education drives – proof that even in cities, community awareness can bridge gaps in knowledge.

Two participants’ reflections capture the shift: “In our village I used to bathe my newborn at once and give her honey,” one rural mother says. “After the meeting, I kept my second baby warm on my chest and fed him only breastmilk. He’s strong now, much better than my first.” Meanwhile, a young mother from an urban slum adds, “I thought vaccines could wait, but the nurse explained that Polio drops and BCG start at birth. Now I’ve marked my daughter’s shot dates and feel at ease.” Such voices show how learning translates immediately into changed practice.

Mobile Outreach and the Road Ahead

To ensure no village is left behind, NGOs have joined the chorus. Mobile medical units of Smile Foundation bring these lessons directly to hamlets and slums. In one example, a rural clinic-on-wheels organized an infant-care session right in the heart of the community. For instance, a recent newborn health awareness camp in Badiya Gena (Ajmer district, Rajasthan) was run by Smile Foundation’s mobile “Smile on Wheels” team. There, the travelling doctors and nurses reviewed all the key points – breastfeeding, hygiene, immunizations, keeping babies warm and spotting illness – with dozens of local parents. It was a subtle reminder that the work of trust-building extends beyond static clinics.

The cumulative impact is encouraging. National indicators show India’s infant mortality steadily declining (IMR fell from 34 to 30 per 1,000 births between 2015–21), and experts credit not just hospitals but empowered communities for this trend. Yet challenges remain: some areas still show hesitation around modern care, and urban slums can be as ignorant of newborn needs as remote villages. Continued emphasis on dialogue and respect for culture will be key. As one seasoned ANM put it, “We never tell mothers their ways are bad; we tell them how to keep the good and make the baby safer.”

These stories underscore a larger truth: newborn care is as much about people and trust as it is about medicine. When an ANM kneels down to speak in the mother tongue, or a doctor listens to elders’ concerns, new ideas have room to grow. As rural India educates itself, villages cradle not just their infants, but a hopeful future – one community meeting at a time.

Much of India’s public conversation about women’s nutrition remains tethered to maternal health — “healthy pregnancies,” “safe deliveries,” “reducing maternal mortality.” These are vital goals, but this narrow framing reduces a girl’s worth to her reproductive role. It overlooks her present: the teenage student squinting at a blackboard because she lacks energy; the girl who drops out after puberty because menstruation becomes a burden in the absence of nutritious food or proper hygiene facilities; the teenager juggling homework with household duties while coping with chronic anaemia.

Girls deserve good nutrition not simply to become healthy mothers someday but because they are human beings whose dreams and abilities matter today.

Yet, nutrition in adolescence undeniably shapes future health. Anaemia during teenage years increases the likelihood of low birthweight babies, preterm deliveries, and complications during childbirth. Poor nutrition reinforces a cycle where a girl’s weakened body becomes the fragile foundation of the next generation’s health. In this way, the consequences of adolescent malnutrition spill far beyond the teen years — shaping entire communities.

Understanding What Girls Need and Why They Often Don’t Get It

The nutritional needs of adolescents are simple in theory, but complicated in practice.

Growing teenagers require:

• More energy, to fuel rapid physical and cognitive development
• Healthy fats, to support the brain and stabilise hormones
• Protein, to build stronger muscles and tissues
• Calcium, to strengthen bones during a critical growth phase
• Iron, to prevent anaemia in menstruating girls
• Zinc and folate, to support immunity, cell repair and emotional wellbeing

These are not luxury nutrients. They are basic requirements for a developing body.

But millions of girls do not get them — not because the foods are unavailable in India, but because of gender norms and household patterns that dictate who eats first, who eats most and who eats best. Girls too often fall at the bottom of this hierarchy. The consequences can last a lifetime.

Globally, micronutrient malnutrition among women is now recognised as a major public health crisis. In India, it intersects with entrenched gender inequality, lack of dietary autonomy and limited access to health services. A menstruating adolescent who is anaemic may miss school frequently; she may drop out earlier, narrow her job prospects and enter motherhood early and underprepared. Her child, in turn, inherits those vulnerabilities — a generational echo of nutritional neglect.

A System That Must Recognise Nutrition in Adolescence Early On

India has launched several strong national programmes — Poshan Abhiyaan, Anaemia Mukt Bharat and Swasth Nari Sashakt Parivar Abhiyaan — signalling political recognition of the problem. But intent alone cannot compensate for how deeply adolescent nutrition is siloed across ministries, departments and household expectations.

If India wants to unlock the potential of its adolescent girls, the approach must be broader, more integrated and more rooted in a “pre-motherhood lens.”

This means:

• Nutrition education embedded meaningfully in school curricula
• Lessons that link diet to health, menstrual hygiene, emotional wellbeing and future livelihoods
• Health systems that recognise girls as individuals with their own nutritional rights
• Social protection that ensures girls get adequate food even in households under strain
• Programmes that treat adolescent girls, women who are pregnant, lactating mothers and women outside the reproductive cycle as distinct groups — not one homogeneous category

Empowering adolescent girls to serve as peer educators can be transformative. When a teenage girl confidently speaks to classmates about iron supplements, healthy eating and menstrual health, she challenges norms from within her own community. Similarly, involving boys and men in reshaping expectations can shift household dynamics in ways that support girls’ wellbeing.

Measuring success, too, must go beyond haemoglobin levels. Attendance in school, confidence in the classroom, self-advocacy, healthier menstrual experiences — these reflect deeper, more sustainable improvements in girls’ lives.

Meeting Girls Where They Are

Civil society organisations play a critical role in bridging the distance between policy and lived experience. Smile Foundation’s Swabhiman is one example of how community-led interventions can strengthen government programmes. By supporting national campaigns like Poshan Abhiyaan and Anaemia Mukt Bharat, and by training ASHAs, ANMs and Anganwadi workers, Swabhiman strengthens service delivery at the last mile.

In many communities, it is these frontline workers — not distant officials — who help girls understand nutrition, navigate adolescence and access support. Their presence makes policies real. Their visits ensure that the system’s promises reach the girls who need them most.

Swabhiman’s model is practical and rooted in trust:
health camps, nutrition sessions, menstrual hygiene awareness, counselling and peer mobilisation. By bringing services directly into communities and building the confidence of teenage girls, it challenges the quiet barriers that have kept them invisible for too long.

A Future Built on Nourished Girls

India is at a pivotal moment. With one of the world’s largest adolescent populations, the country stands to gain — or lose — enormously from how it treats its girls today. Adolescent nutrition is not simply a health issue; it is an economic strategy, a gender equity imperative and a moral responsibility.

A nation that nourishes its girls nourishes its future.

When an adolescent girl has access to nutritious food, health information and the agency to make choices, the ripple effects extend across generations. Healthy girls become healthier women. Educated girls are more likely to secure dignified work. Empowered girls grow into mothers who understand nutrition not as a burden, but as a right.

The path to that future does not require reinventing India’s systems — only expanding their imagination. Girls are not future mothers alone. They are students, workers, leaders, decision-makers and citizens.

Recognising this is the first step. Nourishing them is the next.

In Ramanathapuram, Tamil Nadu’s southern edge where the land narrows towards the Palk Strait, villages stretch far from the nearest town and healthcare is often a distant promise. Here, the difference between early diagnosis and delayed treatment can decide the course of a life.

For decades, healthcare in India’s rural and remote regions has been shaped by geography as much as by policy. Even as India’s health system makes notable improvements in expanding infrastructure and insurance coverage, large swathes of the population, particularly in hard-to-reach coastal and interior areas, remain beyond the easy reach of hospitals and clinics. The reasons are not quite abstract: the nearest health centre may be 15 kilometres away, transport is expensive or unreliable and for a daily-wage labourer, a day spent seeking care can mean a day’s earnings lost.

In these landscapes, the promise of accessible healthcare for all hinges on bringing consultations and diagnostic services closer to where people actually live.

That is what Smile Foundation’s Smile on Wheels project has been doing across India, and in Ramanathapuram, through its partnership with Healthium Medtech Limited, it’s proving how proximity can transform public health.

The Distance Between Illness and Care

For people in rural India, the journey to medical attention often begins late. Most families wait until symptoms become unbearable before seeking a doctor. In a region like Ramanathapuram, where small hamlets are scattered across salt pans and arid stretches, that delay can be fatal.

A majority of rural Indians depend on private clinics or informal practitioners for their first medical consultation, largely because public facilities are too far or poorly equipped. Many of these consultations end without any diagnostic test. A fever might be treated with an antibiotic, a chronic cough dismissed as seasonal allergy. Hypertension, anaemia or diabetes, conditions that require testing and monitoring, often go undetected until complications arise.

The problem is not ignorance but inaccessibility. People know when they’re unwell. What they lack is access to doctors, diagnostic tools and affordable medicines.

The Missing Middle of Rural Healthcare

For decades, India’s health reforms have focused at two ends of the spectrum: expanding tertiary hospitals in cities and building sub-centres in villages. Yet, the missing middle that connects these two levels remains fragile.

Diagnostic testing is one of its weakest links. The World Health Organization estimates that 70% of medical decisions depend on laboratory results. But in rural India, diagnostic testing remains largely inaccessible. Most Primary Health Centres (PHCs) lack basic equipment for blood, urine or imaging tests. Even when equipment exists, trained technicians and regular supplies are in short supply.

This means that diseases like anaemia, malaria, tuberculosis and diabetes, common in rural areas, are often underdiagnosed or misdiagnosed. A patient might receive temporary relief from a generic prescription but lose precious time before the root cause is identified.

This is where mobile healthcare units like Smile on Wheels become game-changers. They fill this gap as a structured extension of the healthcare system itself.

Taking Healthcare to the Doorstep

In Ramanathapuram, with support from Healthium Medtech Limited, this idea takes the form of a mobile hospital equipped with doctors, nurses, lab technicians and essential diagnostic tools. It travels from village to village, parking near schools, community halls or panchayat buildings.

Residents gather early, carrying their medical records (if any), or simply recounting their symptoms. A doctor consults them, a nurse takes vitals, and tests are conducted, right there, in the van. From blood sugar and haemoglobin to pregnancy tests and basic cardiac screening, these diagnostics provide clarity that was previously absent.

For many patients, this is their first-ever medical check-up. For others, it’s the first time a doctor has come to them instead of the other way around.

One of the van’s doctors describes the impact vividly: “When we test a woman’s haemoglobin and show her she’s anaemic, she finally understands why she feels tired all the time. We give her iron tablets, yes, but we also give her knowledge.”

Why Diagnostics Tests are a Development Issue

It is tempting to view diagnostic testing as a technical service, one more box to tick in healthcare delivery. But in remote communities, it is fundamentally a development issue.

The absence of timely diagnosis keeps people trapped in a cycle of ill health and economic vulnerability. A labourer who doesn’t know he has diabetes keeps working until fatigue and complications make him unable to earn. A woman with untreated anaemia passes on nutritional deficiencies to her child. Families spend their limited savings on late-stage treatment instead of prevention.

A study in The Lancet found that non-communicable diseases accounted for approximately 60% of all deaths in India in 2019, up from 37% in 1990. The reasons could very well have been lack of nearby testing, transportation costs and long waiting times.

By contrast, when diagnostic testing is local, the benefits ripple outward. It builds community awareness, reduces long-term treatment costs and strengthens trust in public health systems.

The Smile on Wheels programme in Ramanathapuram demonstrates this ripple effect daily. In one coastal village, a series of blood sugar tests revealed that nearly a quarter of adults had undiagnosed diabetes. Today, these individuals receive follow-up consultations, dietary advice and free medicines. In another, regular maternal health check-ups have helped detect high-risk pregnancies early, reducing complications at childbirth.

The Power of Partnerships

Behind every successful health intervention lies an ecosystem of partnerships. The collaboration between Smile Foundation and Healthium Medtech Limited exemplifies how private sector support can amplify public good.

Healthium Medtech, a global medical devices company, brought not just financial support but also an understanding of what quality healthcare infrastructure entails. Its partnership with Smile Foundation enables sustained outreach covering thousands of individuals who might otherwise remain invisible to the formal health system.

This partnership reflects a broader shift in India’s development landscape: corporate social responsibility (CSR) is no longer about one-time donations but about strategic, long-term engagement with communities. By focusing on healthcare access and diagnostics, Healthium Medtech and Smile Foundation are addressing one of the most persistent inequities in India’s health landscape, the rural-urban divide.

Data, Diagnosis and Dignity

The numbers tell part of the story. Each Smile on Wheels van serves between 20000 to 25000 people a year. The Ramanathapuram project alone covers dozens of villages, providing consultations, tests, medicines and health education sessions.

But the deeper transformation lies in what this data represents: dignity through diagnosis.

In remote areas, people are often resigned to their health conditions as fate. Access to a medical consultation and a diagnostic test shifts that narrative. It gives people control over their health and choices.

An elderly farmer from a fishing hamlet near Mandapam said it best after receiving his first ECG test: “All my life I worked by the sea and thought breathlessness was just age. Now I know it’s my heart, and that it can be treated.”

The Role of Preventive Care

While treatment remains vital, the future of rural healthcare will depend on prevention, and prevention begins with early detection.

Regular diagnostic screening for blood pressure, glucose and anaemia can avert complications from chronic diseases. Maternal health check-ups can prevent high-risk pregnancies from turning tragic. Periodic consultations can ensure minor infections don’t escalate into emergencies.

In Ramanathapuram, the Smile on Wheels teams are also conducting community awareness sessions teaching families about hygiene, nutrition and when to seek medical help. Over time, this builds a culture of preventive care, which is cheaper, more sustainable and far less painful than crisis care.

Beyond the Van: A Vision for Systemic Change

The success of mobile healthcare models like Smile on Wheels offers important lessons for India’s broader public health policy.

First, mobility can be a legitimate model of primary care. In areas where it is impractical to build and staff permanent facilities, mobile units can ensure consistent, quality access.

Second, diagnostics should be viewed not as an add-on but as an essential public good integrated into every level of care. From village health camps to telemedicine platforms, early detection must become the centrepiece of public health strategy.

Third, partnerships between NGOs, corporates and government agencies can create a multiplier effect. The private sector can bring innovation and logistics; NGOs like Smile Foundation bring grassroots credibility; and the government brings scale. Together, they can bridge the healthcare divide faster than any one entity can alone.

Towards a Healthier Tomorrow

As India moves towards its goal of universal health coverage, reaching the “last mile” remains its greatest challenge, and greatest opportunity.

The people of Ramanathapuram are not statistics; they are reminders that access is the foundation of equity. When a child’s fever is diagnosed early, when a mother’s blood pressure is monitored regularly, when a diabetic worker receives free insulin at his doorstep, those are victories that add up to national progress.

The programme, powered by partnerships like that with Healthium Medtech Limited, proves that healthcare doesn’t need to be confined to buildings. It can move, it can adapt, it can reach the unreached.

Every consultation, every test, every diagnosis brings not just relief, but recognition of people who deserve care, of communities that matter and of a country still striving to make “health for all” a lived reality.

Because ultimately, as Smile Foundation reminds us, smiles begin with good health, and good health begins with access.