Nyiranganduhimana Claudine is a mother of four from Bumbogo, Rwanda. She joined GHI’s first cohort of mothers in our Antenatal Care Program last August while she was five months pregnant with her fourth child.
At Claudine’s first training she eagerly told our staff that “these trainings will increase our knowledge.”
She added, “community health workers used to tell us what food to eat while pregnant, like fruits, dodo [amaranth], and animal source foods,” but mentioned that she often struggled to gain access to these types of food. “If we get help, we can learn where to find them. It is in this context we came [to the ANC program] to learn so that we can know where to find nutritious food.”
Proper nutrition in pregnancy is critical to providing children with the essential building blocks for brain development, healthy growth, and a strong immune system. When mothers are not properly nourished they are more likely to have low birth weight babies who are then more susceptible to malnutrition.
For six weeks, Claudine and 86 other mothers from Bumbogo diligently met at local government offices or health buildings, to learn about key ANC topics. The trainings covered the importance of early ANC visits, how to shop for healthy, affordable foods and create a balanced meal, why hygiene and food safety are important to prevent malnutrition, and the importance of timely initiation of breastfeeding and complementary feeding, along with tips on postnatal care.
In Rwanda 37% of children are chronically malnourished. Our core health center program is designed to address this problem through an integrated solution combining sustainable agriculture and comprehensive health education. However, our ANC program is designed to intervene a step earlier – before malnutrition even begins.
Evidence suggests that approximately one-third of stunting is manifested as small for gestational age and preterm babies, which reflects the importance of targeting during pregnancy and in the pre-pregnancy period. 
The lessons are designed to provide key information to expecting mothers to increase their chances of having a healthy child who remains healthy well into the future.
The program met and exceeded Claudine’s expectations of learning more about nutrition and where to access nutritious foods. She notes: “All the trainings were instructive. For example the training on having early tests during pregnancy was really helpful. Those tests made me aware of the position of my baby in the womb. Additionally, these tests give us valuable information which can be useful to mitigate difficulties faced during pregnancy.”
She adds, “we have also learned the side effects associated with taking traditional medicines and [eating] mud (a common practice for pregnant women in Rwanda). I abstained from these things and as a result I gave birth to a healthy baby. We have learned many things through these trainings and they made me knowledgeable!”
After a busy season of trainings and cooking demonstrations, 207 mothers graduated from our first ANC cohort. Graduations, whether for our ANC program or core health center program, are always incredibly joyful times where GHI staff get to celebrate alongside mothers and observe the great power caregivers have to make real changes for themselves and their families.
Surveys conducted before and after the program show exciting results. The number of expecting mothers who had attended an ANC visit increased from 79% to 90% after the program; average ANC knowledge tests scores increased from 30% to 78%; and women meeting the minimum dietary diversity threshold increased from 51% to 80%.
After graduating Claudine remarked, “In general my family has really benefited from this program. I used to cook only potatoes and beans and I was satisfied. But the thing my family has learned from this is to make a meal composed of four food colors. I try to make a meal composed of four food colors, if I have ‘energy’ food [i.e. white color/starches] I know that I have to mix it with food rich in protein, minerals etc. For example, if I cook sweet potatoes which are energetic I will add beans from brown color, tomatoes, dodo and carrots. I always make sure that the meal served is a balanced meal.”
We visited Claudine and her family at their home in Bumbogo, just one month after the birth of her baby girl. She talked about the importance of her community and her desire to give back. “I am proud to share knowledge with them [other pregnant women in my community]. I learned for free and I should share that knowledge with them freely.”
She smiles as she adds, “I could tell them to have early pregnancy tests, before 4 months, and I could explain to them the benefits of having early tests during pregnancy. I could also tell them to have at least four tests during their pregnancies, to eat a balanced meal prepared hygienically, to have a garden and to follow advice from GHI staff… I can even teach them to make one pot in one hour; there are so many things I can teach them!”
Claudine’s daughter continues to grow at a healthy rate after her birth in January.
With the knowledge she’s learned and skills she’s gained, there is a lot to be hopeful for in the future. She says, “My vision is to keep on preparing balanced meals for my children to grow better. A child who eats healthy food grows better and becomes smarter.”
Indeed, children who are well nourished in the first 1,000 days of life (from conception to age 2) have a higher chance of success in the future. It is in this period that a child’s brain and body are developing the most rapidly. As a result, good nutrition is essential to provide the foundation for healthy and productive futures. Children whose bodies and minds are limited by chronic malnutrition are at greater risk for disease and death, poor performance in school, and decreased economic opportunity.
The ANC program was initially set up to be a trial program, but due to the impressive successes, knowledge gains, and positive feedback, we are now planning to scale it up from 4 health centers in Gasabo to all 20 health centers in our partner communities in the coming season. This will greatly expand the support available to pregnant women.
Coupling the ANC program with our already comprehensive Core Health Center Program will provide the holistic methodology we need to truly address the problem of chronic malnutrition in Rwanda.
Armed with an arsenal of tools for success, Theogène Aimée, and thousands of children like her, will have the best shot at a better future – a future where they’ll be able to reach their full potential.