Mille Giorni / A Thousand Days - An Early Intervention Program that Supports Pregnant Women and Young Mothers who Live in Hardship or Poverty and Social Exclusion in the Rione Sanità of Naples, Italy

Project location: ITALY, Naples
Project start date: June 2015 - Project end date: May 2016
Project number: 2015-013
Beneficiary: Associazione Pianoterra Onlus


Due to its socio-demographic and urban characteristics, Rione Sanità is a great paradox: despite being located in the historical centre of Naples, it is a "suburban" neighbourhood. The district unfolds along a maze of descending and sloping alleys, is wedged by only two roads that connect to the city, and is surmounted by the Maddalena Cerasuolo bridge, which since its construction in 1809, marked the neighbourhood's separation from the rest of Naples.
Rione Sanità has a high population density (67 thousand inhabitants in 5 square kilometres), and is heavily degraded; it has few infrastructures, and the resident population lives in precarious economic conditions.
Problems such as drug addiction, incarceration, debt and unemployment (42.7 %) are rampant. Most of Rione Sanità's families are supported by the precarious, infrequent and/or illegal work of women.
In the district there is a high birth rate (11 for 1000) and high rate of maternity at a young age: 3.1 % of mothers are younger than 20 years old, and 6.2 % of them are adolescents. Mothers often have a low education level (35.2 % reach the middle school level, and 8.9 % reach the elementary school level), and most of them perform their first gynaecological visit after the 11th week of pregnancy. 61.2 % of women give birth by C-section and the cases of children born at term with lower than average birth-weight (< 2,499 g) are frequent, probably due to lack of adequate care and assistance during gestation (according to CEDAP statistics).
More than half of the new-born have brothers and sisters. The children of Rione Sanità, due to the combined effects of the urban context they live in and the precarious situation of their families of origin, have problems integrating in school. The children often quit school (the dropout rate is 30%), few of them complete middle school, and fewer still enrol in high school.
The effectiveness of early intervention in support of parenthood, activated from the very start of pregnancy, continued throughout the first 3 years of life of the child and structured around different aspects of the health and wellbeing of the family is scientifically proven. In addition, this approach causes a reduction of future social expenses. The main, proved effects, can be identified on different levels:

- For children: a better cognitive, emotional and physical development, reduction of learning and behavioural problems, reduction of abuse and neglect, better psychosocial outcomes as adults, better parenting as adults.
- For parents: decrease in maternal (and paternal) depression and anxiety, stronger self-esteem, better social and productive abilities, improvement of reproductive health for mothers.
- For families: improvement of relationships within the family, better social relations, better use of health services.
- Other effects are represented by the reduction of future social expenses: decrease in number of teenage pregnancies, better pregnancy outcomes with lower health costs for low birth weight and infants with pathologies, decrease in number of neglect and abuse cases with lower costs for social services, decrease in number of cases of children with school problems with lower costs for educational support, decrease in number of children leaving school resulting in lower costs for better school performances and less social drop-out, increase of enrolment rates in high school and university; decrease in number of wasted years resulting in lower costs for secondary education and increase of the education level; increase of labour/work force position and increase of GDP and increase in revenue from income taxes, decrease in number of substance abuse resulting in lower costs for dedicated services, decrease in number of accidents resulting in lower costs for health care, crime reduction resulting in lower legal expenses.

In Rione Sanità there are different organizations that offer family care and support; on one hand, there are the institutions - hospital, counselling, and social services - but very few women turn to these institutions; on the other hand, there are volunteer organizations and individuals. Every year there is a high rate of children hospitalizations at San Gennaro Hospital even for small pathologies; this is mostly due to difficult living conditions of certain households and the inability to benefit from social and health services. The parish priest of the Basilica di Santa Maria della Sanità is very active in the neighbourhood and together with L'Altra Napoli Onlus association he has started a series of redevelopment programs of the district through cooperatives and associations of young people. Most of the initiatives are addressed to teenagers and young adults.

In light of all of these considerations, what emerges is an urgent need to provide the neighbourhood with an integrated program dedicated to mothers (from the very start of their pregnancy) and to very young children (0-3 years old).
Every year less than 800 children are born in Sanità. Almost 50 percent of them are born in low-income families and most of them grow up with isolated/marginalized parents (including migrants). The Mille Giorni / A Thousand Days program is addressed to 40 direct beneficiaries with the priority of involving the most vulnerable pregnant women that will follow an individual and integrated plan using the methodology described above. All other beneficiaries (about 100) can participate to one or more activities offered by the program based on 4 pillars:

1. Networking for social capital activation
2. Outreach and Raising awareness
3. Edutainment
4. Follow up and evaluation

This present project relates to the start-up of the program: 12 months.
The entire program will last five years.

The Nando Peretti Foundation has awarded a grant for this project. The project's activity includes the activation of a close collaboration with public local authorities dealing with maternal and child health such as family clinics, paediatricians, general practitioners, gynaecologists, ASL. It also includes the community coordination of services for the family and the collaboration with other associations active in the territory.

1.1 Establishment of the network of Mille Giorni / A Thousand Days: it consists on the arrangement of a framework agreement with some entities already involved in the formulation of this proposal, such as: the Family Clinic, Save the Children Italia Onlus, San Gennaro Community Foundation, the parish priest of Sanità, ACP, CBS.
1.2 Event of presentation of the program to the community: The program will be presented to the community in a popular location of Rione Sanità (i.e. Basilica di San Gennaro Extra Moenia or Nuovo Teatro Sanità).
1.3 Increasing of network participants: The agreement may be stipulated with other realities interested in the program and with other parenthood support programs (citizens birth places and the like). The coordinator of the project will contact and involve in the program other similar realities.
1.4 Event of presentation of the results to the community and the social capital: The results of the program will be presented to the community and the eventual other stakeholders at the end of the first year of activities in a popular location at Rione Sanità.

Outreach and Raising awareness
The activity concerns the involvement of mothers and expectant mums in health and self-care paths and parental support through the knowledge of the services offered by the territory and by the community, and a guide to encourage their fruition.
2.1 Analysis of needs and evaluation of opportunities: A psychologist of Pianoterra will meet and welcome all the women interested in the program for a first evaluation and analysis of needs. The meetings will take place in the morning, from 9 am to 1 pm at Punto Luce Sanità, an afternoon care centre for children and adolescents (6 - 16 years old) promoted by Save the Children Italia Onlus and run by Pianoterra Onlus.
The psychologist will select 40 direct beneficiaries and organize with them, their child and their family unit, an individual and integrated plan.
2.2 Identification of Peer Mum and Training: Throughout local institutions and organizations involved in the project, 10 available and suitable mothers of the Rione Sanità will be identified to become Peer Mums. They will spread their knowledge about the program Mille Giorni /A Thousand Days, locate and involve pregnant women or mothers living in hardship situations that would normally be difficult to reach. The training of Peer Mum includes a theoretical lesson plan of 40 hours led by trainers from different disciplines, and 10 hours of practice following the activities of Pianoterra's psychologist.
2.3 The Suitcase: In the hospital, at the moment of birth, a Suitcase containing several necessities for the new-born child will be given to the women involved in the program's activities since the 4th months of pregnancy. Program's activities run by Pianoterra or other stakeholders, include: medical examinations, tests and ultrasound scans recommended by SSN, attendance in maternity, breastfeeding and childcare courses. The suitcase will contain bath-oil; sweet almond oil; zinc oxide paste against rashes; a natural sponge; scissors with rounded tips; wet wipes; sterile gauze; digital thermometer; a mosquito screen; a cotton onesie, romper suits, socks; bibs; a small blanket; a bathrobe; other objects such as toys and useful books about the early interactions between mother and child.
Due to the difficulty to reach women in the first trimester of pregnancy, the Suitcase will be distributed to 20 beneficiaries during the 12 months of the start-up of the program.

The activity is addressed to all vulnerable women (about 100), in continuity and integration with the already existing local services. It includes services and diverse educational opportunities to mothers and expectant mothers offered by Pianoterra Onlus. The activity will offer:
3.1 A guide/leaflet to specialist medical examinations, tests and ultrasound scans recommended by SSN, and knowledge about the local health care realities will be distributed to the stakeholder and to the beneficiaries of the program.
3.2 Meetings with health care specialists focusing on the wellbeing of woman and child: a gynaecologist, a specialist in breast health, a nutritionist, a paediatric nurse, a psychologist, a social worker, a paediatrician.
3.3 Meetings on child development with a paediatrician, a psychologist, a paediatric nurse and a social worker.
3.4 Meetings of perinatal and child health according to Sei più uno (six plus one) program by the Italian Ministry of Health;
3.5 Courses on maternity care, breastfeeding support, childcare.
3.6 Psycho-educational and parenting support meetings.
3.7 Creative and expressive workshops (cooking, sewing, self-care, baby massage).
3.8 Specific projects to ease the mother/child interaction and relationship, such as Nati per Leggere (born to read) and Nati per la musica (born for music).

Follow up and evaluation
Each organization involved will employ a human resource to analyse and evaluate the project. The present proposal includes the establishment of a Team that will meet on a monthly basis to update and assess the development/progress of the project.
Every 6 months, the team will analyse the qualitative and quantitative data collected by the staff directly involved in the activities (workshops, courses, number of registrations for the Suitcase, etc.).
The quantitative data will concern the number of mothers who have been reached, the number of mothers involved and the activities they have participated in.
The qualitative data will cover the analysis of the interviews or questionnaires of appreciation and involvement, and the evaluation of parenthood skills acquired. The comparison with other partners will be very useful for eventual improvement and changes.
The team will draw up 2 detailed Reports (one in itinere and one ex post).

Associazione Pianoterra Onlus
Established in Naples in 2008 by Alessia Bulgari, Ciro Nesci and Flaminia Trapani, Associazione Pianoterra Onlus promotes projects that sustain vulnerable families and the mother-child dyad in particular.
Pianoterra Onlus operates between the II and the III Municipality of Naples.
The II municipality includes the greater old town centre from the Quartieri Spagnoli to the central Station (including the Harbour area, Forcella, Avvocata, Montecalvario, and Mercato). The III municipality includes the neighbourhood of Stella and San Carlo All'Arena, in particular the area between Sanità and Piazza Carlo III.
The two Municipalities are very heterogeneous. Some "Rione" have high population density and high level of degradation, unemployment, low level of education, early motherhood, etc.
The intervention methodology is based on an integrated, individual, early approach that begins during pregnancy and continues throughout the first 1000 days of the child's life. As many studies attest (WHO, SSLPs, Lancet, ACP, etc.) by offering better opportunities to each child at the time of birth (and even before, i.e. during the mother's pregnancy), and by favouring the development of maternal and childhood services that include prenatal care, health assistance for infancy, early childhood education and family support, one is able to prevent the many health and developmental problems which often occur in contexts of marginalization and poverty.
By following this approach, Pianoterra works closely with the most vulnerable families and establishes a "pact of reciprocity" with them. The free, necessary and urgent items that the beneficiary receive - milk, clothing, accessories for early-childhood needs, and more - are matched by the participation in workshops that foster personal growth and emancipation, and which seek to strengthen the self-esteem and empowerment of women and mothers; when possible, alongside personal re-integration, we offer opportunity for professional requalification.
Pianoterra, in partnership with Save the Children Italian onlus, has a specific project "Fiocchi in ospedale" at Ospedale Cardarelli - Naples - that provides a dedicated space inside maternity/new-born wards whose main object is to promote infancy rights from the very first moment post-partum, supporting the wellbeing of the mother and the baby from the very first day. The space welcomes and accompanies the mothers-to-be and new parents who face problems such as poverty, solitude, social isolation, depression and difficulty in parenting care. The project is intended to reinforce the post-partum welfare system of support, extending it to the whole family and creating a unit which addresses itself to the whole mother-child issue by accompanying vulnerable mothers from the hospital to an effective interface with the outside world, however complex the situation may be.
Pianoterra avails itself of the expertise of a team that places attention and "care of relationship" at the centre of its intervention: the relationships to the child, to the mother, and to the social workers are evaluated in depth so as to determine the needs and resources of each individual and to tailor a suitable itinerary that reflects the individual's priorities.
Pianoterra collaborates with different partners: associations, social services, ASL, family clinics, hospitals, foundations, universities and schools. Throughout a network of synergies and exchanges, Pianoterra promotes the realization of a shared welfare that is able to sustain the development of the social capital of the area of intervention, and that coordinates social assistance services on a local level. The final goal is to build a self-reliant community, and to educate and repair while focusing on the specific needs and resources of each single family.

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