Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) is a community-based flagship program that aims to reduce poverty and empower women living among marginalized sections of the rural population, and has been operating in Uttar Pradesh since 2002. RGMVP organizes women into Self Help Groups (SHGs) to enhance their economic and social inclusion and empower them to demand their entitlements provided by government. Between January 2011 and March 2013, a health behavior change communication model (HBCM) was introduced through the SHG platforms. The overall objective was to improve maternal and child survival and nutritional outcomes for children below five years. TRAction is supporting a case study to investigate whether HBCM within the SHG platform has resulted in improved recognition and appropriate care seeking.
India: State of Uttar Pradesh
This case study aims to examine whether HBCM has resulted in improved recognition and appropriate care seeking. Research questions include:
This study will use both qualitative and quantitative methods to examine the effectiveness of HBCM for improving recognition and appropriate care seeking. The qualitative component will include group interviews with women, their families, and neighbors. Information will be gathered on various components of treatment seeking behavior, such as pathway of illness recognition and care seeking, time series of events, barriers to health seeking, and number of visits made. A quantitative survey will examine the differences in recognition and care seeking before and after implementation by comparing villages where HBCM has been implemented with control villages. Data will be collected from households that report any birth within the last nine months of survey. Other factors to be assessed include demographic characteristics, knowledge of various danger signs of maternal and newborn complications, and types of complications experienced.
Despite the prevalent belief that bleeding after delivery for more than a month is normal, women still reported severe bleeding after delivery as a concern. . These women’s prior experiences of symptoms, as well as those of the other women in their families and neighborhoods, aided recognition of symptoms and their severity. Men or husbands were unaware of the severity of PPH, as women considered it shameful or embarrassing to talk to men about it. Among maternal death cases, households involved in self-help groups preferred public hospitals as their first step of care, as opposed to households not involved in self-help groups, who largely relied on home-based care. If the perceived causes of newborn illness symptoms were supernatural in nature, then families sought care from traditional healers. Households involved in self-help groups recognized symptoms of newborn illnesses earlier and took action more promptly than households not involved in self-help groups, who delayed action to seek care until symptoms were perceived to be severe.
This study shows that the coexistence of traditional healers, home remedies, and private and public health facilities reflect a medically pluralistic society in which different types of treatments are sought for improving maternal and newborn health. Women experience PPH, yet normalize it, as it is culturally acceptable to bleed for about a month after childbirth. Community norms restrict women’s mobility until a ritual purification bath on the ninth day after delivery. Private care providers are preferred for treatment due to their proximity to most women’s homes. The perceived causes of newborn illness, whether ‘medical’ or ‘supernatural’, influence decision-making and care seeking. SHG households seek care for their newborns on the same day of illness onset, while non-SHG households delay seeking care outside of home by at least a day.
This study will examine whether HBCM within the context of SHGs is an effective way to improve recognition of and care seeking for maternal and newborn complications. Findings will be shared with health authorities and policy makers in India to inform decisions about future approaches to reduce maternal and neonatal deaths. SHG meetings can include discussions of maternal and newborn illness and causes of death in their area, as case studies, and help identify both facilitating factors and barriers, along with ways in which these deaths could have been prevented. TRAction will synthesize the findings from this and four other recognition studies in order to gain a global understanding of factors influencing recognition and care seeking. Experience from this study will be used to inform the development of communityoriented approaches for addressing maternal and newborn health in low and middle income countries.
Principal Investigator: Kumudha Aruldas