Syed Saad Ahmed

Social Norms and Traditions Can Harm Maternal and Child Health. How Do We Change Them?

Alt Text: There is an image on the right and text on the left. The image shows a woman pushing a cart with a heavy sack on it and two men standing in the background. Their faces are not clearly visible. On the left is written “Social Norms and Traditions Can Harm Maternal and Child Health.” against a beige background and “How Do We Change Them?” against a crimson background.

Poverty and a lack of resources can limit healthcare access,¹ leading to poor maternal and child health outcomes.² However, even where resources are not a constraint, social norms and traditions can impede mothers’ and children’s health.³

Take, for example, the prevalent food taboos for pregnant and weaning women in various countries: Ethiopia,⁴ India,⁵ Ghana,⁶ and Indonesia,⁷ to name a few. Due to long-standing traditional beliefs, many communities regard highly nutritious foods such as dairy products,⁸ meat, eggs, fruits, or vegetables as harmful to mothers. This limits their nutritional intake even where food availability might not be a problem. During field work across the state of Rajasthan in India, I have met pregnant women who have cows at home, but do not drink their milk.

Patriarchal strictures can similarly affect maternal health.⁹ In many communities, women are allowed to have their meals only after all other family members have eaten.¹⁰ If there isn’t enough food at home, they have to go hungry while others eat their fill. These norms apply to pregnant women as well, even though their nutritional requirements can be higher than those of others.¹¹ Besides, women continue to be disproportionately saddled with domestic responsibilities, even during pregnancy, which does not allow them to get adequate rest.¹²

In many societies, women have to do all household work alone, even during pregnancy. Photo by Vedrana2701, Envato Elements.

So, how do we go about changing these harmful norms and traditions? A common strategy is Social and Behavior Change Communication (SBCC), which uses behavior science to positively influence knowledge, attitudes, and practices.¹³ SBCC is not just about sharing knowledge,¹⁴ but also creating a conducive environment for behavior change.

While many might not be familiar with the term SBCC, they would recognize the technique from campaigns to promote safe sex, handwashing, social distancing, and masking, among other healthy behaviors. It has been successfully used in a variety of contexts and geographies, including to promote maternal and child health.¹⁵

In this blog, I would like to share some first principles that can help social impact organizations effectively design and implement SBCC initiatives. These are based on my experiences of working on communications programs and are inspired by the back-to-basics approach of Kelly and Barker.¹⁶

How SBCC Can Better Serve Communities

1. Engage deeply with your audience

SBCC cannot be a one-way street, where we merely provide information and expect societal norms and individuals’ behaviors to change. Rather than trying to convince people, we need to understand why they hold certain beliefs or follow certain behaviors and enable them to foster changes on their own.

One such technique is participatory learning and action, which facilitates the community’s involvement in identifying challenges and appropriate solutions through group reflection and learning.¹⁷ It has led to a reduction of maternal mortality and neonatal mortality across several low- and middle-income countries and could potentially save 300,000 mothers and babies every year.¹⁸

A group of 30 people or so are sitting on red chairs under a large gazebo while participating in a community meeting. A facilitator’s back is visible in the foreground. — A participatory meeting in Kayu Ara Permai Village, Siak, Indonesia. Perdana Putra/CIFOR-ICRAF (CC BY-NC-ND 2.0 | Downloaded from Flickr)

2. Acknowledge and address power differentials

Policymakers and nonprofit staff often have more access to knowledge and resources than the communities they work with. It is important to recognize these differences and find ways to overcome them when designing and implementing SBCC campaigns. Nobody likes to be told what to do, especially by someone who might be more privileged. However, by putting oneself in others’ shoes and prioritizing their lived experiences, we can begin to build bridges.

3. Involve communities at every stage and regularly seek feedback

Nonprofits conduct research with affected communities to assess what SBCC techniques might be best suited for their context. However, many do not involve them in the design and planning of SBCC interventions or materials, such as posters or brochures.

A study under the Manoshi project in Bangladesh found that while the SBCC materials influenced mothers to change their healthcare-seeking behaviors, they were uncomfortable with some aspects of it.¹⁹ They did not want to keep posters with human images in their house as it was forbidden in their religion.

While studies are important to assess the impact of SBCC programs, involving communities in these initiatives’ creation and execution helps cater to their sensibilities, avoid gaffes, and ensure greater receptivity throughout the program.

While these ground rules can help plan and implement more effective SBCC campaigns, they are by no means exhaustive. It is also important to recognize that SBCC is only part of the solution and might need to be combined with other measures, such as cash transfers,²⁰ policy changes or affirmative action, to be truly effective.

Citations

Prakash R, Kumar A. Urban poverty and utilization of maternal and child health care services in india. Journal of Biosocial Science. 2013;45(4):433-449. doi:10.1017/s0021932012000831
Adu J, Owusu MF. How do we improve maternal and child health outcomes in Ghana? the International Journal of Health Planning and Management. 2023;38(4):898-903. doi:10.1002/hpm.3639
Omer S, Zakar R, Zakar MZ, Fischer F. The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan. Reproductive Health. 2021;18(1). doi:10.1186/s12978-021-01151-6
Amare W, Tura AK, Semahegn A, Teji Roba K. Food taboos among pregnant women and associated factors in eastern Ethiopia: A community-based cross-sectional study. SAGE Open Med. 2022;10:20503121221133935. Published 2022 Nov 19. doi:10.1177/20503121221133935
Chakrabarti S, Chakrabarti A. Food taboos in pregnancy and early lactation among women living in a rural area of West Bengal. J Family Med Prim Care. 2019;8(1):86-90. doi:10.4103/jfmpc.jfmpc_53_17
Siaw GA, Agbenyeke LE, Serwah A, Gyasi GEO. Food Taboos and Avoidance Practices affecting Pregnant Women at Larteh in the Akwapim North District, Eastern Region, Ghana. Journal of Hospitality and Tourism. 2023;3(3):42-53. doi:10.47672/jht.1684
Diana R, Rachmayanti RD, Anwar F, Khomsan A, Christianti DF, Kusuma R. Food taboos and suggestions among Madurese pregnant women: a qualitative study. DOAJ (DOAJ: Directory of Open Access Journals). Published online December 1, 2018. doi:10.1016/j.jef.2018.10.006
Debela BG, Sisay D, Hareru HE, et al. Food taboo practices and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. Sci Rep. 2023;13(1):4376. Published 2023 Mar 16. doi:10.1038/s41598-023-30852-0
Yankuzo KI. Okeshola FB, Adegboyega K, Abubakar MB. Patriarchy as a barrier to women’s access and utilization of antenatal care and child immunization services in Zamfara State, Nigeria. Fuoye Journal of Sociology. 2023: 1(1). https://www.fuoyejournalofsociology.com/article/patriarchy-as-a-barrier-to-womens-access-and-utilization-of-antenatal-care-and-child-immunization-services-in-zamfara-state-nigeria-2/
Hathi P, Coffey D, Thorat A, Khalid N. When women eat last: Discrimination at home and women’s mental health. PLoS One. 2021;16(3):e0247065. Published 2021 Mar 2. doi:10.1371/journal.pone.0247065
Kominiarek MA, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Med Clin North Am. 2016;100(6):1199-1215. doi:10.1016/j.mcna.2016.06.004
Scorgie F, Lusambili A, Luchters S, et al. “Mothers get really exhausted!” The lived experience of pregnancy in extreme heat: Qualitative findings from Kilifi, Kenya. Social Science & Medicine. 2023;335:116223. doi:10.1016/j.socscimed.2023.116223
Centre for Social and Behaviour Change Communication. What is Social and Behaviour Change Communication. Accessed July 7, 2024. https://www.centreforsbcc.org/what-is-sbcc/
JMC Hub. Exploring the Concept and Role of SBCC in Development Communication. Accessed July 9, 2023. https://jmchub.in/media-and-society/sbcc-in-development-communication-concept-role/
Mahumud RA, Uprety S, Wali N, Renzaho AMN, Chitekwe S. The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta‐analysis. Maternal and Child Nutrition. 2021;18(1). doi:10.1111/mcn.13286
Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public Health. 2016;136:109-116. doi:10.1016/j.puhe.2016.03.030
3Ps. Introduction to Participatory Learning and Action (PLA) Training Course Handbook. Published 2016. Accessed July 25, 2024. https://3ps.org.uk/site/files/Download/PA%20Handbook2016.pdf
Prost A, Colbourn T, Seward N, et al. Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013;381(9879):1736-1746. doi:10.1016/s0140-6736(13)60685-6
Sarker BK, Mridha MK, Dasgupta SK, Islam N, Reichenbach L. The effect of behavior change communication (BCC) interventions on maternal neonatal and child health (MNCH) knowledge in urban slums of Bangladesh. Manoshi No. 17. January 2012. Accessed July 6, 2024. https://www.researchgate.net/profile/Noushin-Islam/publication/231537355_The_effect_of_behavior_change_communication_BCC_interven-_tions_on_maternal_neonatal_and_child_health_MNCH_knowledge_in_urban_slums_of_Bangladesh_No_17_January_2012/links/0912f506bad32cd61b000000/The-effect-of-behavior-change-communication-BCC-interven-tions-on-maternal-neonatal-and-child-health-MNCH-knowledge-in-urban-slums-of-Bangladesh-No-17-January-2012.pdf
Field E, Maffioli E, Zaw NT, Hong J. The Impact of Maternal Cash Transfers on Child Malnutrition in Myanmar. Innovations for Poverty Action. Published September 12, 2019. Accessed July 31, 2024. https://poverty-action.org/study/impact-maternal-cash-transfers-child-malnutrition-myanmar

Stay in Touch with Syed Saad Ahmed

ABOUT THE THOUGHT LEADERSHIP FOR
PUBLIC HEALTH FELLOWSHIP

The mission of the Boston Congress of Public Health Thought Leadership for Public Health Fellowship (BCPH Fellowship) seeks to:

Incubate the next generation of thought leaders in public health;
Advance collective impact for health equity through public health advocacy; and
Diversify, democratize, and broaden evidence-based public health dialogue and expression.

It is guided by an overall vision to provide a platform, training, and support network for the next generation of public health thought leaders and public scholars to explore and grow their voice.

RETURN TO THE THOUGHT LEADERS