Samvarthana Project: An Interview with Shilpa, a mother of 8 month old boy (by Bennett Cook, Intern from Allegheny College, USA)

‘Nurturing the first 1000+ Days – A Convergent Approach to Child Survival & Development’ is an effort to ensure safe mother hood and Child Survival & Development being implemented in two districts of Karnataka. This project is also a comprehensive Social & Behaviors Change Communication (SBCC) strategy as well as a capacity development framework and creates enabling environment in the villages.

GRAAMs SBCC approach follows the process of identifying, unpacking and analyzing of social, cultural and economic factors regarding norms in order to define key barriers and motivators to change, then to design an intervention to develop a comprehensive set of communication objectives, intended audiences and consistent messages to support and encourage positive behaviors. As part of this process case studies conducted in Mysore district. Below given is a case study documented by Mr. Cook Ben, Allegheny University, USA.

GRAAM_Samvarthana-Project_2016

“Education combined with the support and independence, educated husband had Tremendous impact on understanding of socio cultural health issues in villages”- A case study of Mrs. Sheela, mother of Yuvin, eight months old baby in Golur, Nanjangud taluk, Mysore district (Names has been changed)

Motivation to seek information and knowledge for improved health outcomes for their child:

“I seek out for new information and knowledge on health to improved health outcomes for my child. I utilize the ASHA

advices whenever possible. I always try to get information on best practices in child bearing including television and magazine. If child is sick I approach doctor instead of turning first to traditional beliefs such as tying yantra or dara for my child which is the practice strongly deep rooted in my village. I am strictly following food and health diet for myself and child, consisting of a variety of iron and vitamin rich vegetables and grains. She also plans to have another child in a few years once the first has grown up a little, and hopes for a girl. She stated that “getting a good quality education for my child is my most important focus” says Sheela.

Sheela (28 years old) is an educated (Graduate and diploma in education) and independent woman in her society, and makes many decisions on her own, although her parents have a large influence. She did note that her parents almost always agree with her because she is well educated.

Sheela had her first child, Yuvin, at the age of 27, with no complications. Yuvin is now 8 months old. Surprisingly she wants to try again in a few years to have a girl, which is a typical in the village as males come with more benefits for the family. She says she specifically wants to wait two or more years to reduce the risk of pregnancy complications, and so she can give Yuvin enough attention. She claimed this was also due in part to watching her niece, who had complications during pregnancy because she was too young, and the child had stunted growth. She also remarked that her sister in law (who was present during some parts of the interview) is “Much younger than me and has two children already, she had the first one at 16”. When the sister in law heard this she seemed to smile as if semi-embarrassed. She commented afterwards that getting married early at the ages of 15 and 16 are common in the village as is domestic violence, and she had not suffered.

She was wed to Basavana at the age of 25. Interestingly, she chose to postpone getting married (something which is informed was very atypical, especially that she had a say in the matter) so she could focus on getting an education, making friends, and seeing sights. She tells with a slight laugh “Once you get married here, your free life is over”.

Her husband supports her financially and emotionally and plays an active role in caring for the child. He was very attentive and insisted she rested, made sure to bring her whatever food she wanted, in addition to extra healthy food.

“I began to eat more food as soon as I learnt I was pregnant to accommodate mine and the child’s needs. Family was extremely supportive and parents gave many good suggestions while pregnant such as not to lift heavy objects, to eat right, not to travel or to go outside when it was cold, and especially to keep the child close. I was well prepared during pregnancy and kept money set aside for emergencies and regular hospital fees, which my parents had borrowed, packed spare clothes. Although pregnancy had no medical complications, she suffered a multitude of problems at the local government hospital”.

Health Information and Access: “I received most of information from the local ASHA and from ANMs at the local clinic, and seek them out for advice, in addition to the ASHA’s regularly scheduled home visits. ASHA’s information to be very limited, give very little information on how to prepare for pregnancy, danger signs and pain during pregnancy. Instead stick to nutrition information almost exclusively unless prompted to another topic. “They [ASHAs] never give information on delivery pain, only on nutrition”.

She acquired the knowledge on neonatal health and biology during her studies in college. She also actively seeks out child health information on television (although it is unknown if she owns a television or watches it elsewhere) and in magazines. This is making good use of Karnataka’s high media access rate. Although the rate of access is higher for men, 81% of females had access to media in 2011.

Health seeking behaviour: Sheela has all the information about basic infant and maternal health care, she responded to almost all of them well. She is aware of HIV and STIs, can recognize the symptoms of dehydration and sickness in infants, and practices kangaroo care.

Continuing to responding she says “I am aware of anemia during the pregnancy and its effects. Hence I have taken provided 100 IFA tablets from the Primary Health Centre, and has made changes in my diet to prevent iron deficiency anemia from occurring. I also take vitamin supplements. Additionally, I practice good hygiene and wash hands and before feeding infant regularly. I have access to safe drinking water, which is common in Karnataka at an access rate of 87.5% which is higher than the national average and the 10th best of all Indian states.

After the delivery Sheela practiced her knowledge on new born health care to raise the baby well. She explains “I fed the baby the colostrum, delayed bathing the child for several days, and breastfed him exclusively up to six months after introduced complementary foods. I did not care for the local traditions surrounding childcare and I think most of the practices are harmful. Some are relatively harmless and somewhat beneficial such as not allowing the mother and child out of the house for five weeks after the child is born, and if they do go out they absolutely must be covered. I believe prevailing other common traditions are extremely harmful in the village is the reluctance to go to doctors”. When asked what was her drive to get this information she pointed to the fact that “I have seen so many failures and mismanaged pregnancies in the village and I did not want to become like them”.

“Her education combined with the high level of support and granted independence from her also educated husband obviously has had a tremendous impact on her understanding of sociocultural health issues. In fact, there seems to be no problems with her or the child. The overwhelming problem seems to be the role of traditional medicine in the village by way of the elders influence, coupled with a sense of reluctance among the less educated to accept modern health practices over traditional ones.”

“Her stand on later marriage would lead to better health outcomes, as opposed to the village average of allegedly only completing up to 5th or 7th grade education and getting married in the adolescent age which effectively stops much of their education as they then are expected to do housework, something.

“The late marriage factor is unusual in that her parents did not “force” her or pressure her into getting married right away, which seems like a very likely scenario in the village society. Sheela’s unusually high level of motivation to seek out health information is also likely a large factor in her and her child’s health success”

She says almost all the other villagers try to employ traditional medicine at home, or go to spiritual healers and elders. She thinks they should immediately go to the doctor if sick, as she does. A council of elders has a large level influence in the village and they insist on the value of traditional medicine. They advocate practicing customs such as the yantra (silver sheet roler tied with thread), tying bands around the arms to ward of sickness, using herbs to treat the umbilical cord, and other detrimental practices such as early washing of newborns.

Education combined with the high level of support and granted independence: Sheela’s case is likely an outlier on the very good end of the study spectrum in regards to infant and maternal health. She demonstrates an unusually high level of compliance with modern healthcare practices, and seems to have abolished much of traditional childcare from her routine. She has unusually high level of motivation to seek out health information is also likely a large factor in her and her child’s health success.

Her education combined with the high level of support and granted independence from her also educated husband obviously has had a tremendous impact on her understanding of sociocultural health issues. In fact, there seems to be no problems with her or the child. The overwhelming problem seems to be the role of traditional medicine in the village by way of the elders influence, coupled with a sense of reluctance among the less educated to accept modern health practices over traditional ones.

It is somewhat expected that her level of education and later marriage would lead to better health outcomes, as opposed to the village average of allegedly only completing up to 5th or 7th grade education and getting married in the mid-teens, which effectively stops much of their education as they then are expected to do housework, something Shilpa specifically noted.

Overall, Sheela’s case represents the ideal outcome of the influence of health care practices on mothers in rural India, not only is she and her child healthy, but she is able to effectively integrate all information she learns into practice. She also accomplishes this while self-reporting she is very happy.