Welcome to Vol.5 of 'Behaviour Change Matters’. We discuss inspiring initiatives and thoughts about nutrition. In Chhattisgarh, tribal grandmothers promote good nutrition habits for mothers. Dr. Arun Gupta tells us ‘Time to prioritise investing in breastfeeding’. In the partners’ section, the WHO representative in India highlights the role of communication in behaviour change.
Sid Shrestha
Chief - C4D, UNICEF India
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TRIBAL GRANDMOTHERS USE THEIR POWER OF INFLUENCE FOR NUTRITION PROMOTION
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Baapis visit each house to advise pregnant women and mothers of newborns about good nutrition practices, especially breastfeeding, Dantewada, August 2021. UNICEFIndia/2021/ Vinay Panjwani
Alpana Sikdar, 50 years old, meets pregnant women and mothers of newborns in her village to counsel them about good nutrition habits. “There are newborns here, I advise the mothers about breastfeeding; there are some pregnant women in the village, I tell them about eating well during pregnancy,” she says. Shanti Kashyap, another elderly woman from a neighbouring village, adds that she advises pregnant women to get registered at the Anganwadi Centre (Health Homes) to ensure their immunization is complete and utilize nutrition supplies distributed at the centre to pregnant and lactating mothers.
Sikdar and Kashyap are Baapis, or Grandmothers in the Gondi language of Dantewada district, Chhattisgarh, in central India. They are part of the ‘Baapi Nu Uwat’ programme launched in December 2020 by the district administration with UNICEF support to help address malnutrition, especially among pregnant women and children. Dantewada is one of the 115 ‘aspirational districts’ prioritized by the Government of India for focused work on key development indicators such as health and nutrition. One of the main challenges in the district has been addressing cultural practices around childbirth such as taboos around nutrition, avoiding colostrum, bathing the baby immediately after delivery, and keeping the mother and child isolated from the main household. Baapi was thought to be the ideal person to help bring behavioural change not just among pregnant women but the whole family.
In every village, an elderly woman was involved to shoulder this responsibility as a volunteer. There are 239 Baapis in the district. They are trained by the district administration on communication skills and how to talk to the community about government schemes for addressing malnutrition.
Baapi Savitri Raipuria says, “I have six children of my own. The better a lactating mother eats, the better the milk will be, and the more healthy the child. I advise mothers to breastfeed immediately after delivery. I tell them that mothers’ milk is the best for the child.”
While one Baapi is an elected representative in the panchayat, another one used to work in the agriculture department. Deepak Soni, Dantewada district official says “Baapis are respected in the community for their wisdom and hence able to motivate mothers, frontline workers, and community members to practice key behaviours on health and nutrition.” Job Zachariah, Chief of UNICEF Chhattisgarh, adds that Baapis help boost demand for government services such as immunization, nutrition support, anaemia reduction, adolescent health, and hygiene.
Since the launch of the initiative, across all 239 villages of Dantewada district, the community was engaged in nutrition promotion activities thanks to the grandmothers using their influence to ensure every mother or mother-to-be has the right information for a healthy and nutritious maternal life.
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"BREASTFEEDING NEEDS TO BE PRIORITIZED AND INVESTED IN": DR. ARUN GUPTA
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In this edition of the newsletter, we discuss the role of communication in breastfeeding promotion with Dr. Arun Gupta, a pediatrician from the Breastfeeding Promotion Network of India (BPNI). Dr. Gupta is a pediatrician with more than 30 years of experience. He is committed to building up issues around supporting women to succeed in optimal breastfeeding practices. Motivated by his strong belief, and noticing that problems started more often in health systems, he mobilized a group of pediatricians to engage in founding the national network, 'Breastfeeding Promotion Network of India (BPNI)', in 1991.
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A health worker explains breastfeeding to a mother during a Home-based newborn care (HBNC) visit in Chitrakoot, Uttar Pradesh. UNICEF India/2020/ Vishwanathan
Q1: You have been working on the promotion of breastfeeding in India. How have things changed in recent years?
In terms of policy, we have been reviewing the Infant and Young Child Feeding (IYCF) policy every three years since 2005. The fifth report was launched in 2018. The policy has 10 indicators such as accuracy of information and support in hospitals for breastfeeding. India has not moved an inch on the objective score, which remains between 40-45 out of 100. Among the 98 countries we have monitored, India stands at 79. What has changed in terms of the policy is maternity leave has gone up from 12 weeks to 26 weeks. This is a major step. Misinformation has come down, but support in hospitals for breastfeeding has also gone down.
Q2: What role does communication play in promoting breastfeeding?
If you want to increase structural support, you need to build an environment. A communication campaign cannot replace one-to-one counseling, it can be an addition to that. We are making women responsible for breastfeeding without giving adequate support at the workplace and in hospitals. Breastfeeding should start within an hour of delivery but in most hospitals, there is a gap. When we talk of community support and media, policy support must be led by the government. There are policies to protect from commercial baby food. We need supportive policies in the workplace. The employer, both in the public and private sector, must provide a crèche. There is a need for structural support. 90% of women are in the unorganized workforce. Government policies influence the mind of society: so much of what happens at the family and community level depends on the policy.
Q3: In terms of social attitudes to breastfeeding in public space what changes do you see?
In rural areas, we see no problem in breastfeeding in public. In urban areas, there is a mixed response, a sense of embarrassment. We are not advocating for a separate room or space for women to breastfeed. It is a normal physiological method of feeding a baby.
Q4: In terms of communication, what more can be done?
There is no point in telling a mother that breast milk is good. This does not help if you do not offer services. The messaging must be along with a helpline or a service for counseling where a woman can go if she has a problem like ‘not enough milk or low milk supply’ while breastfeeding. Most problems have a simple solution. Not having enough milk is also more a perception problem than a real problem. It can be prevented if we prepare women during pregnancy. There can be a helpline, a physical centre for breastfeeding counseling at a hospital, and a system by which women can be directed to breastfeeding counselors at the time of discharge post-delivery. Women should be able to meet lactation counselors. There is a need for communication to the government for universal maternity entitlements, including all women in the unorganized sector. We need facilities to support women to breastfeed during emergencies. We have estimated that an investment of 5 dollars per child born is required to provide interventions to ensure support to women to breastfeed, in addition to funds for maternity protection. This would be towards legislative reform, communication, and support for breastfeeding in hospitals and emergency settings. Overall, breastfeeding needs to be prioritized and invested in.
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MESSAGE FROM OUR PARTNERS
DR. RODERICO H OFRIN, WHO REPRESENTATIVE TO INDIA
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"Communication has played a key role in the global and local response to the COVID-19 pandemic. There is a need to constantly engage the public as response partners. We have seen that behaviour change for health plays a crucial role in any public health emergency. From my own experience, the response to various emergencies -- the 2004 Indian Ocean Tsunami, cyclone Nargis in Myanmar, the 2015 earthquake in Nepal, the Ebola outbreak in Liberia, and the Rohingya crisis -- all prove the critical role of effective communication for behaviour change. This makes it truly important to share lessons and stories from the field on what works. We can all learn from each other. This newsletter is a welcome addition for knowledge sharing for better actions on the ground."
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“Entertainment-Education Behind the Scenes – Case Studies for Theory & Practice”, a new book has a chapter on AdhaFULL, a transmedia initiative developed by BBC Media Action in partnership with UNICEF. The goal of the initiative was creating recognition of gender stereotyping and discrimination among adolescents and their parents and the confidence to address these. The book chapter on AdhaFULL and transmedia has been authored by Joyee Chatterjee, Radharani Mitra, Ragini Pasricha and Lauren Frank.
Schools Are Reopening. Should Parents Worry About Covid-19 Outbreaks? 'Research shows that children are not the main source of transmission of COVID-19 in the community, school reopening is unlikely to lead to a third wave, and with adequate precautions, the risk of infection to children can be minimized.' Article by Shreya Khaitan, IndiaSpend, September 2021
Interview with Dr Rajan Sankar, Ambassador, IMPAct4Nutrition, on accelerating private sector action for nutrition; By Tarun Bhardwaj, Financial Express, August 2021
IEC WAREHOUSE: New IEC materials added include case studies from across states on a range of issues such as menstrual hygiene management; promoting Infant and Young Child Feeding practices among caregivers; and Role of Faith-Based Organizations in promoting child rights; UNICEF India, 2018
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MUMBAI TALENTS TAKE ACTING TO THE STREETS FOR HYGIENE PROMOTION
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Community mobilisers use street plays to raise hygiene and COVID-19 awareness in the slums of Mumbai, September 2021. Picture credit CACR.
In the urban slums of Mumbai – “film capital of India”, acting talents together with social mobilisers took to the streets to showcase their singing and acting skills for public education. As crowds watched hygiene promotion and COVID-19 awareness street play, water dispensers, hygiene supplies including hand sanitizers, soap bars and face masks were distributed in the surrounding community. The UNICEF supported WASH initiative aims at reaching 250,000 persons in 14 slums across 9 cities in Maharashtra.
The actors led by Ashok Kedar say they thoroughly enjoyed reaching out to people. "Music and story-based street plays in regional languages are powerful tools for spreading messages to the masses. Reinforced messaging will help bring about positive change."
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