Sure Start’s communications efforts put maternal and newborn health in front of a wide audience

Sure Start uses creative methods to convey important information about maternal and newborn health to communities. In both Uttar Pradesh and Maharashtra, the program uses interactive and entertaining tools including dance, music, theater, and games to create awareness.

Getting the message out

In Uttar Pradesh, an extensive mass media campaign called Pehla Ek Ghanta (The First One Hour) has been rolled out in the districts in which Sure Start operates. The effort includes setting up hoardings (billboards) and outfitting rickshaws with awareness-building messages, as well as organizing quizzes and screening films embedded with maternal and newborn health information. Round 2 of the campaign, which was completed in April 2010, targeted nearly 5,500 villages, with a focus on holding special women’s and men’s group community meetings for each village, one in the morning (mostly for educating mothers) and the other in the evening (for sensitizing the men in the community). Creative communications tools such as a dart game and “wheel of fortune” were used during the morning mothers’ group meetings to highlight key messages. For the “evening shows,” video shows were played on an LCD projector for the entire village, with question and answer games interspersed through the session.

In Maharashtra, where Sure Start has received substantial press coverage, a well-publicized campaign organized with active support from the government helps spread awareness about the Janani Suraksha Yojana and the Matrutva Anudan Yojana, which are government schemes to improve the health of mothers and newborns.

On the whole, Sure Start communications efforts are centered around five key messages: cord care, thermal care of the newborn, immediate and exclusive breast feeding, birth preparedness, and danger sign recognition.

Communicating across cultures and languages

In Maharashtra’s towns and cities, Sure Start has developed materials to facilitate home visits for behavior change. The task is complex. Sure Start must engage with immigrant populations that come from distinct cultures and speak different languages—every house holds a different audience.

The project has produced information, education, and communication materials that are prominently displayed in all the health posts and centers of the Navi Mumbai Municipal Corporation. Early signs of progress are encouraging.

A very special letter

When his wife became pregnant, Mr. Ramkaran, a resident of Sabji village in Rae Bareli district, received a letter. That in itself was not unusual. But, Mr. Ramkaran discovered, the letter itself was anything but ordinary—it was from his unborn child.

The unborn child’s voice addresses the father-to-be, emphasizing the importance of:

• “…my mother receiving tetanus toxoid immunization”
• “…my mother receiving iron and folic acid tablets”
• “…you, my father, ensuring my mother gets adequate rest and nutrition”
• “…ensuring money and transport is prepared for a safe delivery in the hospital”
• “…ensuring my mother attends “mothers’ group” meetings in order to learn more about recognizing the warning signs, and being prepared for my birth”

The 132, 000 men who have been reached through the campaign (including fathers-to-be and elected village headmen) have unanimously praised this idea. The letters help soon-to-be fathers to better understand their pivotal roles in the well-being of their children.

Sabji village: bringing about change from the inside out

In Sabji village, Ms. Ramvati is one person who knows her community from the inside out. She is an Accredited Social Health Activist who makes home visits to pregnant women. “Sure Start has given me good communication material and skills to go into people’s houses and explain safe birth practices,” she explains, “including identifying danger signs and undertaking adequate preparations for birth.” Sure Start materials, home visits, and “mothers’ group” meetings have helped expectant mothers understand the need to pay more attention to their nutrition and immunization. “On the whole, they seem to be more aware now,” notes Ms. Ramvati.

“Earlier, people were somewhat suspicious and some even forbade me from coming into their houses, but I now receive a lot of respect,” she says. “People ask me to sit, offer me tea, and actually listen to what I say. Having said all this,” she adds. “I would like to say that the more training we receive from Sure Start, the better we will be able to do what we do.”

“I will do some things differently”

In Sabji village, Ms. Sudama is a mother of three who is expecting her fourth child soon. “Didi [the Accredited Social Health Activist] comes to our house, and therefore I know how to access a four-wheel vehicle when I need to go to the hospital,” says Ms. Sudama. “I have also kept the telephone number of the doctor handy.” Ms. Sudama keeps much of the information on her birth preparation calendar—a practical and creative gift from Sure Start—that she has displayed prominently on her wall.

On another of Ms. Ramvati’s visits, Ms. Sudama was given a tiffin box. “I am using the plastic tiffin box to put aside some cooked food for myself and consume it after everyone is done,” she says.

Sure Start also gave Ms. Sudama a piggy bank to encourage her to save so that the hospital visit does not drain her family’s resources. Like hundreds of mother-to-be, she now puts small amounts of money into the piggy bank whenever possible, and speaks proudly of her new approach toward her pregnancy. “I already have three children,” she says, “but this time around I will do some things differently.”

A quick look at some of Sure Start’s achievements

Uttar Pradesh

• 85 percent of all registered pregnant women now receive the tetanus toxoid vaccine by their third trimester.
• 80 percent of all registered pregnant women now receive iron and folic acid tablets.

Maharashtra

• In Navi Mumbai, the percentage of women delivering their babies in hospitals has increased from 79 percent in 2007 to 95 percent in 2009, and the figure continues to rise.
• In Pune, the percentage of women attending a prenatal checkup for the first time in the first three months of pregnancy has increased by 4 percent in just one year (from 46 percent in 2007 to 50 percent in 2008).
  

Photos (from top): PATH, Lakshman Anand, PATH.