Health-seeking behaviors among pregnant women in low-resource settings in India are abysmally low. The latest National Family Health Survey (2016) revealed that only 35% of women in Maharashtra, a high-income and highly urbanized state in India, accessed full antenatal care, (ANC) including at least four antenatal visits, at least one tetanus toxoid injection and iron folic acid tablets or syrup taken for 100 or more days. Having worked with communities living in informal settlements in the megapolis of Mumbai and its suburbs for nearly two decades, the Society for Nutrition, Education and Health Action, (SNEHA) a non-profit organization that works on women and children’s health across the life cycle, aims to strengthen bonds with women and children from marginalized and vulnerable slum communities to influence decision-making in health matters. SNEHA’s Maternal and Newborn Health Program works with communities as well as public health systems to bring about tangible change in indicators, attitudes and health services.
At the community level, one of SNEHA’s many outreach strategies is to conduct events such as baby-showers, or godhbharai. These culturally relevant community events have immense potential in improving the health-seeking behavior of pregnant women while expanding their knowledge of and willingness to use available public health services.
These baby showers are typically conducted at local health posts close to where intended beneficiaries live, giving pregnant women an opportunity to feel welcome at health facilities. Creating a feeling of festivity and celebration is central to the godhbharai, in which women receive garlands and are offered fruits as a take-home souvenir. These events are conducted in collaboration with public systems, with public workers and personnel in attendance. These personnel contribute by giving health and nutrition talks and assuring the gathered women of the system’s commitment to their health and the babies’ wellbeing.
Here are five lessons learned from conducting these events:
- Provide a useful platform for sharing critical health information
These baby showers combine celebration of the pregnancy as a life event, while disseminating valuable health information on the importance of seeking ANC, pregnancy registration, birth preparedness as well as newborn care and breastfeeding. They also enable public health staff to talk about relevant programs, such as the Janani Suraksha Yojana, a conditional cash transfer scheme that encourages institutional deliveries. Field workers share stories of second-time mothers who register themselves with a public facility for delivery after hearing about the benefits. The 2016 endline survey of Beyond Boundaries found that average institutional delivery rates among the intervening beneficiaries was around 89.5%. Distributing birth preparedness and complication readiness cards that list information in an easy-to-digest manner helps empower women with information and take charge of pregnancy and birth.
- Disseminate practical nutrition education
Organizing stalls at the venues with sample meal plans and food items showcases an optimum pregnancy diet. The stalls have samples of lentil sprouts, boiled eggs, roasted whole-flour snacks and soups to emphasize the importance of maintaining a healthy intake of protein and iron rich foods, while pregnant. Selecting affordable and low-cost food items demonstrates that it is possible to eat a healthy diet on a low budget. This can motivate pregnant women to go back home and start eating and cooking mindfully.
- Introduce the local public health facility as a touch-point during pregnancy and labor
Holding these events at the health post—rather than in a community space—has helped lead more women to use public health facilities and services. The events are attended by public health workers and employees, bringing together public health staff and the community. Health post staff arrange for antenatal check-up kits at the event. For many women, it is their first visit to a health facility and an opportunity to learn about the services they offer. When women see motivated and engaged public health personnel, they are often keen to register their pregnancies, come for antenatal check-ups and give birth in a public health facility. This can also give them the confidence to become empowered users of public services. According to the endline survey, on average about 95% of women received four or more antenatal check-ups.
- Facilitate support
Given that many beneficiary communities are migrants and often have families and social networks hundreds of kilometers away, bringing pregnant women together in an event creates a community of support to share joys and resolve anxiety. Informal social networks have positive effects on knowledge of health practices, during pregnancy, birth and child development. The geographical layouts of slum communities encourage interaction and friendships, thereby having a positive effect on health.
- Connect community health volunteers to beneficiaries
A cadre of community health volunteers attends these baby showers. Volunteers are connected to pregnant women and then help women register their pregnancies, take them for antenatal visits, intervene in the case of emergencies and organize transportation during labor. They are trained in basic and emergency obstetric care and to spot danger signs during pregnancy and labor.