Health Behavior Change – A long road ahead

Contributed by Nidhi Chakrabarty (edited by Susan Thomas)

On a recent visit to Paharpur village of Saharsa district, Bihar, while observing a dissemination of a health video with members of a self help group (SHG), I overheard discussions about a woman by the name Kaili Devi, in another SHG and her seven children, all of whom are severely malnourished. Upon asking them for more information I realized that the family lived close by, so I decided to visit them and see for myself their situation.

Kaili Devi (35) and Dinesh Sada have two daughters and five sons. The eldest child is 13 years old and the youngest was born just 4 months ago. Kaili Devi was married to Sada at the age of 20. Sada used to work at a brick kiln where he used to earn up to INR 5,000 per month but had to leave that job as the poor working conditions took a toll on his health. Since then he has not been able to find a stable job. Now he takes up daily wage labor that earns him around INR 2,500-4,000 per month.

The staff of the partner organization shared that the family is under tremendous financial burden and none of the children are able to get a proper meal a day, leave alone healthy diet. They also shared that Kaili Devi, has been a member of Durga SHG since October 2013, where ASHAs (Accredited Social Health Activist or frontline health workers) as well as Parivartan Sahelis (community health workers referred to as Community Change Agents) share critical information with the SHG members on maternal, infant and young child health care and nutrition.

However, Kaili Devi, has been unable to adopt the practices related to family planning and has to now visit the doctor almost daily for injections to just survive, let alone the fact that the infant is severely and acutely malnourished. Kaili Devi is unable to provide nutrition to the child and could not even breastfeed the child for more than 30 seconds.

Over the last few years, the Government of Bihar has been focusing extensively on improving facility-based healthcare for new-borns and mothers with New Born Care Corners (NBCCs), Special New Born Care Units (SNCUs) and labor rooms in first referral units across the state.

A study by the Institute for Health Metrics and Evaluation in Seattle, USA reported earlier this year that pregnancy-related deaths among Indian mothers have declined at an annual rate of 3.1 per cent since 2003, which is slightly faster than the global rate. However, what I saw at Kaili Devi home only helped drive home the point that more must be done to improve these indicators and others such as the startling figures of malnutrition that remains like a scar on our nations health indicators.

When I asked her husband, Dinesh Sada, about why he did not avail of the government schemes or adopt family planning practices, he replied that the more children he had the less he’d have to worry about money as the moment they turn 8 to 10 years old, they would start earning and ease the financial burden.

Clearly, I thought to myself, none of the SHGs or government schemes or any other such investments are able to explain or inform and persuade people adopt the best practices related to family planning and health and nutrition. The SHG that Kaili Devi is a member of does not use the mediated video dissemination method yet.

However a few weeks later I discovered a slightly different story in a neighboring village called Tariyamma in Simri Bakhtiyarpur, Saharsa, which is only 20 kms away. Here I met Duriya Devi (29), who has been a member of Nath Baba SHG since last 2 years.

Her husband Nirmal Sada works as a laborer in Delhi and earns up to INR 6000 – 7000 per month and sends about half of it to Duriya Devi each month.

Duriya Devi has four girls. The eldest is 10 years old and the youngest is one and a half years old and she is six months pregnant yet again, hoping for a boy this time.

All her children were brought to life in the small room of her house by the local dai (traditional birth attendant), as she neither had the money to afford the hospital nor did she know the benefits of delivering a child in hospital.

The members of the group criticized her for getting pregnant again, not knowing how to explain the ill effects it would have on her and her family, yet they made her save money.

I was hesitant about saving the money with the SHG but the members compelled me to, said Duriya Devi. Then the Saheli, Soni Devi, started explaining everything with the help of the videos, and I saw the video Prasav Poorv Tyaari (pregnancy preparedness) and I had more clarity and awareness as to why I should save money and choose to deliver my baby in the hospital, shared Duriya Devi.

These videos were ones created by the community members of the same village after Digital Green and partner NGO (Project Concern International) gave them training on the health related issues and on how to produce the video. Digital Green had then trained a number of Sahelis in disseminating the video among members of the SHG.

After watching the videos not only has Duriya Devi saved up to INR 1500 for the delivery of her child in the hospital, she has also made a note of the name and phone numbers of a cab driver, an ambulance and of a Saheli as well as an ASHA . I will definitely attend all the meetings where the videos will be shown, said Duriya Devi happily.

Since Digital Green started working on the health behaviors in 2012, we have found that it is not easy, nor is it possible to observe change, especially long-term change, as fast as we could in the agriculture domain. However, we know we have much to hope for when we see these changes effected even with one family at a time.