Transcript 3.67M - K4Health

Maternal and Newborn
Health Training Package
Session 9: Engaging Influential Actors
Office of Global Health
and HIV (OGHH)
Office of Overseas Programming &
Training Support (OPATS)
Two Dimensions of Culture
 Development programs (MNH) are more appropriate
and effective when they consider a community’s
cultural realities.
 One way to understand culture is to look at two,
inter-related dimensions:
– social structure (roles of family members, household
decision-making dynamics, and communication patterns)
– community and social norms (rules of conduct and
behavior that guide interactions with others; rooted in
customs, traditions, and value systems)
Discussion
 Please share one thing you’ve
observed in your
community/host family around
household decision-making
that affects some aspect of
maternal and newborn care –
either positively or negatively.
 Please share an example of a
cultural value in your
community that affects some
aspect of maternal and
newborn health.
Two Types of Cultural Systems:
Individualist and Collectivist
In many developing
countries, a
collectivist cultural
system underpins
social structures and
community and social
norms
Key Features of a Collectivist
System with Implications for MNH
 Group identity more important than individual identity
 Interdependence valued more than independence
 Collective, often hierarchical decision-making
predominates; younger mothers in particular, rarely
make independent decisions regarding health-related
practices
 Multi-generational and extended families influence
attitudes of individual family members
 Respect for elders as age and experience confer
responsibility and authority. Elders play a key role in
passing on learning to younger people
Key Features of a Collectivist System
with Implications for MNH
 Gender-specific roles and responsibilities for MNH
– Senior women (grandmothers, aunts, etc.) often have
primary responsibility for advice and management of
health matters concerning mothers and newborns
(breastfeeding, infant feeding, care of sick infants,
bathing infants, infant care while mothers do other tasks,
etc.)
– Men provide financial and logistical resources for
prenatal, delivery and postpartum care, drugs, health
center visits on a routine and emergency basis; they are
key decision-makers for child spacing and family planning
Discussion
 Volunteers and many development workers
come from individualist societies that stress
and/or value self-reliance, personal
achievement, individual independence, and
youth
 What happens when they work in
communities anchored in a collectivist
system?
Social Influence
 Social influence comes from the field of social
psychology. Defined as:
– changes in an individual’s thoughts, feelings,
attitudes or behaviors that result from interaction
with another individual or group
 The level or power of influence by others
depends on their immediacy to the individual,
their number, their perceived expertise, their
perceived authority, and other factors.
The Buffalo Food Story
 This story is a simple way to explain social
influence. Please listen.
 How would you tell this story in this country?
Who influences whom?
Religious Leaders
and MNH
 As the Buffalo Story illustrates, religious
leaders are often very influential. Their
statements and actions can make a difference.
For example:
– Pope Francis and breastfeeding in Europe
– The Emir of Kano and polio immunization in
Nigeria
Post Adaptation
 Share any country-specific information on
religious leaders and their involvement and
influence on maternal and newborn health issues.
Examples of MNH Practices Rooted in
Culture
 Postpartum and postnatal care of
newborns in Uzbekistan: period of
seclusion; intensive coaching of
mother by senior women
 Healthy timing and spacing of
pregnancy in Cambodia: notable
influence of husband but also peers
and mother-in-law
 Family planning in Mali: trusted
source of information are family
members and peers
Implications for SBC in MNH
 Grandmothers often viewed as “barriers and
obstacles”
 Family planning programs focus on women,
assume “nuclear”
families with
optimal couple
communication
But…
 The guardians of tradition are not averse to
change!
 It depends on the approach…
Wrap-Up
 Consider the maternal and newborn health
activities and services that you support along
with your counterpart.
– Regarding all we’ve discussed, what strikes you?
– What are you doing now that is effective in
bringing about desired changes in maternal and
newborn practices?
– In light of what we’ve learned, what do you think
you should stop doing or start doing to be more
effective and why?
Individual: Those who practice the
desired behavior, e.g., mother, father,
and/or maternal or newborn caregiver
Household: Members who have an
influence on this individual’s behavior,
e.g., grandmothers, husbands, aunts, etc.
Community and outreach: Individuals,
groups, or institutions with an influence
on individual and household members for
this behavior, e.g., community leaders,
religious leaders, opinion leaders,
traditional birth attendants, etc.
Health Facility: Health service providers
(government, private, NGO) that have an
influence on individual, household,
communities practice, and behavior
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An Example
 In Niger, a social influence analysis identified
the following people who influence the
mother’s care of a baby with diarrhea
 Older women and grandmothers, fathers of
young children, bokas (traditional healers),
and marabouts (religious leaders)
(From The Grandmother Project)
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