The Mabrouk!("Congratulations!") Initiative was designed to raise awareness and discussion among young married couples in Egypt around pre-marital/newlywed counselling, antenatal care, safe delivery, postpartum care (maternal and child health and family planning), and infant health, and to create sustainable social change related to health practices across the stages of family life. Part of the Communication for Healthy Living (CHL) project, the Mabrouk! Initiative combined a multimedia campaign with interpersonal and community empowerment approaches to reinforce programme effects.
The CHL project's "Mabrouk” Initiative identified marriage as a strategic entry point for family health messages, as married couples make many health and behaviour decisions that will have life-long effects on family health. These include decisions about having children, husband-wife communication on health, how to safely manage pregnancy and delivery, proper postpartum, neonatal, and infant care, and the successful initiation of family planning and practice of 3-5 year birth-spacing. In order to address these issues, the initiative used a number of strategies which included both mass media and community-based outreach and interpersonal communication.
Television - CHL, with several media partners, co-produced an entertainment-education television variety show, Al Afdal ("The Best"). During the Muslim holy month of Ramadan in 2004, 2005, and 2006, the show addressed various health themes in a segment for newlyweds. These segments featured call-in contests and on-location interviews with brides and grooms at their weddings in focal governorates. In Ramadan 2005, the weekly show featured messages concerning husband-wife communication, 3-5 year birth spacing intervals, and positive gender roles. In addition, once a month the show hosted on-location, newlywed events in focal CHL governorates for live audiences.
Interpersonal communication - Postpartum home visits were considered an essential part of the Mabrouk! Initiative. Nurses visited the homes of postpartum women to discuss infant health and postpartum care for the mother. They encouraged women to start family planning within 40 days after delivery. According to the organisers, in 2005 and 2006 nurses conducted over 23,000 postpartum home visits in 8 governorates of the country. Also, hospital staff delivered CHL messages and materials, including the Mabrouk booklet, to over 130,000 postpartum women before they left hospitals, which provides information about antenatal and postnatal care, breastfeeding, and family planning.
Empowering communities - CHL provided women's empowerment training and worked with local voluntary organisations, called community development associations (CDAs), to assess and address the health needs of their villages. In the first year of the programme, CHL staff guided three CDAs through the early stages of carrying out the health programme in their villages. These CDAs then paired with newer CDAs to share their knowledge and skills, thus building their capacity. As demand for civil society engagement for health grew, more CDAs joined the programme each year. The community mobilisation programme started in 7 villages in one governorate. By 2006 it had expanded to 120 villages in 8 governorates, with a total population of about 500,000. CDAs trained outreach workers, recruited from local CDAs to make first contact with newlywed couples, to assist nurses with the postpartum home visits.
Newlywed Celebrations - are lively events, based on an Egyptian custom of group wedding receptions, where the families and friends of multiple newlywed couples join in one large event and share in the festivities and costs. The first Newlywed Celebration held in El Minya governorate in September 2004, involved 150 couples and their 9,000 guests; subsequently, small events were held in three more governorates. Through the Mabrouk Initiative, the CHL project continues to engage these couples in village-level health interventions as they build their family life together.
Mabrouk booklet - The Mabrouk booklet was distributed to newlywed couples throughout Egypt by health outreach workers, facility-based health workers, maazouns (Muslim marriage registrars), and priests. Several hundred thousand copies have also been distributed as inserts in popular magazines and at CHL Newlywed Celebration publicity events. The Mabrouk book contains instructions for each reproductive life stage: managing a pregnancy, safe delivery, postpartum, and initiation of family planning.
According to the organisers, monitoring and evaluation used numerous national and local data sources to document the process and effects of the initiative. An annual national survey, called the Egyptian Health Communication Survey, provides information on audience exposure to different CHL programme messages and activities and on the effect of the programme on behaviour change. Television reaches nearly all households in Egypt and was reported as the main source of CHL information by 70-90 percent of adults nationally, compared to about 10% who report exposure to CHL information through community events. The Village Health Surveys, a panel study conducted in 10 focal villages in Menya and Fayoum governorates where community-based interventions are intensive, monitors local implementation and outcomes of CHL. Finally, a maternal and child health monitoring system is used by local outreach workers and their facility-based counterparts to track indicators of birth spacing, malnutrition, infant growth rates, breastfeeding, and many others. These surveys and other programme-specific studies will be used to measure outcomes, determine future needs, and refine communication strategies and activities on an ongoing basis.
Research findings over time indicate that women who practiced early family life-stage behaviours (prenatal care, contraceptive use after the first child, immediate breastfeeding after delivery) are more likely to perform later life-stage behaviours: having a smoke-free area in the home, handwashing before cooking, adopting avian flu preventive measures, and self-exams for breast cancer.
Reproductive Health, Maternal Health, Children, Family Health, Social
According to the organisers, there are 700,000 marriages in Egypt every year. Project organisers stress that focusing on marriage as the entry point to a lifetime of good family health is an effective strategy for achieving sustainable health behaviour change.
United States Agency for International Development (USAID), the Johns Hopkins University Center for Communication Programs (JHUCCP), Save the Children, Egypt