Author: BBC Media Action's Health Adviser Emebet Wuhib-Mutungi, originally posted on April 27 2017 - Following the launch of BBC Media Action's Global Health Stories site, Emebet Wuhib-Mutungi explains how influencing mothers-in-law and husbands can help improve the health of mothers and their babies. 

Over 800 women die every day because of complications caused by pregnancy or giving birth. Almost all of these women live in the Global South. And most could be saved through simple precautions, like going for regular antenatal check-ups.

But as we discovered through our work in Bangladesh and Ethiopia (watch the video here for more background), expectant mothers often don’t go for check-ups early enough. Our research into people’s beliefs suggests this is because Bangladeshis view pregnancy as a ‘natural process that doesn’t need special attention’, while in Ethiopia, going for a check-up is seen as inviting ‘bad luck’. We've seen similar views in India and South Sudan.

In Bangladesh and Ethiopia, mothers-to-be and their families don’t follow a number of other medical recommendations either. For example, ‘preparing for childbirth’ in Ethiopia generally doesn’t involve deciding on where to give birth, how to travel there and getting that all-important hospital ‘grab bag’ ready. Instead, the primary focus is on organising a big social event for family and friends to give thanks for the new life. Not doing so is frowned upon.

So… why is this?

Mother-in-law knows best?

Both Bangladeshis and Ethiopians believe that everything baby-related is the responsibility of women, with mothers-in-law – particularly in Bangladesh – serving as the ultimate arbiters of pregnancy.

Mothers-in-law are in turn likely to give their daughters-in-law advice based on their own experiences and what has always been done in their communities: give birth at home.

Expectant mothers are unlikely to defy both society and their mother-in-law to follow medical recommendations. This is because humans are social beings. When we choose whether or not to do something, we’re heavily influenced by social norms – what the people we love, respect and are surrounded by would normally do or strongly expect us to do.

Influencing the influencers

To encourage more women to seek medical help in pregnancy, it became clear that it was important to influence mother-in-laws.

Husbands – usually the household decision-makers – tend to not get involved in plans for childbirth. We saw this as an opportunity to engage men, who could then encourage their pregnant partners to adopt safer habits.

To reach and convince these family members to do things differently, we created TV and radio shows featuring husbands and mothers-in-law supporting the kind of practices we wanted to catch on. But modelling new behaviours isn’t enough to get them adopted. So to help audiences make informed choices, the shows also provided a space for discussion and explained why, for example, antenatal appointments were worth attending.

Inspiring change through fictional characters and real-life experiences

Of course, leveraging influencers, like mothers-in-law or men, to improve women and children’s health isn’t a new approach. What is less well-known is what works when trying to do so.

Speaking to audience members and project staff five years on, it was clear that husbands and mothers-in-law who tuned in to our shows saw themselves and their lives reflected in their fictional or ‘real life’ counterparts. This, they said, was critical.

As one husband told me, this was the first time he heard other men like him talk about accompanying their wives to the health clinic for her check-ups or saving money for a birth. While such anecdotes give us an idea of what inspired people to do things differently, they don’t give us – and the global health sector – the much-needed hard evidence of ‘what works’.

What we can say with confidence is that, after watching or listening to our programmes, husbands and mothers-in-law in both Bangladesh and Ethiopia are more likely to know the recommended guidance and to believe that it’s commonly followed in their community.

With improved knowledge and new perceptions of local social norms, influencers can offer better advice and support, helping secure a safer future for mothers and their babies. It’s just difficult to say exactly what it was about the programmes that set off this chain of events.

Future food for thought

Through influencing influencers, we’ve also begun to tackle gender stereotypes. For instance, we’ve shown that it’s OK for men and women to talk openly and freely together. In Ethiopia, our male and female radio presenters often share their own baby stories with each other in a light and friendly way.

We’ve also helped show that caring about babies is just as manly as keeping a job down and putting food on the table. Our TV drama in Bangladesh achieved this by weaving together storylines about male characters struggling with debt and ‘bad guys’, together with those about couples having a baby.

We’ve succeeded in getting men to watch and listen to our shows and get more involved in what’s considered a ‘woman’s issue'. We’ve done so without overtly challenging the status quo in which ‘men are the decision-makers.

Our next challenge is figuring out how we can help transform traditional gender roles, which could arguably have even longer-lasting impacts that also go beyond health.  

If you want to find out more about how BBC Media Action used media and communication at scale to improve maternal, newborn and child health, go to our digital platform, Global Health Stories.

Emebet Wuhib-Mutungi is a Health Adviser with BBC Media Action. She tweets as @ewuhib.

Click here to access this BBC Media Action Insight blog and related links on their work in Ethiopia and Bangladesh. 

Image credit: BBC Media Action

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