Every day in Bangladesh, more than 320 newborn babies die, and women have a 1 in 110 chance of dying during childbirth. Lack of knowledge, social and cultural barriers, and inequitable access to services, particularly in lower socio-economic groups, are limiting the uptake of healthier maternal and neonatal practices. With nearly 100 million Bangladeshi adults having access to a television, BBC Media Action developed a television drama, Ujan Ganger Naiya (Sailing Against the Tide), and discussion show, Natoker Pore (After the Drama), to help respond to these challenges. (See Related Summaries, below.)
The programmes aimed to change behaviour around and improve knowledge about the importance of regular antenatal care (ANC) check-ups, preparation for birth, and essential newborn care. They also sought to promote discussion, address the social norms that drive behaviours, and encourage pregnant women to: go for ANC check-ups with a skilled health worker, prepare for birth, and deliver with a skilled birth attendant.
BBC Media Action used a randomised controlled trial in 2 locations in Bangladesh (rural and urban), to test the impact of the health drama, with and without the additional effects of the complementary discussion show. Nine hundred women of reproductive age who had watched TV in the last month were recruited. The women were randomly assigned to treatment or control groups: 300 women watched the drama and non-health discussion show, 300 watched the drama and complementary discussion show, and 300 watched a non-health drama and non-health discussion show. All women were surveyed immediately after exposure and 2 weeks later, a sub-sample participated in focus group discussions.
This summary only covers the effects on 2 outcomes: health knowledge and behavioural intent.
Compared with the control, watching the health drama positively affected 4 of 5 knowledge areas (need to go for ANC in the first trimester, need to exclusively breast-feed in the first 3 days, need for 4 or more ANC check-ups, and need to always go for ANC), and watching the health drama and health discussion show positively affected 5 of 5 (also: need to start breast-feeding within an hour) knowledge areas. For example, women who watched the health drama only had an increase in knowledge of the need for 4 or more ANC check-ups of 15 percentage points compared with women in the control group; the number was 38 percentage points greater than the control group for those who watched both the health drama and health discussion show.
Intent to Practise:
Compared with the control, watching the health drama positively affected 4 of 9 behavioural intentions, and watching the health drama and health discussion show positively affected 6 of 9 behavioural intentions. For example, women who watched the health drama only had an increase in the intent to go for 4 or more ANC check-ups of 10 percentage points compared with women in the control group; the number was 42 percentage points greater than the control group for those who watched both the health drama and health discussion show.
Increased Discussion of Maternal and Newborn Health Issues:
Most women had gone on to discuss information from the programmes with others, suggesting a potential diffusion effect. However, neither format affected women's intentions to talk to their husbands about exclusive breastfeeding in particular.
Audiences responded differently to the two formats, with equal, dose response, reinforcement, and dampening effects being seen. Content analysis of the programmes found that covering a health topic often and providing information that audiences perceived to be new led to greater increases in knowledge and behavioural intent. It also suggested that, by covering pregnancy complications, the discussion show may have unintentionally triggered viewers to associate ANC check-ups with ill health, thereby dampening the drama's effects on this knowledge area.
Analysis also revealed intra-audience differences in responses to the two formats. For example, urban women gained more knowledge on the importance of going for 4 or more ANC visits from watching the health programmes than their rural counterparts.
"In brief, we found that watching Ujan Ganger Naiya and Natoker Pore, independently or in combination, positively affected both these drivers [women's knowledge and behavioural intent], and that exposure both the health drama and complementary discussion show had a greater effect. The study therefore demonstrated the power of media-delivered health interventions with multiple communication strands."
Emails from Delia Lloyd and Emebet Wuhib-Mutungi to The Communication Initiative on March 23 2017 and April 3 2017, respectively; and Can a Health Drama and Discussion Show Affect the Drivers of Behaviour Change? [PDF], by Anna Godfrey, March 2017.