Council researchers assisted the Government of India in assessing the factors influencing family health behaviors in Bihar, India.
India accounts for one-quarter or more of maternal and child mortality worldwide, and for over one-quarter of the disease burden attributable to nutritional risk factors among children under age five. India's northern states, including Bihar and Uttar Pradesh, account for a large proportion of this disease burden. While reviews of family health interventions have documented that simple home- and community-based interventions can considerably reduce the burden of maternal, newborn, and child mortality and morbidity and malnutrition, the adoption of these interventions has remained low.
A well-aligned communication strategy that includes culturally contextualized messages on family health delivered through mid-level and mass media can play a key role in modifying high-risk practices and shaping demand for the adoption of preventive family health practices. In Bihar in 2005–06, 49% of women and 22% of men had not heard or seen any family planning messages in mass media, wall paintings, or billboards, and only 19% of women had contact with a frontline family planning worker. Following the Council’s involvement in a “landscaping” study in Uttar Pradesh that aimed to develop an evidence-based behavior change communication (BCC) strategy, the Council contributed to a study in Bihar to assess the factors influencing attitudes, perceptions, and practices of family health behaviors.
Key lessons revealed by the study include:
- There is a need to focus on women, particularly young mothers and newly married couples, mothers-in-law and other "wise" females in the family, husbands, and health providers as key audiences for improving selected behaviors.
- Because health providers often cannot reach small hamlets far from villages and health facilities, special efforts are needed to focus on difficult-to-reach and poorly developed villages.
- Women from marginalized groups like scheduled castes and those with no education also require special focus. BCC strategies to improve family health behaviors can be implemented in partnership with media agencies.
- Newspapers publish few items on health and development themes. To increase coverage of health issues a communication strategy will need to tailor communication approaches to each newspaper's priorities, making health an attractive issue for public debate, and train journalists to cover these issues effectively.
The government of Bihar is committed to the integration of BCC into the state’s health delivery system and is working across sectors to promote the strategies outlined in the Population Council’s work. Specifically, the Minister of Health called on various agencies to promote the BCC strategy and the messages it outlines across sectors.
In addition, project materials are widely used throughout Bihar, providing critical information on barriers to and factors facilitating behavior change, what messages need to be promoted, and the most successful means of communicating them. Numerous partners and institutions—namely UNICEF, the UK Department for International Development, and the Bill & Melinda Gates Foundation—are also using the study’s findings and resulting publications to assist in BCC initiatives in other states in India.