He wears thick rimmed red glasses, white hair, and a small peppered mustache to fit. In less than five minutes of meeting him, he’s singing. He bolts out the lyrics to a poem he has written, harking on the importance of taking Iron and Folic Acid tablets, additional rest, having nutritious foods, and other advised practices for safe pregnancies and maternal health. We have been working with this material here in rural India now for a couple weeks, but this is the first time I hear it presented in a way this fun and engaging.
Health volunteers in rural India have plenty of challenges. Their clientele are uneducated and poor and the volunteers themselves are often uneducated and poor. They all live far from the health centers that can help them, and the only way to get there is over a bumpy dirt road on the back of a bike, a rickshaw if they can find one, or on foot… not exactly ideal for a woman in labor. And one of their toughest challenges, as noted by ASHAs, other health volunteers, and doctors is that the pregnant mother just doesn’t believe that medicine, additional nutrition, and other recommended practices for a safe pregnancy could potentially save her or her child’s life or at least save them some trouble in the immediate or distant future.
Reportedly, the main instigator in this arena is the mother-in-law. She keeps a watchful eye on her grandchild to be and instructs the mother on what to do and often times perpetuates old wives tales like getting a tetanus vaccine will make the mother sterile and is also very wary of newer practices like taking Iron and Folic Acid tablets, which she may not understand help prevent anemia and painful swelling. Other traditions are upheld, like the men of the household eating first and if there isn’t much food left afterward then the women, pregnant or not, simply don’t eat as much as they should.
It’s not hard to see why it’s so difficult to change old habits. The ASHA program is very new in India (only about four years old) and recruits ASHAs on the criteria that they are a woman not originally from the village where they now live, but have come to live there through marriage. This ensures that the ASHA will most likely stay in that village for the rest of her life, as she is already married and won’t be running off somewhere else to find a man. This also means that she has no credibility in the village where she works. She is young and has come from somewhere else, so who will listen to her?
Trying to promote the same safe practices through means of a mobile phone as an engineer from the west is a much further stretch. So what do you do? Take the same messages that the ASHAs are already saying, the same messages that are listed on wall paintings in the villages, the same messages that are still being ignored, and put them line by line on a mobile phone and hope that will work better? No… you build a volcano.