5.3 Chapter Discussion

This data collection effort was extremely valuable and provided a rich source of additional information on the perinatal ritual landscape in Bihar. Again, the main output from these discussions is a synthesis of the data in Table ?? into a narrative format that incorporates information from all the data streams (see Chapter 11), which in turn formulates the major synthetic document that other Project RISE endeavors will draw from.

Many of the rituals recorded here were new to the Project, and indeed were new to some researchers who have been working on this topic in Bihar for many years. For instance, we learned that one of the reasons why a pregnant woman should avoid the market might be that a woman might see her who is struggling to get pregnant. If she is so inclined she can sneak up on the woman and pull a loose thread from her sari, which would transfer the pregnancy from the pregnancy woman to the one who pulled the thread. With this as a risk anyone would avoid the market.

As noted in other datastreams, some norms and beliefs are so fixed that they may be virtual barriers to a successful intervention. In some cases attempts might be better to focus on adjacent behaviors or to search for ways to work around a certain norm rather than change it. An example from this dataset is that the news of pregnancy is typically not revealed to anyone outside the immediate family until three months or longer, which includes ASHAs. In rare cases, an ASHA might be contacted for pregnancy tests, but most of the time the husband would get the pregnancy kit from a pharmacy. After the 3rd month, the ASHA is informed so that the pregnant mother can get in the system (ANC registration) and family can start getting benefits (such as IFA tablets). Even though the family can start getting benefits earlier, they don’t inform the ASHA, because of the fear of exposing the pregnancy. Another fear mentioned was of the ASHA giving TT injections which are believed to be a risk for causing death or some deformity in the child (Baccha kharab ho jayega).

In integrating Project RISE data with the process of co-design, we began to view the perinatal journey from the Mother’s perspective as being like a play where a limited set of actors appear and disappear from the stage as the journey progresses. Because of this, it is important that our study of influencers in messaging also realizes that there might be points with certain influencers are not on ‘the stage’ for the mother, meaning that they cannot access her to delivery any kind of message. This synthetic finding is supported here as well in that when a newly married woman comes to her new husband’s house, she doesn’t have any trusted adviser except for the mother-in-law or her own mother whom she probably only communicates with by phone. The experience is somewhat isolating. She has little to no household agency. The MIL might often play the role of a gatekeeper and even prevent the ASHA from talking to the new bride for fear the ASHA might give advice about about contraception. So for much of this early period, the MIL and young woman’s own mother end up being the most significant health influencers. Secondary advisers might include an older sister-in-law. For all tasks that require stepping out of the house, the husband will accompany and be the main decision-maker.