9.5 Individual Vignette Descriptions
9.5.1 Colostrum
First is a list of the specifics of the respondents’ causal attributions of feeding colostrum, broken up between what it prevents and what it promotes or provides. For Q1, Colostrum is pretty similar to the Health vignettes on average with one primary exception. There are many more responses that attribute decision-making to the knowledge-ignorance of the mother. Q4 shows lower rates of conflict compared to other vignettes. Q6 asks when a mother should be told about colostrum. This is supposed to be in general, and not necessarily based on this vignette. However, Condition had a clear effect on the ASHAs who went from saying mothers should be told about Colostrum 7 months or later into pregnancy to thinking they should be told between 3 and 6 months into pregnancy. Mothers were not affected by condition and generally thought mothers should be told 7 months or later into pregnancy.
| Prevents | Promotes/provides |
|---|---|
| Excessive Milk | Stamina |
| Disease | Milk production |
| TB disease | Strength |
| Anemia | Nutrients/Vitamins |
| Pneumonia | Energy |
| Diarrhea | Development (including brain) |
| Fever | Makes lungs strong |
| Measles | better eyesight |
| tetanus | beauty |
| Blood turning blue | sickness |
| no lack of blood | vomiting/diarrhea/upset stomach |
| malnutrition | nipple pain |
| cough/whooping cough | stomach pain |
| mental illness | fever |
| typhoid | thinness/weakness |
| jaundice | |
| malaria | |
| sore throat | |
| trouble speaking | |
| crying | |
| paralysis | |
| stomach pain | |
| polio | |
| cancer | |
| cold | |
| handicap | |
| asthma | |
| kala azar | |
| Breasts swell |
For further analyses on the colostrum vignette, please see Appendix B.1.1.
9.5.2 IFA Tablets
The most important result from this vignette is a sign that there is little knowledge of the benefits of folic acid in preventing neural and spinal birth defects. The causal reasoning focuses primarily on benefits of iron for blood health. Beyond that, IFA elicits patterns typical of Health category vignettes; though the decision is seen to rest with mothers even more so. In addition, there is fairly large agreement that mothers need to be told the benefits within the first 4 months of pregnancy, with ASHAs emphasizing even earlier communication than mothers.
Causal Reasoning
| Prevents | Promotes/provides |
|---|---|
| anemia | blood |
| skin disease | iron |
| weight loss | benefits eyes/protect mother from night blindness |
| malnutrition | walking |
| fever | “heat” |
| polio | sharper mind |
| tetanus | vitamins |
| itchiness of arms and legs | child’s weight |
| stomache-ache | strong bones |
| filarial | proper development |
| pregnancy aches and pains | no problems at delivery |
| death | white complexion |
| chronic sickness | dizziness |
| filarial | harm to infant/miscarriage |
| sleepiness | |
| vomit/nausea/upset stomach | |
| blind baby |
For further analyses on the IFA tablets vignette, please see Appendix B.1.2.
9.5.3 Exclusive Breastfeeding
This vignette shows a similar profile to the other Health vignettes with few exceptions. Q2 elicits more mother as the main decision-maker, more so than any other vignette. For Q2 (why): there are a greater proportion of social role justifications rather than Health Knowledge justifications. Similar to Colostrum Q6, there is general consensus to discuss with mother in the final trimester of pregnancy.
| Prevents | Promotes/provides |
|---|---|
| contains protein | Milk production |
| provides warmth | vomitting |
| fever | liver health |
| typhoid | general health/strength |
| malaria | brain/mind development |
| contains vitamin | weight gain/fat |
| cyst/lump in breast | digestion/stomach health |
| contains protein | |
| disease | |
| cold | |
| cough | |
| diarrhea | |
| fast pregnancy | |
| pneumonia | |
| kala azar | |
| breast pain | |
| vomitting | |
| goitre | |
| TB | |
| bleeding after deliv | |
| ends thirst | |
| breast cancer | |
| stomach ache |
For further analyses on the Exclusive Breastfeeding vignette, please see Appendix B.1.3.
9.5.4 Vaccine-Pregnancy
This vignette differed from other Health vignettes in a few notable ways. All Health vignettes showed a greater number of Health explanations for Q1 Consistent rather than Inconsistent, but the disparity here is even greater than the first three. Perhaps the biggest distinction with the rest of the Health vignettes is that the husband is seen as an important decision-maker here; the husband more rare in the other 4, including vaccination during infancy. There is general consensus to tell mothers to vaccinate within the first four months of pregnancy.
| Prevents | Promotes/provides |
|---|---|
| Tetanus during delivery | Remain healthy |
| handicaps/disabilities | Good child health |
| disease | Safe pregnancy |
| polio | Provides vitamin D |
| hepatitis | Miscarriage |
| stammering | Fever |
| cold | Wound |
| Cough | Injection causes pain |
| Problems | Abortion |
| Weakness | Damages child |
| chicken pox | Causes disease |
| cholera | Damages mother |
| Pneumonia | Causes handicap |
| child mental health problems | child vomittting |
| malnutrition | heats up body |
| cancer | good nutrition |
| ‘bleeding of water wastage’ | |
| abortion | |
| dhanushtkar | |
| mother’s paralysis | |
| miscarriage | |
| deafness/dumbness | |
| utreus infection during delivery | |
| hawa juda | |
| fever | |
| congenital disease | |
| polio | |
| formation in womb | |
| delivery problems | |
| TB | |
| Stomach pain | |
| asthma | |
| Infant death |
For further analyses on the Vaccine-pregnancy vignette, please see Appendix B.1.4.
9.5.5 Vaccines-Infancy
This vignette has little distinguishing it from the other Health vignettes. The mother is seen as having more decision-making control than the vaccines during pregnancy (Q2). For Q6, most people agree the mother should be informed around the time of birth.
| Prevents | Promotes/provides |
|---|---|
| malnourishment | strength |
| asthma | health |
| black cough | lameness |
| cancer | mental health |
| child death | disease |
| cold | growth |
| cough | child will have evil eye |
| diarrhea | child death |
| disability | increases eyesight |
| disease | swelling from injection |
| dry cough | weakness |
| fever | wound |
| goutre | |
| hepatitis | |
| infection | |
| jaundice | |
| kala azar | |
| lameness | |
| malaria | |
| measles | |
| meningitis | |
| mumps | |
| paralysis | |
| pneumonia | |
| polio | |
| sickness | |
| smallpox | |
| TB | |
| tetanus | |
| typhoid | |
| whooping cough | |
| throat’ | |
| chick pox | |
| encepahlitis | |
| iron deficiency | |
| kala azar | |
| loose motion | |
| low IQ | |
| malnourishment | |
| the child being posessed | |
| spolio |
For further analyses on the Vaccine-infancy vignette, please see Appendix B.1.5.
9.5.6 Institutional Delivery
This vignette elicits some unique response patterns because of how institutional delivery is incentivized. Like a Health vignette, it has a lot of Health responses for Q1 and Q3, but because of a number of well known incentives, such as financial and based on engaging with the government and receiving the associated documents, it also elicits a number of Other Benefits responses. Compared to the two Family Planning vignettes (which are the two other Other Benefits vignettes), husbands plays less of a role in decision-making, but still more than a typical Health vignette. The most frequent response for when institutional delivery should be discussed with the mother is in the last trimester.
| Promotes/provides |
|---|
| safe delivery |
| newborn immunication/vaccine |
| can refer to others if something goes wrong |
| doctor/nurse available |
| ambulance service |
| facilities |
| less pain |
| deal with loss of blaod |
| oxygen available |
| less disease like pneumonia, skin problem |
| IV drip |
| ultrasound |
| operation/c-section can be performed |
| child treated/tested for disease |
| deals with deficiency of blood/water |
| lots of medicine available |
| vaccination |
| safe delivery |
| food |
| handle excessive bleeding |
| pain reduction |
| incubator for premature birth |
For further analyses on the institutional delivery vignette, please see Appendix B.1.6.
9.5.7 Family Planning No Children
A unique aspect of this vignette is in Q1, specifically comparing the ASHAs and Mothers in the Inconsistent condition. ASHAs gave 0 “other benefits-costs” explanations for going against an ASHAs recommendation, and the Mother’s gave this explanation 44% of the time! Q3 showed that these other benefits are very rare to be considered a good persuader to use family planning, and instead they should only focus on Health. This appears to be an important discrepancy that should be leveraged for greater uptake of family planning for young women with no children- the reasons beyond your health to delay having them. Husbands play a large role here; ideally there would be a way to engage them as well. The most frequent time suggested to have this discussion is right after marriage. Another note: the causal reasoning of the is presented a bit differently because it focusses on a number of different causes (e.g., the consequences of use of contraception vs. being a young mother).
| Cause | First Effect | Second Effect |
|---|---|---|
| contraception | loss of blood | then miscarriage |
| contraception | infertility | |
| family planning | becomes weak/broken | |
| family planning | remains healthy, becomes strong | |
| later birth | better home condition | |
| later birth | better raised | |
| later birth | more fun/autonomy | |
| prevents young birth | benefit child’s mental health | |
| prevents young birth | no loss of blood/anaemia | |
| prevents young birth | remains healthy/strong | |
| with age | utuerus develops | reduces risk of miscarriage |
| young birth | able to tolerate more pain | |
| young birth | abortion | |
| young birth | asthma | |
| young birth | back pain | |
| young birth | becomes weak/sick | |
| young birth | Child death | |
| young birth | child death | |
| young birth | delivery problems | |
| young birth | delivery problems | |
| young birth | disabled | |
| young birth | disease/illness | |
| young birth | diseases | |
| young birth | dizziness | |
| young birth | extremities swelling | |
| young birth | fever | |
| young birth | impairs child’s mental health | |
| young birth | infertility | |
| young birth | lack of blood | dizziness |
| young birth | less need for operation | |
| young birth | lose eyesight | |
| young birth | loss of blood/anaemia | |
| young birth | low blood pressure | |
| young birth | malnourished child | |
| young birth | malnourished child | |
| young birth | miscarriage | |
| young birth | mother death | |
| young birth | mother death | |
| young birth | necessitates major operation for delivery | |
| young birth | pneumonia | |
| young birth | poorly raised | |
| young birth | premature birth | |
| young birth | prevents mother’s education | |
| young birth | produce less milk | |
| young birth | tuberculosis | |
| young birth | typhoid | |
| young birth | uterus does not open | |
| young birth | major operation | |
| young birth | pain in abdomen & waist | |
| young mother | improper care |
For further analyses on the family planning-no children vignette, please see Appendix B.1.7.
9.5.8 Family Planning
This vignette stands out for how it elicited the fewest Health responses across Q1,3, and 2Why of any. The most frequent response for when to discuss with the mother is right after her most recent child.
| Effects of having more children |
|---|
| weakness |
| lose eyesight |
| weak uterus |
| lack of blood |
| malnourished |
| swelling in extremities |
| bad health |
| disease |
| remain healthy |
For further analyses on the family planning vignette, please see Appendix B.1.8.