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.

Table 9.17: Causal attributions of feeding colostrum
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
sore throat
trouble speaking
stomach pain
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
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.

Table 9.17: Causal attributions of Exclusive Breastfeeding
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
fast pregnancy
kala azar
breast pain
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.

Table 9.17: Causal attributions of Exclusive Breastfeeding
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’
mother’s paralysis
utreus infection during delivery
hawa juda
congenital disease
formation in womb
delivery problems
Stomach pain
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.

Table 9.17: Causal attributions of Exclusive Breastfeeding
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
kala azar
whooping cough
chick pox
iron deficiency
kala azar
loose motion
low IQ
the child being posessed

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.

Table 9.17: Causal attributions of institutional delivery
safe delivery
newborn immunication/vaccine
can refer to others if something goes wrong
doctor/nurse available
ambulance service
less pain
deal with loss of blaod
oxygen available
less disease like pneumonia, skin problem
IV drip
operation/c-section can be performed
child treated/tested for disease
deals with deficiency of blood/water
lots of medicine available
safe delivery
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).

Table 9.17: Causal relations of family planning (with no previous children)
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
lose eyesight
weak uterus
lack of blood
swelling in extremities
bad health
remain healthy

For further analyses on the family planning vignette, please see Appendix B.1.8.