This narrative account of Roshni’s perinatal journey is informed by qualitative and quantitative information, but the primary source for it is from the interviewing-the-interviewers qualitative discussion that were done at the end of the project (see Chapter 5). This is a narration of what a typical woman in Bihar might encounter and think about during pregnancy. This framing makes it a plausibly typical experience, but this also requires some decision-making in how the information is presented, which leads some of the variation in these behaviors to be under-examined. For this reason, we discuss some of the details about convergence across data sources and generality of the issues that Roshni faced.
As mentioned above, an analogy can be made between for how Roshni experiences different sources of influence coming in and out of her immediate sphere of relevance like actors on the stage of a play. As such, the voices of some actors are more prevalent at some points than others. In the case of the ASHA, there are a few points where she is clearly ‘on the stage’ but there are also many points where she has little or no presence at all.
These times when the ASHA is ‘off the stage’ are barriers to messaging about health care and the uptake of certain recommended behaviors. For instance, the ASHA has relatively little access on the first few days postpartum, when there are a few inter-connected behaviors of concern to the global health community, such as cord stump treatment, bathing the newborn, or dietary restrictions on the mother. Our surveys showed that more than half the women sampled are treating their cord stump with a substance, about 1/3 are bathing their newborns within 24 hours of delivery, and a little less than 1/3 avoid cereals in the first six days after birth.
Another factor affecting the ASHA’s ability to be ‘on the stage’ is the moving of women between villages. This complication is difficult from the mother’s perspective because she may be new to a village, could be young and or timid, and until pregnancy has no formalized way of establishing a relationship with her ‘new’ ASHA in her husband’s family’s village.
The narrative account above indicates that there are a few situations where the ASHA’s presence is especially absent. One is pre-pregnancy for women attempting to become pregnant, where women rely on a number of traditional and/or folk-biological techniques when trying to conceive. Another is at the beginning of pregnancy. The strong desire to conceal the pregnancy for at least the first trimester, which is common all over the world, has the potential to delay ANC registration in a way that is non-optimal with respect to several aspects of perinatal messaging and healthy behavior, such as taking IFA. If a woman starts IFA at the very beginning of her third trimester, has no issues of supply, and takes them dutifully, then she can get in the full recommended dosage before delivery. However this leaves plenty of room for error, in that if there are any further delays or inaccuracies then this can result in missing some of the IFA tablets. Furthermore, it may be the case that beginning IFA before the third trimester is ideal for maximizing the potential of folic acid to lower the risks of certain ailments.
In closing, this narrative illustrates the many interaction parts of the messaging and sources of influence that a young mother readily encounters during her perinatal journey. There are essentially no bad actors here, as everyone near the mother, and the mother herself, are only seeking behaviors, practices, and rituals that are motivated by intentions of avoiding risk and promoting health to the mother and child. When some behavior appears not to do that, it is not due to a problematic motivation and any messaging campaign or intervention needs to recognize that.