2.3 Why Ritual?

Rituals are socially stipulated normative behaviors. In all societies, rituals influence or interact with beliefs and behaviors relevant to maternal and newborn health (Legare et al. 2020). Because they are “normative” rituals are part of a culture’s “received wisdom,” that is, information that is both actively and passively culturally transmitted about expectations for how to behave and why.

Importantly, the term “ritual” does not just apply to practices that are ancient or traditional, but biomedical and hygienic behaviors that are typical of educated western societies are also often rituals, or have ritualized components. For example, many diverse health-relevant behaviors ranging from tooth-brushing to hand-washing are culturally transmitted and normative. Across diverse global populations, rituals are used to promote health, cure illness, and attempt to solve problems. By focusing on rituals, we can address the deep-rooted barriers to health-promoting behavior and create long-term sustainable solutions for behavior change (RISE 2018).

As such, when we discuss “ritual” in Project RISE we are interested in the full repertoire of traditional, normative, and biomedical health practices that include layman impressions of ritual, such as taboos, superstitions, religious or folk-medical practices as well as health behaviors with proscribed formal steps that may include less obvious forms of ritual like vaccinations, hand-washing, or following the biomedical recommendations for an institutional delivery. In all of these cases, the ritual behaviors operate as culturally sanctioned responses to perceived threat.

Part of the reason that rituals should be incorporated into CHW interventions, and health-interventions generally, is that they are highly intertwined in health, hygiene, and diet. Part of what rituals do is help people manage risks or anxiety associated with perceived threats. Further, rituals are connected to many of the main themes emphasized by SBCC research. For instance, rituals can greatly affect social cohesion, connections among community members, and can also facilitate the development of trusting relationships. Rituals are often connected to public ceremonies that mark transitions in one’s life course or elevations in status. All of these touch on the WHO recommendations for health-sector interventions mentioned above.

Ritual-based behaviors reinforce social affiliation, thus leading to long-term maintenance of behaviors. Engaging in shared ritual practices in the context of a group increases social group bonding and increases preference for ritual behavior. For example, people who participate in group rituals identify more strongly with their group, and are more likely to continue to affiliate with the group over time than people who have not participated in group rituals. Rituals promote the high fidelity maintenance and transmission of group behavior over time. People are also more likely to continue to engage in behavior over time if it is a ritual group practice. Rituals are thus critical for understanding the motivation to engage in group-level behavior.

However, the potential of ritual for human-centered-design has not been thoroughly explored and, as far as we know, there aren’t existing studies to draw from that explain how to most effectively leverage them. That said, there are three general ways that we might expect to harness or leverage ritual based on existing research:

  1. identify and modify existing health-related rituals

  2. introduce and ritualize new health-related behaviors

  3. rituals that are not directly related to the target health outcome can be used to reinforce positive health behaviors

Identifying which of these ways to use ritual, and how, is also a Project RISE objective. It is likely that these will be used in tandem to inform design. Further, different behaviors will have different potentials and specific nuances of cultural or normative resistance to change. In some cases a recommended health behavior is completely new and the task is more of convincing beneficiaries that there are real benefits to adopting it. In other cases, a recommended biomedical ritual may overlap or even conflict with the purview or a traditional ritual. These cases will require different tactics for leveraging and convincing.

For this reason we may need to distinguish between ritual awareness and ritual leveraging. Rituals, beliefs, practices, habits, and behaviors are all examples of complex cultural phenomena that do not exist in isolation. A ritual awareness examines these things for how they connect so that solutions may come in the form of tweaks or the potential of changing a seemingly non-health-related ritual because of its influence on another. Ritual leveraging is more direct in that it modifies or directly applies a ritual to health behaviors of interest. Such possibilities are determined after extensive synthesis and analysis of the data streams.


Legare, Cristine H., Santosh Akhauri, Indrajit Chaudhuri, Faiz A. Hashmi, Tracy Johnson, Emily E. Little, Hannah G. Lunkenheimer, et al. 2020. “Perinatal Risk and the Cultural Ecology of Health in Bihar, India.” Philosophical Transactions of the Royal Society B: Biological Sciences 375 (1805): 20190433. https://doi.org/10.1098/rstb.2019.0433.
RISE, Team. 2018. “Project RISE Proposal.”