Care-seeking practices in South Asia: using formative research to design program interventions to save newborn lives

The purpose of this paper is to summarize the formative research findings of newborn care practices in poor and rural districts of Bangladesh, Nepal, and Pakistan and to explain how these findings were used to design behavior change communication elements of newborn care programs. In-depth interviews and focus group discussions regarding newborn care practices were conducted with mothers, mothers-in-law, delivery attendants, health care providers, husbands/fathers, male and female community leaders, religious leaders and elderly influential persons between 2002-2003 in three countries supported by Save the Children's Saving Newborn Lives program. Key findings from each country are summarized according to time periods and care-seeking practices: antenatal care, birth and emergency preparedness/care-seeking, postnatal care and care-seeking for newborn illness. All country reports indicated cultural and religious barriers to seeking care as well as limited societal knowledge about the importance of care-seeking and recognition of maternal and newborn danger signs. Routine care-seeking, especially during the postnatal period, was universally low. When families did seek care, they preferred remedies from traditional healers rather than skilled health workers because of cultural and religious beliefs, poor access to health facilities, and financial barriers. Findings from the country reports were used to design behavior change communication strategies that addressed the underlying reasons why newborn care practices were sub-optimal. Cultural and religious barriers, though strong, were not insurmountable in implementing effective behavior change communication strategies. Formative research from South Asian countries has proved crucial to program approaches to improve care-seeking for maternal and newborn care, increasing availability and access of key services, and expanding family and community knowledge and demand for these services.