Successful Behavior Change Communication Process to Reduce Postpartum Alcohol Intake

Introduction

"Behavior Change Communication (BCC)" or “Social and behavior change communication (SBCC)”, or also referred as "Communication for Development (C4D)" is based on proven theories and models of behavior change. BCC is an interactive process using communication strategically to promote positive health outcomes through positive behavior changes [1, 2].

Breastfeeding and breast milk provide benefits beyond nutrition that are unparalleled by any infant formula. Historically alcohol use has been promoted in Breastfeeding [3]. Alcohol levels in the breast milk are similar to the blood alcohol levels of the mother at the time of feeding [4]. World Health Organization (2001) [5] had shown that the benefits of breastfeeding outweigh the risks of an occasional drink of alcohol. The levels of awareness about alcohol use and lactation is low [6].

Results

The mean age of the mother at birth of the first child was 23.8 years in the pre-intervention sample. There were seventy-three primi gravid and age of the mother at birth of the first child was 23.9 years in the post- intervention sample. There was no significant difference of the mean age at the first birth in the two samples (p = 0.43) (Tables 1-6). Other than the income level of the post-partum mothers there was no significant difference of the two samples taken at the Assessment (pre intervention).

is no significant difference in outcome of delivery in the two samples (p=0.55)

A self-administered questionnaire was given to a sample of randomly selected postnatal ward staff. There were 60 participants each at the pre-intervention and post-intervention stages. From the government sector there were 7 medical officers, 12 nursing officers / nursing sisters and 21 midwives (Table 5). From the plantations, 20 plantation midwives were selected in the pre and post-intervention samples. In the pre- intervention sample, 23.3% were with less than 5 years’ experience and 76.7 % with more than 5 years’ experience.. In the post-intervention sample, there were 20.0% with less than five years’ experience and 80.0% with more than 5 years of service experience. At the Action Research stage all staff in the selected hospitals was given a behavior Change Communication on prevention of alcohol on the postpartum period.

63.2% in the pre-intervention sample had taken alcohol during the postnatal period. In the focus group discussions following reasons were identified for postpartum alcohol intake. At the action research stage following were elicited through qualitative data collecting techniques.

“Alcohol was given as a medicine.” “A table spoon or two for mother’s tummy aches, the wound in the stomach heels and if mother takes before breast feeding it would be helpful for neonate’s tummy aches, alcohol was given when mother is given chicken, when she takes a bath to avoid catching the cold, as a stimulant for letting down the milk and given when the mother seems to be sad or unhappy”.

Discussion

Traditionally, the postpartum period is supposed to end at six weeks after birth. Research on postpartum period is very scanty (WHO 1998a). This research focused on the response of a health care system to the needs and challenges of the postpartum period in a multiethnic and multicultural society, “the plantation population in Badulla District”. The “Plantation population” in Sri Lanka is considered underprivileged, according to their socio economic background The DHS 2016 shows that: percentage of Households with improved source of drinking water by residence 99% urban 91% rural and only 43% in estates(plantation) (DHS 2016), Households with no electricity 1.3% urban 3.3% Rural, and in 4.% estates (plantation). Residence by Lowest quintile urban 7.6% rural 19.8% and in the estate (plantation) it is 70.8%. DHS (2016) No schooling: urban 2.6% rural 4% estate plantation 14.5%. These DHS indicators in 2016 (The last DHS survey in Sri Lanka) shows that the plantation sector is still deprived in Sri Lanka.

The study design was a-static group comparison design (cross-sectional study) and took the form of “Before-after study”. Such a study design is considered as a “pre-experimental” design rather than a quasi- experimental because neither control group nor randomization is practiced. Pre-test is being the “before” or “pre-intervention” and post-test is being the “after” or “post-intervention”.

The immediate postpartum period: is the period 6 to 24 hours after delivery, the period in which the mother is usually expected to be in a maternity ward under ward staff care.

Socio – demographic factors of the postpartum plantation mother: There was no significant difference of the 452 postpartum mothers who participated at the pre- intervention stage and the 205 mothers who participated at the post-intervention stage in regard to socio demographic factors. The only difference was the economic condition which can be contributed to the pruning season where the labor force is curtailed to the minimum. Majority of mothers in the study were Indian Tamils by ethnicity and Hindu by religion. Age of the mothers who participated in the study varied from 17 to 44 years. The mean age of the mother at birth of the first child was around 23 years which is almost equal to the Demographic Health Survey (DHS 2016) which was 23.7 Extended families in this study were 59.3% in the assessment stage and 64.1% in the evaluation stage, but it was only 31% for the DHS (2000) survey. The difference may be attributed to the fact that this study covers the postpartum period of the mother and, it is well observed traditionally that the maximum family support is given during this period.

It is a well-accepted fact that educating a woman would reap high returns when it effects on family welfare, particularly on the health and nutritional levels of children are taken in to consideration. In the assessment and evaluation stage, 11.7% and 9.3% plantation postpartum mothers have never attended school. This figure is DHS (2016) 14.5 %. The alarming finding in this study is that 27.7% from the pre-intervention sample and 22.3% from the post intervention sample could not read at all the daily newspaper given in their language, and only 42.5% and 45.6%of the plantation postpartum mothers in the two samples, respectively, could read the paper easily only. In the DHS 2016 it was even lower only 38.9% in the estate/plantation could read a whole sentence. This low literacy rate of the plantation community urges paying more attention to this fact in planning health interventions and providing special care to the plantation mother.

DHS 2016 shows that plantation estate population consume alcohol more than their counterparts Urban 34.6% Rural 37.4% estate 44.9% drink alcohol. Habits of the plantation mother are also culturally influenced. In the focus group, discussions with community leaders and in-depth interviews with a mother and a grandmother showed facts regarding taking alcohol during postpartum period are a cultural practice with the estate community. Majority (63.4%) of the postpartum mothers in the study population had taken alcohol. In the literature, it has been documented that this habit of taking alcohol by postpartum mother is prevalent in other communities [7, 8]. Routine obstetric care often does not identify these women. In the action research stage ward staff were trained in Behavior Change Communication (BCC) and made aware to speak with the postnatal mother regarding the negative effects of alcohol on a neonate’s brain. The message has been well conveyed, as it was observed in the evaluation that only 19.4% had taken alcohol in the postnatal period after the intervention with a significant improvement. Only 58.5% ward staff in the pre- intervention sample advised plantation mother not to take alcohol in the postpartum period. It significantly improved to 95% after the intervention. After the intervention ward staff advising mothers in the plantation not to take alcohol significantly improved (P<0.001) [9, 10]. However, a study has indicated that lactating women, who were either encouraged to drink or received no advice at all about alcohol, reported drinking significantly more than the women who were advised not to drink. A hundred different customs, some beneficial but some harmful, are at work. Implanting scientific ideas in non-scientific cultures meets with resistance. All who work in primary health care must seek to understand peoples' beliefs about the causation of disease and its cure. The basic elements of social anthropology and Behavior Change Communication must be inculcated in their training programs so that those who work in the health service can do so with empathy. Moreover, success often depends upon modifications outside the purely medical field so that knowledge of the community in a wider sense is needed. The community should be studied for its folk medicine, economics, family structure, politics and religion, and for its systems of value and prestige. "Behavior Change Communication (BCC)" or “Social and behavior change communication (SBCC) or "Communication for Development (C4D), can be used as the vehicle for this community empowerment.

Conclusion

This study shows that Behaviour Change Communication process (BCC) can significantly reduce alcohol use of plantation postpartum mothers, which will improve the health of the plantation mother and the child.

Acknowledgement

Dr. I. Hettiarachi (Earlier Director PHDT), Director and staff at the PHDT Badulla and, all Managers and Midwives in the plantations during data collection my data collectors Dr Velaudan and Mrs. Munaweera (RSPHNO), All who participated in the study.