Behavior Change: Critical for Newborn Survival

The following piece is part of a series highlighting Global Perinatal Health. Originally posted in the Bill & Melinda Gates Foundation blog, re-posted with permission. 

There’s plenty of evidence that simple and affordable interventions can save newborn lives. So why haven’t we been able to translate this knowledge more effectively into gains in newborn survival?

A critical problem is getting people to change their behavior. In order for any community-based health intervention to be successful, families and communities must transition to new behaviors.

Is there a science or method for enabling a smooth and sustained transition? Where are we falling short in our current efforts towards improving newborn survival? Are there insights from other disciplines that we can integrate into our current understanding of behavior change?

These were some of the questions that besieged my colleagues and me as we designed an essential newborn care intervention package for a rural Indian community in 2004, and continue to challenge us even today.

Our recently published paper "Behavior change for newborn survival in resource-poor community settings: bridging the gap between evidence and impact” in Seminars in Perinatology discusses the importance of behavior change for newborn survival and presents the “Behavior Change Management” framework that we developed for addressing this issue.

The first realization as we examined prior literature on behavior change was that most of the theories and models were based on experiences in the developed world with behaviors related to lifestyle or addiction, such as diet, smoking, and sexual behaviors. However, newborn care behaviors in traditional community settings are unique in several fundamental ways, and require a rethinking in order to make behavior change interventions effective. In our paper, we outline key differences between lifestyle-related behaviors and newborn care behaviors, along with their implications for behavior change interventions for newborn care.

Another common assumption is that giving people information will lead to desired changes in behavior. A low literacy rate does not mean that communities are ”empty cups” that can be filled with new knowledge. In fact, they have been extensively schooled, but in a completely different way; their education is based on traditional knowledge and practices handed down over centuries by word-of-mouth. Ignoring this reality is a recipe for failure. The socio-cultural context and worldview of communities has to be very carefully integrated into the design of behavior change interventions.

There could be many approaches to enable people to change their behavior with different degrees of success. We began by listening intently to the community's needs, just as a business consultant would pay attention to a client's requirements in order to customize a solution for them. We then drew upon lessons from the fields of epidemiology, behavioral science, organisational behavior and change management in order to develop the Behavior Change Management framework.

The framework was successfully applied in the Shivgarh trial, where it led to a 54 percent reduction in the newborn death rate over a 16-month intervention period.

Related articles:

Kumar V, Kumar A, Darmstadt GL: Behavior change for newborn survival in resource-poor community settings: bridging the gap between evidence and impact.Semin Perinatol 34:446-461, 2010.