DISH II PROJECT SAFE MOTHERHOOD STRATEGY
PREPARED 1 - 2 MARCH 2001

COMMUNICATION AND PROMOTIONAL STRATEGIES

There will be three audiences for communication messages. Each will have slightly different messages, approaches and media materials. The strategies are described for each audience.

Audience # 1: Women aged 18-35 living in rural areas of DISH II districts

Objective: To increase awareness of the risks involved during pregnancy

and the puerperium and the importance of having birth preparedness plans.

Key promise: If you know the risks involved in childbearing and have a birth preparedness plan, you will have a safer delivery and will be more likely to have a healthy baby.

Message points:

• Description of services to expect during ANC, PNC and delivery at a health facility.

• Risks during pregnancy, labour and delivery and during postpartum period:

Pregnancy:

1. Antepartum hemorrhage (bleeding)
2. Anaemia
3. Malaria
4. Pre-eclampsia
5. Ectopic pregnancy
6. STDS/HIV
7. Miscarriage
8. Premature birth

Labour & Delivery:

1. Obstructed labour
2. Eclampsia
3. Bleeding (hemorrhage)
4. Ruptured uterus
5. Still birth
6. Malpresentation

Postpartum:

1. Bleeding
2. Infection
3. Retained placenta
4. Fistulas or prolapse
5. Mastitis
6. Problems with baby (e.g syphilis, gonococcal eye infection, respiratory tract infection, jaundice, UTI, low birth weight/prematurity)

• When delivered in a health facility, some problems with newborns can be corrected early.
• Locations of ANC, PNC, delivery assistance (rainbow over the yellow flower for ANC and PNC)
• Importance of postnatal care, especially during the first week.
• Danger signs during pregnancy, delivery, postnatal period
• Danger signs for new born babies
• Describe a birth preparedness plan and how to make one.
• Address misconceptions that stop women from using services:
• Crossing roads, standing in doorways, sitting where another has been sitting does not affect pregnancy
• Reassure that privacy and confidentiality is maintained at health facilities
• Infertility, miscarriage and difficult labour are not the result of infidelity. Explain possible causes of miscarriage and difficult labour.
• When delivering at a health facility, you can tell the health provider how you would like to dispose of the placenta.
• Preparing for the baby before birth will not adversely affect the child. Use testimonies from couples who have prepared for childbirth.
• Generally speaking, it is not a good practice to drink or eat or take herbal pessaries/mixtures during pregnancy, labour or delivery or to give them to babies. They can cause premature labour, ruptured uterus and diarrhea. Babies can be born asphyxiated.
• Health providers are well-trained in maternity care and are concerned about the mother’s and baby’s health.
• Health facilities that provide delivery assistance are equipped to handle most obstetric emergencies and the midwives and doctors have been trained to do so. They know when it is beyond their capability and where to refer.
• Feel free to ask questions and discuss your pregnancy with the health provider. They will listen to you and help you.
• Communication with your husband about your pregnancy not only when you need something.

Media and Materials:

• Copies of RH IEC Working Group borchures about safe motherhood for distribution.
• Radio spots on:
• Risks of pregnancy, labour & delivery, postpartum period
• Birth preparedness planning
• Services available when delivering at a health facility; the advantages of delivering at a health facility
• Drama script for use by districts
• Health Matters issue on safe motherhood (including a list of facilities with delivery assistance
• Messages on "Olujegere Lw’obulamu" and "Orujegyere Rw’amagara" radio programmes
• Poster and calendar
• "Nze N’owange" community radio programmes (add Runyankole programme on Radio West)
• Birth preparedness plans for use with clients adapted from RCQHC and translated to vernacular

Audience # 2: Rural men 20-45 years old and older women 50 years and older living in DISH II districts.

Communication objective: To convince the audience of the importance of antenatal care (ANC), delivery at health facilities and postnatal care (PNC), and developing a birth preparedness plan together with their pregnant wives/daughters.

Key promise: If you ensure that women attend antenatal care, deliver at health facilities, go for postnatal care, and prepare plans for childbirth, you will be protecting the lives of your women/daughters and their children.

Message points:

• Services have improved now. Things have changed. Providers are better trained and facilities are better equipped.

• Describe antenatal, delivery and postnatal services.

• Delivering at health facilities is safer than delivering at home.

• Describe a birth preparedness plan and why it is important.

• Danger signs during pregnancy, labour, and postpartum period.

• Danger signs in new born babies

• Risks during childbirth, pregnancy and postnatal period.

• Locations of antenatal, postnatal and delivery services (antenatal and postnatal care available where you se the rainbow over the yellow flower).

• Health workers are well trained and concerned about the woman and her baby. You can rely on them to take good care of her.

• Men should discuss pregnancy and childbirth with their wives and provide emotional support.

• Testimonies from couples who made plans and followed them.

• Counter misconceptions as for women

• There is no medical reason to restrict some foods during pregnancy. Fish, eggs and salt plus chicken can be safely eaten during pregnancy.

• Generally speaking, pregnant women, women in labour and new born babies should not be given herbs to eat. Women should not be given herbal pessaries. They can cause premature labour, ruptured uterus or diarrhea. Babies can be born asphyxiated.

Media and Materials:

• DISH centerpiece TV programme(s) translated to vernacular
• Identify other videos including "Three Visits" that can be shown in communities
• Health Matters issue on safe motherhood, including the role of the father, aunties, and mothers in law
• "Olujegere Lw’obulamu" and "Orujegyere Rw’amagara" radio programme episodes
• Radio spots for men and mothers-in-law
• Identify radio talk shows for men and incorporate safe motherhood messages

Audience # 3: Health providers offering maternal health services in

Objective: To increase the proportion of health providers who offer "client friendly" maternal health services and assists ANC clients prepare birth plans.

Key promise: If you offer "client friendly" maternal health services and assist ANC clients prepare birth plans, you will be respected, recognized and appreciated by the community and your superiors.

Message points:

• Qualities of client friendly services:

• Waiting time less than 1 hour.

• Emergencies attended to immediately

• Observes infection prevention

• Encourage client questions

• Ensures privacy and confidentiality

• Provides correct and updated information about pregnancy, labour and delivery

• Treats clients and respectfully regardless of clothing, culture, level of education.

• Understands local cultural practices and adapts services as much as possible (e.g. delivery position, placenta-to-go).

• Welcomes husband and relatives during delivery

• Clean facility

• Open 24 hours/days, 7 days/week.

• Why and how should providers get feedback about services from the communities they serve.

• Benefits of and how to prepare birth plans with all ANC clients.

• The dangers to the mother during the first 6 hours and first 6 days after childbearing; and the need for postnatal care.

• Testimonies from satisfied clients.

• Examples of places that provide client-friendly services.

• Location for emergency obstetric (EOC) referrals

• How to plan for emergency transportation.

Media and Materials

• Self-instructional materials for use during training and support-supervision on: 1) client friendly maternal health services, and 2) birth preparedness planning. Certification upon completion.
• Desk/table chart reminding providers about client-friendly maternal health services
• Provider magazine or newsletter
• Lists of facilities offering delivery assistance and emergency obstetric care in each district for posting in health facilities
• "I care about you" badges for providers
• In each district, work with 2 health facilities—one level 3 and one level 4 health centre to get community perspective of maternal health services and rearrange services to be more client friendly. Document process and share with other health facilities
• Beginning with these model "client friendly" services, train Community Resource Persons (CORPS) and PDCs to do birth preparedness planning follow-up with clients
• Organize regular reproductive health outreaches that include birth preparedness planning and other antenatal services.

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