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CM10.3 | CM10.3 | Pregnancy, Childbirth and Feeding Practices — SDL Guide (Part 3)
Counselling and Community-Level Behaviour Change
Effective modification of harmful traditional practices requires a structured, multi-level approach that combines individual counselling with community norm change. At the individual level, the ANM or ASHA uses interpersonal communication (IPC) during ANC visits: the counsellor assesses current beliefs, identifies the specific practices present in that household, validates the cultural meaning behind them, and proposes a negotiated modification that the family can accept. A useful framework is GATHER (Greet, Ask, Tell, Help, Explain, Return) — used by family planning counsellors but applicable to all behaviour change conversations. At the household level, the counsellor must engage the decision-maker, not just the pregnant woman: the mother-in-law or elder female in the household often has greater authority over dietary and delivery decisions than the woman herself. Including family members in ANC education sessions dramatically improves practice change. At the community level, village health and nutrition days (VHNDs) at the Anganwadi Centre provide a platform for group education: they reach multiple families simultaneously, allow peer sharing of positive experiences, and reduce the social cost of deviating from tradition (because when multiple families change together, the change becomes the new norm). Trained traditional birth attendants (TBAs): rather than simply prohibiting dai practice, many programmes train dais in clean delivery technique, recognition of danger signs, and referral pathways — converting them from a source of harm into the first link in the referral chain. This aligns with the inclusion principle in community health: work with community influencers rather than against them. Key programmes supporting behaviour change in this domain include the MAA programme for breastfeeding, POSHAN Abhiyaan for nutrition, and the ASHA Incentive Scheme for institutional delivery promotion.
SELF-CHECK
India's NFHS-5 reports an early initiation of breastfeeding rate of 41.8%. Which of the following BEST explains why this rate is low despite decades of counselling?
A. Lactation physiologically fails in a large proportion of Indian women
B. Institutional deliveries have replaced home deliveries, where initiation was easier
C. Social norms favouring colostrum denial and prelacteal feeding persist, reinforced by elder family members and traditional birth attendants
D. ANMs are not trained in lactation support and cannot assist early initiation
Reveal Answer
Answer: C. Social norms favouring colostrum denial and prelacteal feeding persist, reinforced by elder family members and traditional birth attendants
Social norms — particularly the belief that colostrum is 'dirty' and the practice of giving prelacteal feeds (honey, sugar water) before the first breastfeed — are the primary driver of low early initiation rates in India. These norms are maintained by elder authority (mothers-in-law) and, historically, by traditional birth attendants who advised against colostrum. Lactation failure is physiologically rare. Institutional delivery, if anything, provides an opportunity for facility staff to support early initiation — the gap there is more about staff motivation and workload than about delivery location per se.