For those us working in social and behavior change communication (SBCC), we have seen time and time again that access to care, products, or services does not necessarily translate to their use.
We know that access alone cannot overcome the many factors such as family, custom, community, media and/or religion that influence an individual’s behavior. This gap in access and use is especially the case in Nigeria, where data show net ownership does not often translate to net use. It’s time to personalize this data; this is why I want to share the story of Mrs. Agatha Udeme Silas, and the power of interpersonal communication.
In early 2015, Mrs. Silas, a trader living in the small community of Ntoh Udoh Ewan in Akwa Ibom State, Nigeria, learned she was pregnant with her fourth child. Despite the fact that she has access to the community health center and even delivered her first three births in a hospital, Mrs. Silas decided to deliver this particular pregnancy using a traditional birth attendant and was determined not to attend antenatal care (ANC) sessions. This decision was based on the predominant custom in her community, where women take herbs during pregnancy and deliver their babies through traditional birth attendants. Mrs. Silas was eventually influenced by her community to practice this custom and her decision – a decision she made just at the onset of her pregnancy – was further reinforced by her mother and fellow traders.
“…they normally tell me that it is better to give birth at home than in the hospital, that they would give me some roots that would help me, that is why I decided not to give birth at the hospital.” – Mrs. Silas
With this decision and without the watch of health providers, Mrs. Silas became quite sick early in her pregnancy. Like many people in her community, she hadn’t been told about the importance of ANC, so she resorted to taking herbs as the treatment for her fever. However, her health did not get better –in fact, it got worse. Even at this point, Mrs. Silas did not visit the health center but started praying in the local church for better health.
Fortunately, six months into her pregnancy, Mrs. Silas encountered Theresa Peters at the local church. Theresa, a community volunteer with the President’s Malaria Initiative (PMI) and the Health Communication Capacity Collaborative (HC3) Nigeria Malaria Project explained the benefits of ANC to Mrs. Silas. Mrs. Silas was motivated by Theresa’s recommendations and immediately went to the health facility, where she was tested, diagnosed and treated for severe malaria. Moved by her visible improvement in her health, she decided to attend ANC throughout the rest of her pregnancy.
She eventually gave birth to a healthy set of twins.
Inappropriate health care seeking behavior has exposed many people to health risks such as miscarriages, severe malaria and even loss of life. The story of Mrs. Silas is just one of many from the community volunteer work around health care seeking. With well over 900 community volunteers in across several states in Nigeria, PMI through HC3 is conducting face-to-face conversations to address these gaps between access and use through one-on-one and small group discussions to promote appropriate health seeking behaviors.
I feel moved to share Mrs. Silas’ story because many people around the world are in her situation. I believe it is our duty in the SBCC community to continue to reach out to these communities and their members just like HC3 did through the work of Theresa Peters.
Are you using SBCC to address barriers that exist on the community, state, or national level? We would be glad to hear the many successes that SBCC is recording in various parts of the world. Join us on Springboard and share your stories with us.