S URANGANI A BEYESEKERA, C OMMUNICATION FOR D EVELOPMENT S
PECIALIST UNICEF G HANA Identifying and addressing norms to improve
Exclusive Breastfeeding practices in Ghana
Slide 2
T HE C HALLENGE Exclusive Breastfeeding (EBF) continues to be a
challenge in Ghana. 87% of respondents in a KAP study says that
breast milk is the best food for children But less than 50%
actually practice EBF Many new born children are given water,
gripe-water and honey and sometimes even pap These practices are
steeped in many factual beliefs
Slide 3
F ACTUAL B ELIEFS Colostrum is toxic and can poison the baby If
a baby boy is breastfed with the first 7days the woman will not
conceive again Infants need to be given water or else they become
mean when they grow up and will not take care of the parents
Exclusive breastfeeding is difficult and unrealistic Breast milk
alone will not satisfy the baby. Baby will sleep better if given
other foods. Children who are exclusively breastfed have difficulty
in accepting complimentary food
Slide 4
O N E XCLUSIVE BREAST FEEDING & COLOSTRUM New mothers would
like to EBF But, the action is interdependent Huge influence by the
MIL Empirical expectations on the new mother All new mothers Obey
their MIL Normative Expectations on the NM The NM believes that
every one thinks she should obey the MIL
Slide 5
T HE MOTHER - IN - LAW New Mothers deliver at home Then it is
both an empirical and normative expectation MIL makes decisions
about the child
Slide 6
W HAT A FATHER SAYS We live with our parents and wives in the
same compound and according to our tradition the elderly of the
family is the care taker of our children and family health issues.
These care takers are the barrier to practicing Exclusive
Breastfeeding. A father in Gburumani in the Tolan District of
Northern Ghana who has observed the influence of family on his wife
and the infant feeding practices.
Slide 7
W HO IS SHE ?
Slide 8
Q UEEN MOTHER The Queen Mother (QM) plays a pivotal role in
Ghanaian communities Is usually the Chiefs mother or sister She is
the custodian of the stool (throne) and all customs and traditions
related to births, puberty, marriage, funerals, widowhood,
enstoolment, destoolment etc. She has the first say in choosing a
new Chief She is the main advisor to the Chief and sits on the
right hand of the Chief She is consulted on important decisions
concerning to community or the kingdom A hierarchy of QMs exists
based on the traditional groups they belong to;
Slide 9
QUEEN MOTHER Traditional Leader New Mother Mother in law Grand
mother Husband Religious leader New mothers peer Health worker B
ROAD SOCIAL NETWORK OF A NEW MOTHER
Slide 10
W HAT ARE THE RELATIONSHIPS Queen Mother The Most Central and
Highest degree node/ individual in the communit y Mother-in-law
Strongest influence on the NM as she has the strongest tie Husband
and the Grandmother Ties are strong but less than the MIL, but
exerts influenc e Many other individuals Ties not so strong but
influence still exists with TL, RL, HW, Peers
Slide 11
W HAT HAS BEEN DONE SO FAR AND SOME ? The work been done has
resulted in high levels of awareness . but does not translate to
practice (or not enough) We may have not worked with the most
central or highest degree nodes (working with the HW) Did we try to
change one of the scripts of the NM? Without considering the
interdependence of the action of EBF did we not consider the
possible emotional and physical sanctions against the NM? Did we
not look at the need for the new mother to conform to her MILs
expectations her need to be liked (normative influence of the MIL).
Did we miss the issue of social proof the need to conform to what
others are doing if it is good for everyone else then why should I
not do so too?
Slide 12
W HAT WILL WE DO DIFFERENT ? Move from focusing on individual
behaviour to collective behaviour while keeping in mind the
interdependence of the behaviour (Social convention theory) By
looking at the individuals / nodes that have most influence on the
NM and then see who we need to engage with to create a dialogue.
Who influences the new mother? Who influences the MIL or the Grand
mother? Can we then through this discourse / dialogue address the
pluralistic ignorance that exist? I dont think that colostrum is
bad for the baby, but as I believe that everyone else does then I
will do so too
Slide 13
W HAT WILL WE DO DIFFERENT ? We need to address the factual
beliefs By providing them with alternatives and by providing the
MIL or the grandmother with correct information from a credible
source (to the MIL) Start working with the Queen Mother in a
concerted way (to reduce suspicion of the new information) As the
MIL/ grandmother would want to seek social proof from the QM for
their behaviour and thereby conform the to expectation of the
QM
Slide 14
W HAT WILL WE DO DIFFERENT ? Look at power expressions in
relation to the new mother. Power within and Power to to empower
the new mother and help her build her self esteem and self
efficacy. Provide her with the necessary information, tools and
supportive mechanisms so that she can influence decisions
particularly in relation to the health or on whats good for their
baby
Slide 15
W HAT WILL WE CONTINUE TO DO ? We will continue to work with
the Ghana Community Radio Network to continue to engage different
types of individuals in the deliberations. Due to the format used
by Community Radio it is hoped that organised diffusion will
happen. Will also continue the IPC work being done by Ghana Health
Services and the NGOs. Will also continue to work with national and
regional media
Slide 16
I N CONCLUSION Much information is available on KAP related to
Infant and Young Child Feeding There is a need for more detailed
understanding on relationships and expectations and norms that
exists in Ghanaian culture. The study is also expected to provide
us with a baseline for future measurement of changes of norms.
Through this knowledge we hope to target better our interventions
and start converting this high levels of knowledge to
practice.