The research

The 1996-1998 research indicated that some existing practices are good, some are harmless, others harmful. The idea of Spandana is to promote good practices, to leave harmless practices untouched, and to change harmful behaviour. They do this mainly by providing honest and full information to participants in the project, so that they can make their own choices (informed choice). Some examples can clarify this approach.

The research indicated that after delivery women are believed to be in hasi may, i.e. to have a vulnerable body. In this vulnerable period, ideally lasting three months, women and their children receive a great deal of extra care such as extra energy rich food and rest in a special warm place. Mother and child stay together from birth. This is a good practice and is promoted by Spandana. Women stay in a warm place and keep their bodies warm by taking a hot bath, massages and also by wearing scarves around their heads to protect themselves against the cold and the wind. This custom can be considered to be rather harmless, but its usefulness may be questioned in the biomedical model. The practice is simply left untouched. However, being in hasi may also means, in the eyes of the community, that women and children are considered to be extremely vulnerable to evil spirits. Sometimes this is a reason for parents (women give birth in their homes, a good practice) not to send their daughters to the health services if they are ill after delivery: they could be affected by evil spirits while travelling to the hospital. In an earlier study in 1992, one woman indeed died because her parents did not want her to visit the hospital. Spandana tries to change this behaviour and provides the message that it is very important, in the event of problems, to go to the hospital. But what to do about the evil spirits, then? After long internal discussions, we decided to apply a locally well-known and accepted custom to ward off evil spirits: if women - or rather elders in the family - believe in evil spirits, women could keep a small lemon (nimbu) in their hands to protect themselves.

These examples indicate that while formulating the messages for the intervention, existing practices and perceptions as indicated in the research - are compared with the biomedical model. The final messages, the flashcards and scripts are thus a mixture of the existing behaviour and perceptions of the villagers and information from the biomedical (western) model