Bill & Melinda Gates Foundation

Ruchi’s Story: Breaking Social Norms to Save Newborn Lives

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April 01, 2013

To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together.  

Each of us in our own communities is guided by social norms—those understood beliefs that tell us how to behave. And, depending on the norm and the community, if you buck the system and go against those norms, there may be reactions as inconsequential as a disapproving glance or as devastating as being expelled from your family or community. Being bold enough to break with social norms could be as simple as jay-walking in Seattle (where we all obey traffic signals, even on foot) or giving a friendly hello to a stranger on the streets of South Boston.

Or, on another side of the world, it could be holding a newborn baby.

Ruchi is a community health worker with the Saksham project run by Community Empowerment Lab in Uttar Pradesh, India. Inspired  by her mother, who was a pioneer in her own right in venturing outside her home and village to become a midwife, Ruchi decided to become a community health worker to bring new knowledge to and work for the betterment of, her community. She works in a small traditional village with well-defined social norms. These community members initially were resistant to change and looked at her with suspicion when she first arrived.

 Seeing the condition of the baby deteriorate further, though, Ruchi sprang into action and held the baby in skin-to-skin position

One area of focus of Ruchi’s training and expertise is essential newborn care and working with families and communities to negotiate and teach skills needed to improve newborn care behaviors.

But it was one incident with a newborn that changed everything.

Ruchi reached the home of a newborn within a few hours of birth and found the mother unconscious and the baby cold. The traditional cord-cutter, a low-caste woman whose job is to cut the newborn’s umbilical cord and clean up the “pollution” from childbirth,  had arrived earlier, and after cutting the cord, had bathed the baby right away - which is not recommended as it can lead to hypothermia - and wrapped it in a thin cloth. Even after Ruchi warmed the room and wrapped the baby with warmer clothes, he continued to turn blue and become more lethargic.

Seeing the baby’s condition worsen and the mother unconscious, Ruchi requested the baby’s aunt to give skin-to-skin care to the baby. But the aunt refused, fearing that the evil spirit that she thought was gripping the baby would take over her as well if she held the baby. No family member was willing to touch the baby.

Ruchi realized that the baby would die without more drastic intervention, and decided to give her skin-to-skin care herself.

The decision wasn’t easy; she would be breaking social norms – she was unmarried, this was a foreign practice in the community, and she could face the wrath of her parents and ridicule from her relatives if they came to know about it.

Seeing the condition of the baby deteriorate further, though, Ruchi sprang into action and held the baby in skin-to-skin position. After some time, the baby began to show signs of recovery: she began to turn pink and felt warmer. Ruchi monitored the baby’s temperature with a thermometer, providing additional evidence that the baby’s condition was improving.

Ruchi’s conviction and her efforts saved the baby’s life.

This incident left a lasting impression on the community. They not only realized the benefits of the intervention and skin-to-skin contact, but admired Ruchi for her courage and conviction to break with social norms.

In this case, being willing to take a huge risk and break with norms to do what is physically right but not culturally acceptable up that point in time saved the life of this baby and started the change of social norms. Word spread about the power of skin-to-skin care to save newborn lives, and women from throughout the community began to seek to become empowered through learning to provide it to their newborns.

Change can happen when it comes from within the community.

As we prepare for the Global Newborn Health Conference in South Africa in mid-April, we must remember the vital importance of social norms when we talk about newborn health.

You can help imrove newborn health around the world. Please join my team at Catapult.org. A project in Sierra Leone is building birth waiting homes to ensure moms and newborns get the best available care in those critical hours of delivery.

 
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