Exploring Maternal and Child Health in South Sudan

This 2-page summary shares findings of research to inform a series of radio programmes designed to improve reproductive, maternal, neonatal, and child health (RMNCH) in South Sudan. The project is working to encourage changes in knowledge, attitudes, norms, self-efficacy, and societal support around key health issues prioritised by government and civil society as critical for saving the lives of women, newborn babies, and children. Led by BBC Media Action, with funding from the United Kingdom's Department for International Development (DFID), the project will produce radio programming, coupled with community outreach work and training for local language partner stations and non-governmental/government partners.

According to the research brief, South Sudan has one of the worst rates of maternal mortality in the world. Young women in the country are three times more likely to die in childbirth than they are to complete eight years of basic education.

The research was intended to help understand existing levels of knowledge, beliefs, and social norms around RMNCH behaviours, as well as the barriers and enablers that affect the adoption of recommended health behaviours. Nineteen focus group discussions were carried out with women of child-bearing age, traditional birth attendants (TBAs), and older women between 40-60 years old; 23 interviews with six categories of participants including husbands, community health workers, hospital or health centre staff, male opinion formers, female opinion formers, and government directors for health were also conducted.

The research found that in many cases, women had knowledge and awareness of healthy practices but did not always fully understand what was beneficial about these practices. Additionally, women and their families did not always act on health advice from health workers or health communications if the information went against social or family norms. The majority of women who were or had been pregnant knew that they should attend some form of antenatal care (ANC) more than once. However, they were not clear about what ANC really entailed. Many women felt they were unable to plan regular ANC check-ups due to responsibilities at home and lack of money. The importance of delivering in a health facility or seeking a midwife for delivery did not resonate with some women and their families, even if a health worker had told them that it was important for them to do so. Many pregnant women reported that they would only go to a health facility if complications arose at their delivery. Most participants cited a lack of money or savings as a key barrier preventing them from accessing health services or preparing for birth. As husbands are the key decision makers on whether a woman will be able to buy new things or pay for transport to access services, women often reported that their RMNCH practices depended on the financial status and choices of the father.

Women of child-bearing age often felt that they were not able to carry out recommended health behaviours because they were not practical. For example, women of all ages showed a high level of awareness about breastfeeding a baby very soon after birth, and about half of the women knew that it was recommended that babies should be breastfed exclusively for the first months of their lives. However, they also reported issues such as delays producing or insufficient breast milk, which meant they supplemented by feeding the baby sugar or salt water and porridge. Women were not aware of methods to overcome breastfeeding issues and did not feel that supplementary feeding would harm the baby.

Research findings also point to big differences between RMNCH practices in rural and urban locations, whilst tribal influences also affected practices from region to region. The strength and traditions of a husband's tribal heritage were also reported as the deciding factor around what traditional practices would be carried out around a birth. Participants felt that women in all urban areas are much more likely to seek formal health care and deliver in a health facility than their rural counterparts.

In terms of programme implications, the research concluded that local norms, beliefs, attitudes, and practical realities are far more likely to influence a woman's maternal and child health behaviours than health advice she had been given. Therefore, the importance of and reasons behind carrying out healthy behaviours should be emphasised to encourage uptake. As RMNCH practices and norms vary so much from region to region, radio content should be tailored to the local context and delivered in local languages. As older community and family members, especially husbands, have a huge influence on a mother's maternal health, programming also needs to focus on these groups. Financial and social barriers to improved health practices should also be addressed by programming. For example, if the programme is recommending that pregnant women attend four ANC check-ups, it should also address how a family can save for and plan for the visits.