Page 1 CARE, SHARE, and PREPARE are the watchwords of SUMATA, a unique safe motherhood communication initiative in Nepal, where maternal mortality is the leading cause of death for women of reproductive age. SUMATA is aimed at husbands and mothers-in-law, the key decision-makers in the reproductive health choices of women in Nepal. According to the 1996 Nepal Family Health Survey (NFHS), 539 women die for every 100,000 babies born. This national safe motherhood communication initiative increased awareness of danger signs associated with complications of pregnancy and childbirth and increased birth preparedness to save women’s lives. The initiative— launched on March 8, 2002 in Nepal by the National Health Education, Information and Communication Center (NHEICC)—resulted from a highly participatory process that included the key safe motherhood stakeholders in Nepal. Stakeholders included the Maternal and Neonatal Health (MNH) Program, which is supported by the U.S. Agency for International Development (USAID). Building Partnerships to Save Mothers: Nepal’s SUMATA Initiative Mobilizing for AUGUST 2004 To learn more about this project contact: Diane Summers Nepal Country Representative, CCP [email protected] or Caroline Jacoby Program Officer, CCP [email protected] or Suruchi Sood Senior Program Evaluation Officer, CCP [email protected]. Community women watch one of more than 100 street theater troupes that are part of Nepal’s SUMATA Initiative. A street drama promoting husband and mother-in-law responsibility during pregnancy and childbirth is part of Nepal’s SUMATA Initiative.
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CARE, SHARE, and PREPARE are thewatchwords of SUMATA, a unique safe
motherhood communication initiative inNepal, where maternal mortality is the
leading cause of death for women of
reproductive age. SUMATA is aimed athusbands and mothers-in-law, the key
decision-makers in the reproductivehealth choices of women in Nepal.
According to the 1996 Nepal FamilyHealth Survey (NFHS), 539 women die
for every 100,000
babies born.
This national
safe motherhoodcommunication
initiative increased
awareness ofdanger signs
associated withcomplications of
pregnancy andchildbirth and
increased birth
preparedness tosave women’s lives.
The initiative—
launched on March 8, 2002 in Nepal bythe National Health Education,
Information and Communication Center(NHEICC)—resulted from a highly
participatory process that included the
key safe motherhood stakeholders inNepal.
Stakeholders included the Maternaland Neonatal Health (MNH) Program,
which is supported by the U.S. Agencyfor International Development (USAID).
Building Partnerships to Save
Mothers: Nepal’s SUMATA Initiative
Mobilizing forAUGUST 2004
To learn more about this project contact:Diane SummersNepal Country Representative, [email protected] or Caroline JacobyProgram Officer, [email protected] orSuruchi Sood Senior Program Evaluation Officer, [email protected].
Community women watch one ofmore than 100 street theater troupesthat are part of Nepal’s SUMATAInitiative.
A street drama promoting husband and mother-in-lawresponsibility during pregnancy and childbirth is part ofNepal’s SUMATA Initiative.
MNH Program partners in Nepal areJHPIEGO, an affiliate of Johns Hopkins
University, Johns Hopkins BloombergSchool of Public Health/Center of
Communication Programs (CCP) andCEDPA, as well as the Nepal Safer
Motherhood Project (NSMP), UNFPA
and UNICEF.
As a lead implementing partner of
the strategic health communicationcomponent for safe motherhood and an
MNH Program partner, CCP
collaborated with NSMP in providingtechnical support to NHEICC to develop
the national safe motherhood behaviorchange communication strategy. The
strategy identified the overarching needto address issues such as women’s “shame”
in speaking out about pregnancy and
birth and their low social status, whichunderpins the country’s high maternal
mortality rate. CCP worked with a localadvertising agency to develop the creative
elements of SUMATA.
The messages of SUMATA gentlychallenged the country’s patriarchal
cultural norms by using materials thatlightly pushed the Nepalese beyond their
“comfort zones” related to the status ofwomen by making them think seriously
about making changes without causing
alienation. Women in Nepal are usuallyresponsible for all household tasks
regardless of their health status. TheSUMATA initiative’s sensitive approach
included spots that, for example,
demonstrated the concept of CARE byfeaturing a man carrying water and
animal fodder, while his pregnant wifewalks beside him. Another spot shows a
husband with his arm around his wifewith their new baby.
SUMATA encouraged husbands andmothers-in-law to CARE for pregnant
woman, SHARE love and affection, healthinformation, and her workload, and
PREPARE for childbirth and potentialcomplications. In Nepali, Care, Share,
and Prepare abbreviated spells SUMATA,
an acronym that also is an auspiciousword for mother in Sanskrit.
The slogan for the initiative was
“Pregnancy and Childbirth is Special -Make It Safe.”
A ParticipatoryProcess
The MNH Program and safe
motherhood partners worked together to
strategically address the maternal healthsituation in Nepal. Beginning in
November 2000, the partners under theleadership of NHEICC participated in
“Speaking with One Voice,” a consensus-
building workshop that brought togetherrepresentatives of local, district, and
national groups working in safemotherhood. The partners together
developed a national behavior changecommunication strategy with messages,
along with an advocacy strategy.
The SUMATA initiative’sparticipatory approach to include all
stakeholders at the central, district, andcommunity level led to a more
coordinated communication program.
Before SUMATA, national safemotherhood communication activities
were largely uncoordinated, with nooverall strategic plan aimed at specific
objectives. SUMATA united a largenumber of stakeholders, helped reinforce
messages, and provided a focal point for
behavior change communication activitieswith clear objectives designed to reduce
maternal mortality.
The existing safe motherhood
collaborative environment proved an
important asset in forging newpartnerships among key stakeholders,
including NHEICC, NSMP, UNICEF,UNFPA, and United Mission to Nepal
(UMN). These partnerships continued toevolve and increase collaboration. For
example, Safe Motherhood Nepal (SMN)
selected SUMATA as the theme for itsSafe Motherhood campaign in 2003, and
organized rallies and other public eventsand conferences around the initiative.
Program Design
Using the entertainment-education
approach, SUMATA messages werewoven into a multimedia initiative that
included radio spots and dramas, printmaterials, a television drama, and
community-based street theater
performances. Program staff produced afive-minute video highlighting the
SUMATA community street theaterprogram entitled “SUMATA: Taking SafeMotherhood to the Streets.”
Other SUMATA activities included:
• Agenda-setting radio spots and seven
six-minute SUMATA radio dramas that aired nationally on Radio Nepal.
• A series of six radio dramas incorporating messages about essential
or emergency obstetric servicesbroadcast on regional and FM stations,
targeting districts where those services
are available. NSMP supported translation and adaptation of the
dramas for local broadcast.
• A three-part tele-film Ashal Logne(Good Husband) written, produced,
directed, and performed by Nepal’smost popular duo MAHA (Madan
Krishna Shrestha and Hari Bansha Acharya). Through both private and
public sponsorship, Ashal Logne aired on all major satellite, cable, and
national television stations in Nepal to
critical acclaim, and was disseminated through NGO
networks on videocassette.
• Street theater troupes performed more
than 100 dramas based on radio dramas and adapted to local cultures in
select districts, reaching audiences of more than 50,000.
• A variety of innovative print materials,
including posters, lampshades, danglersand prayer flags featuring CARE, SHARE
and PREPARE messages focusing on male and mother-in-law involvement.
Also, a poster on danger signs. Partner
collaboration led to wide disseminationat the community and district levels.
• Billboards featuring SUMATAappeared at Nepal’s major maternity
hospital in Kathmandu, the Ministry of Health, and 16 rural
districts.
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Nepali men enjoying a SUMATA performance. SUMATA aims toinform husbands to recognize danger signs and to take care of theirwives during pregnancy and childbirth.
Women reading SUMATA prayer flags in front of a health post.
Impact
• Among those exposed to SUMATA, an
overwhelming majority (95 percent) understood its messages with no
significant differences seen byrespondent type. More than three-
fourths of the respondents reported
using the information contained in SUMATA and roughly 89 percent
acknowledged their intention to do so in the future.
• The television shows, local radio broadcasts, and some street theater
initiatives were extremely popular as
evidenced by the privately sponsored rebroadcast of the TV drama over
national and private television and the broadcast of SUMATA radio dramas in
local languages through community
FM radio by other organizations.• Although the program is now
complete, CCP continues to receive
requests for additional materials from other organizations. This demand is a
direct outcome of the participatorydevelopment process and demonstrates
the high quality and relevance of the SUMATA materials. Thes NGOs
played an improtant role in
disseminating SUMATA to more than half of Nepal’s 75 districts.
• The Nepal Family Health Program (NFHP) supported a rebroadcast of the
television drama Ashal Logne on Nepal
Television (NTV). Private sponsorshipsalso led to its rebroadcast on Nepal
One and cable television.
• NSMP continues to support airing of
15-minute SUMATA radio dramas on local FM stations in Nepali, Abadhi,
Bhojpuri, and Tharu languages and
incorporates SUMATA materials in social mobilization programs in safe
motherhood districts. NSMP also usedSUMATA print materials adapted by
local community-based organizations
at “Sasu Buhari Vela” (mother-in-law and daughter-in-law meetings).
• Numerous organizations and agencies request SUMATA print materials,
including the German Agency for Technical Cooperation, Swiss Agency
for Development, Community Action
Nepal, UNICEF, NSMP, SMN, UMN, NFHP, Canadian Center for
International Studies and Cooperation,Care/Nepal (CECI), Engender Health,
Rural Women’s Development and
Unity Center, Yala Urban Health Project, and Amaa Milan Kendra. In
particular, SMN is using SUMATA to support district-level activities.
• UMN has also taken SUMATAmaterials into the remote district of
Mugu, where district health staff reported finding them very useful in
discussing safe motherhood issues with pregnant women and their families.
Conclusion
The SUMATA initiative was widely
acclaimed by safe motherhoodstakeholders, including policymakers,
implementers, and community members.
All the activities and materials were wellreceived at the national, district, and
community level and appear to havesucceeded in elevating the importance of
safe motherhood among the intended
audiences and promoting the adoption ofhealthier behaviors. SUMATA also met
the needs of the Nepali government anddevelopment agencies and its impact
continues to multiply through the activeparticipation of stakeholders that
disseminate SUMATA messages
nationwide.
Mobilizing for Impactsummarizes key research findingsfrom the Maternal and Neonatal HealthProgram of JHPIEGO, an affiliate ofJohns Hopkins University, in partnershipwith the Center for CommunicationPrograms based at the Johns HopkinsBloomberg School of Public Health.
Johns Hopkins UniversityBloomberg School of Public HealthCenter for Communication Programs111 Market Place, Baltimore, MD 21202Tel (410) 659-6300, Fax (410)659-6266Website: www.jhuccp.orgKim Martin, CCP EditorRita Meyer, CCP Graphic Designer
Funded by the U.S. Agency forInternational Development.
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Poster depicting a positive mother-in-law caring, sharing, and preparing forher daughter-in-law’s delivery.
