THE BLOG
01/10/2013 11:31 am ET Updated Mar 12, 2013

Health Interventions and Local Mores: Approaches to Effective Intervention

What impact do local traditions have on health indicators? How can modern approaches be paired with indigenous customs to improve the health of communities? These are some of the questions that our network of correspondents based in Nairobi, Jakarta, Mumbai, Rio de Janeiro, and Mexico City set out to answer on urb.im, the network for just and inclusive cities.

Based in Mumbai, Carlin Carr explores a variety of solutions to high neonatal mortality rates in Mumbai's slums. These initiatives work to improve birthing practices, educate mothers on antenatal care, and broaden access to affordable hospital deliveries, all while honoring traditional practices. One program trains community health volunteers to educate pregnant women to have safe deliveries, and offers antenatal care services, vaccinations, and vitamin supplements. Another organization has built birthing huts, staffed with trained attendants, which offer more hygienic conditions than giving birth in slums. One way to make hospital delivery services more affordable to the poor is by standardizing processes and procedures, as a chain of maternal and neonatal care facilities has demonstrated. Overall, education and awareness are key: trained community health workers can provide new and expectant mothers who deliver at home with the knowledge they need to provide safe conditions for their child and learn simple practices to detect when something is wrong.

In Nairobi, Katy Fentress reports that mothers of disabled children growing up in underserved informal settlements are faced with a daily uphill struggle to feed, nurture, and appropriately take care of their children, especially because of the social stigma against disability. One solution: a theater space that can be used for physiotherapy sessions and community performances, debates, and meetings. This helps not only with supervision and care of the children, but also in fighting the disability prejudice.

In Rio de Janeiro, Catalina Gomez shows how adapting local culinary traditions can improve nutrition. Favela Orgânica teaches participants how to use natural ingredients that they might otherwise discard, such as fruit peels, carrot leaves, and cauliflower stalks. This initiative combats malnutrition in Rio's low-income communities, and also encourages people to avoid wasting food, a crucial element in a neighborhood with high poverty rates.

Breastfeeding children in the first six months of their lives drastically reduces malnutrition, and is often more hygienic than bottle feeding, especially considering the unfavorable water conditions in most slums. However, mostly because of cultural factors and family pressures, many women do not breastfeed their children. Julisa Tambunan proposes a solution to this problem. In Jakarta, mothers' support groups were created to empower women to breastfeed: between 10 and 15 mothers meet twice a month to discuss pregnancy, breastfeeding, and nutrition. The mothers are motivated and supported in their decisions, leading to very encouraging results: breastfeeding rates have increased dramatically.

In Mexico City, social customs deter indigenous peoples from the use of "modern" health care, making this population vulnerable to maternal and child mortality, among other indicators. María Fernanda Cavallo explains that to integrate traditional medicine into the Mexican health care system, a "Department of Traditional Medicine and Inter-cultural Development" was founded. The poor, marginalized, and remote communities not only have access to an effective health care system, but also experience social and cultural inclusion.

As the variety of solutions proposed show, there is no single way to deal with the often difficult relationship between local mores and health interventions. But it is also clear that health programs cannot ignore the importance of traditional customs, nor can they fight them. In such cases, a partnership rooted in compromise is required to intervene effectively.

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