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Taboo talk in Mali marriages overlaps with healthy choices

Couples who flouted cultural norms and discussed family planning were not only more likely to use contraception but also to adopt other healthy behaviors, research in Mali shows.

The healthy actions ranged from getting HIV testing during pre-natal care to seeking treatment for a child’s cough.

Only 30 percent of the participants in a survey of 4,409 women of reproductive age said they had spoken to their husbands in the previous year about family planning.

That suggests that getting more couples talking on the issue could boost health across the board, says Danielle Naugle, research and evaluation officer at the Johns Hopkins University’s Center for Communication Programs.

“If we can change spousal communication for the better, we might be able to improve a lot of the health-seeking behaviors in Mali,” she says.

Taboo topics

The culture in Mali makes it very difficult for couples to communicate, especially on topics such as their bodies, bodily functions, and sex, Naugle says. Women are often married at young ages to older men and move in with their in-laws. They feel embarrassed in those homes to have what are considered taboo conversations, even with their husbands.

Naugle and her colleagues analyzed survey results covering a wide range of health behaviors including family planning, maternal and child health, malaria, HIV, and water and sanitation. They also analyzed data from 33 focus groups and 64 in-depth interviews with women of reproductive age, male partners, in-laws, and health care workers.

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Unsurprisingly, those who communicated with their spouses about family planning were nine times more likely to use modern contraception than those who had not. More unexpected, though, was that those who had communicated about family planning were more than twice as likely to have taken their children for treatment for a cough. They were also nearly twice as likely to have gotten pre-natal care, more likely to deliver their babies at a health facility, and more likely to have gotten an HIV test during pre-natal care visits.

“These behaviors are not really related to family planning, and yet those who communicated about family planning were more likely to adopt a whole list of healthy behaviors,” Naugle says.

Game show to follow

CCP operates the USAID-funded Keneya Jemu Kan integrated health project, designed to reduce maternal, infant, and child mortality in Mali. The project has begun work on using mass media to encourage increased spousal communication. Both a drama series that models open spousal communication and a game show are in the works.

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The game show will emphasize the importance of spousal communication for goal attainment and model open spousal communication in a fun and lighthearted manner while also addressing knowledge of key health behaviors.

Naugle will present the CCP study at the 2018 International Social and Behavior Change Communication Summit in Nusa Dua, Indonesia.

Source: Johns Hopkins University

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