Around 93 million people watched or listened to our health programmes across Bangladesh, Ethiopia, India and South Sudan.

We focused on a number of key practices that are known to have a positive effect on the health of pregnant women, babies and infants.

These included:

• Going for at least four antenatal check-ups and making appropriate preparations for birth
• Giving birth in safer and cleaner conditions, preferably with a skilled birth attendant in a health clinic
• Providing safe, essential care to a baby just after birth
• Seeking prompt and appropriate treatment when maternal and neonatal danger signs were experienced
• Initiating immediate and exclusive breastfeeding that continues for six months
• From six months, feeding a child complementary foods appropriately
• Using modern family planning methods to delay or space pregnancies
• Vaccinating a child against key childhood diseases

We knew it wasn’t enough to target women alone if we wanted change to happen. We also aimed to engage those with a strong influence over the choices women make regarding their health and parenting. This was the only way to ensure we could transform maternal and newborn health outcomes.

Formative research carried out at the start of BBC Media Action’s projects in Bangladesh and Ethiopia indicated that people believed care in pregnancy and birth preparations were the ‘woman’s role’, with the mothers-in-law, particularly in Bangladesh, overseeing this. Men were rarely involved. The mother-in-law was likely to advise her daughter-in-law according to her own experiences and what had always been done in her community or society. In both Bangladesh and Ethiopia this means giving birth at home.

Using these insights, BBC Media Action project teams in Bangladesh and Ethiopia developed effective strategies to appeal to and encourage these influencers to do things differently.

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We wanted to go further. We also wanted to engage women, families and communities who had no access to TV, radio or mobile phone. So we joined forces with government and non-governmental organisations (NGOs) in Bangladesh, Ethiopia and India.

Mass media programmes were adapted and used in weekly radio listening groups, in community outdoor cinema screenings and in one-to-one exchanges. Health workers used mobile content to reach, engage and influence families. Importantly, these activities generated the discussion needed for change. They helped to engage people who might not traditionally be interested in the health of women and babies, like men. And they helped good-quality health communication to become woven into the fabric of local health systems. 

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Our Practice briefing: A bigger splash – partnering for impact further explores these experiences and lessons.

And this Research Summary explains how listening groups added value to the work of the Ethiopian Health Development Army and had an effect on the wider community.

Data analysis shows that pregnant women and new mums in Bangladesh and Ethiopia who watched or listened to our programmes were more likely to follow safer and healthier practices during pregnancy, birth and the early years of a child’s life than those who didn’t watch or listen.

The analysis showed that the actions they took were not related to factors like their wealth, education, access to health services and other important ‘confounding’ factors. This allows us to be more confident that it was our TV or radio programmes that had prompted them to take action.

In India and South Sudan, our research shows that listeners and viewers said the programmes had an impact on their lives.

In India, one of our public service advertisements, Ek Teen Do, was designed to persuade families to leave a three-year gap between pregnancies. Our research shows that one in five women who saw the advertisement said they discussed birth spacing with their spouse and one in 10 said they visited a health facility for family planning advice. While, 4% of women said they went to a health facility to get contraception.

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We learnt a number of things from this work. By using varied media formats and communication platforms to influence people in different ways, we had a greater impact than if we had used just one.

We also carried out a randomised control trial in Bangladesh that revealed women who watched our health drama and supporting talk show knew more about and were more likely to say they planned to follow safer and healthier practices than those who had only watched the health drama.

The findings are in this research briefing: Can a health drama and discussion show affect the drivers of behaviour change?

The film below explains the “theory of change” that lies behind our health programmes and the evidence we have that simply increasing a person’s knowledge was not enough to compel them to adopt safer and healthier practices. It was important that people also discuss the issues with family and friends, believe safer and healthier practices were becoming common in their community and develop a positive attitude towards them.

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Overall, viewers of our TV programmes in Bangladesh were more likely to be knowledgeable about safer and healthier practices, to discuss these issues with friends and family and to have more progressive attitudes and beliefs than those who didn’t watch the programmes. The research shows a similar pattern for our radio listeners living in rural and remote regions of Ethiopia.

Unlike in Ethiopia, women who watched our TV programmes in Bangladesh were no more likely than those that didn’t watch to go for the recommended check-ups in the first three months of pregnancy. We think the prevailing social norm around keeping pregnancy a secret in Bangladesh made this more difficult to achieve. 

In Ethiopia, data suggests men who listened to our programmes were no more likely than those that didn’t to report using modern contraceptives following the birth of a child. People who regularly attended our village listening groups said they felt able to discuss contraception within the group because it was a secure environment. This suggests that enabling more interpersonal discussion could be valuable in encouraging contraceptive use.

In South Sudan, the realities of displacement, dire poverty and scarce health service provision made it difficult for some listeners to adopt healthier practices covered by our radio programmes, such as going for regular antenatal care check-ups and giving birth at a health facility.