In countries where low literacy remains a substantial barrier to development, con- sidering the fact that an estimated 115 million children, mostly girls remain out of school in sub-Saharan Africa and South Asia, strategic health communication can significantly impact women’s development in several countries—for example, India, Indonesia, sub-Saharan Africa, and Dominican Republic. Development pro- cesses made extensive use of IEC and BCC approaches to raise awareness, to in- form and encourage responsible behavior, and to publicize available services in the community. IEC and BCC programs used a variety of formats to deliver appropri- ate messages to targeted segments of the population and in promoting a variety of health messages including family planning, AIDS prevention, better nutrition, and reproductive health. But IEC and BCC often failed to recognize that health com- munication is grounded in a specific socioecological context and complex patterns of behavior in a social system. For instance, IEC and BCC projects on reproductive health and HIV/AIDS often fail to recognize that women in South Asia and Africa have weak bargaining power in the area of sexual relationships, childbearing, and childrearing. Deprivation of women’s reproductive rights stems from the complex nature of social systems that reinforce women’s dependence, deny them a voice in family matters, and identify the family as the most important institution that shapes women’s identity.
Strategic health communication makes a difference in the reproductive health status and quality of life of women by identifying and understanding the specific courses of action needed to modify behavior that leads to lack of control over their sexuality and fertility. Some actions addressed by strategic health communication include stepping up literacy levels among slum women, educating young women on reproductive health issues such as delaying age at marriage and adoption of the small family norm, which will bring down the burden of childrearing on women leaving sufficient time for other fruitful pursuits.
Strategic health communication also engages in a dialogue with policy makers to provide infrastructure such as proper housing, toilet facility, potable water facility, and sanitation to promote health and hygiene management among slum women (Prasad 2008b). Sustained exposure to reproductive health messages through different mass media and interpersonal channels that are preferred among slum women is one of the key objectives of strategic health communication (Haripriya and Prasad 2009).
Strategic health communication goes beyond IEC and BCC approaches by in- tensifying measures that take health to the doorsteps of slum women rather than getting them to go health educators for information. Health workers in strategic health communication initiatives make regular visits to homes of slum women who are pregnant to distribute free iron and folic acid tablets, provide nutritional supple- ments, and motivate them to attend antenatal and postnatal checkups. Reproductive health care should not be equated with just family planning as in the BCC approach but women must be empowered to make informed choices through strategic health communication. Women are not to be considered passive recipients of a benevolent government or voluntary agency program as is the case in many other development
100 K. Prasad
programs (Prasad 2008a). Counseling for husband–wife and strategies to improve couple communication should be adopted in strategic reproductive health com- munication. The strategic health communication initiatives described here demon- strates that intensive information, education, and communication along with better health services can bear positive results and enable slum women in India and other developing countries to enjoy a healthy lifestyle.
Conclusion
The number of people living in slums is growing; adding 55 million over the past decade to reach 827.6 million in 2010. According to the UN (2010), the world slum population in sub-Saharan Africa, South Asia, and East Asia is estimated to grow by 6 million each year. Strategic communication initiatives in slums will be able to translate MDGs into strategic objectives to be achieved in maternal and child health. Strategic health communication can empower women in slums and the com- munity to participate in health-care decisions.
Health care and medical personnel must be trained in strategic communication skills to interact with the community, build confidence, and motivate them to seek early treatment. The number of health service delivery points should be increased, better road and transport facilities should be established in slums, and link volun- teers should be trained from the community to motivate families in slums to make the optimum use of health services.
Strategic health communication for slum women must enable women to freely express their realities and have them taken into account in the development of gen- der-just social systems. Positive role modeling through audiovisual communication tools will help to break the initial resistance and enable the family and community to participate in empowering women toward health care and improving their status.
Strategic health communication can create a gender equitable environment in which boys and girls are equally valued, equally cared for, and equally educated, to move countries toward the MDG of sustainable development.
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Strategic Communication
Communicators were once able to target the “masses” with a single message in a single outlet. Now, the technology-driven, increasingly global, and overcrowded marketplace demands a more strategic approach to communication that was once based on experience and assumptions. A strategic approach is grounded in research and positioned as a cyclical process of research and analysis, development, execu- tion, monitoring, and evaluation. Similarly, such principles are being applied to develop communication aimed at social change initiatives (UNICEF 2005).
Communication (i.e., messages conveyed by various agents such as consumer marketers, corporate communicators, or individual health care providers) was once dominated by a linear, unidirectional approach that was generally top-down or ex- pert-to-novice. While this allowed for message control, it alienated and discounted the abilities and individuality of message receivers or publics. The linear approach lacks an understanding and incorporation of audience capacity, perceptions, needs, and desires into the messaging. Publics, however, can no longer be ignored or treat- ed as a cohesive whole, as evidenced in the permeation of online, digital, and social tools that allow individuals to create, share, and monitor messages with the poten- tial for greater reach than organized media campaigns. Publics utilize such tools as Facebook, Twitter, and YouTube to express their frustrations, as well as percep- tions, desires and needs related to organizations, products, and services. This power shift, from organizations or perceived experts to individuals and concerned publics, requires more focused efforts by an organization’s key individuals to respond to and engage with publics in meaningful ways.