1. Outline Issue: Reducing Maternal Mortality in Haiti’s South East Department UNICEF Action – Information, Education, communication (IEC):  CLTS & Corpovisionarios Adjustments to future work in Haiti Advances in Social Norms and Social Change Course. Joyce Brandful. University of Pennsylvania - July 2012

2. 2009  Low utilisation of health services  High dependence on local midwives /TBAs  High death rate due to complications and delay  300- 350/100,000 births UNICEFUNFPA WHO Ministry of Health /CIDA Policy & Staff Guidelines & Training IEC for Bhv.Chg. Equipmen t & Supplies JOINT PROJECT (2009 – 2013) Assessment Priority Setting Communication Plan Implementation & Monitoring

3. Design Preparation & Implementation Maternal Mortality ProjectSIMILARDIFFERENT External Project ManagersCommunity Led Total Sanitation (CLTS) Use of statistics (EMUSS)CLTS, Coporvisionarios (CPV) - violence against women Other techniques for information collection (KAP) CLTS (Walk of Shame)CPV : Focus Groups, Interviews, Direct observation, survey Presentation of findings (delayed) CLTS : “Ah Ha” Moment CPV: Diagnosis and Community Prioritisation Community Meetings to adopt Communication Plan for Behaviour change CPV : Value Deliberations CLTS: Collective decision, commitment & public declaration Facilitation (Exclusively External Team) CLTS; (local Core Group  Trust)

4. KAP Study Findings (Girls and women 15-49 yrs) Knowledge (Factual Beliefs) – TBA : repository for information on maternal health issues: They have mystical powers and are knowledgeable in traditional medicine. – Wrap bandage tightly around stomach to regain former shape – Use hot bath & herbs to restore organs and genitals to original state after birth – Bury the placenta and plant a tree. The baby will grow as strong as the tree. – Health personnel are unfriendly. The also mock traditional rites and rituals. Attitudes and Practices – After first visit to health centre, consultations continue with TBA – TBA bonding with entire family through visits and meals. IEC Activites: – Health centre interpersonal based sessions – Mass media (radio and posters) Normative Expectations*: – Fully clad, windows closed after birth otherwise “womanhood” is compromised; – Family celebration after the birth is a must.

5. Exclusive use of TBA services and Home Delivery Custom or Social Norm? Necessity Convenience Repeated Action Widespread Conditional Preference Normative expectation Empirical Expectations HYPOTHESES: Social Incentive + Social Sanction both present, THEREFORE Reliance on TBAs has become a social norm. The social sanction appears to be not severe or permanent effect, THEREFORE is weak and unstable. It should be relatively less challenging to shift or replace the social norm. Mutual social expectations Bury the Placenta Incentive (Belonging) No party: Sanction (loss of recognition) Improvements in Health services

6. Implications for future work (1 of 2) Opporutunity & Challenge – Implementation :just about to start – Time bound project Focus & Linkages – Shift from “population at risk” to community relations, and social norms – Link individual with relevant networks in the community : Practices, Embedment, structure relationships, interdependence, etc. – Involvement of girls and women, as well as their family, women’s groups and larger community Information collection & monitoring – Continue relevant network meetings in community with focus on beliefs and expectations – Initiate data on social networks to see possible links to other groups in the project – Provide / or add to empirical work about Social Norms in Haiti

7. Implications for future work (2 of 2) Implementation – Isolate the core values from peripheral ones – Identify the core group / natural leaders – Sustain community discussions  Common knowledge  value deliberations  social learning – Facilitate with relevant skills and competences – Implement the C4D strategy holistically Creativity in Communication – Hook on to core value – Tie in with factual beliefs and empirical expectations – Include all relevant reference networks Coordination

8. Conclusion: Why change? Coordination – 3 Partners + MoH; – Separate group focus. Juxtaposition  Synergy – Reduce fragmentation and segregation. – Identify potential interdependent social networks to advantage – Improve integration of interventions through links with potential social networks/core groups – Reduce transaction costs where possible. UNFPA UNICEF WHO G&W NNNN

9. Transformative Agenda of UNICEF (Human Rights Principles for development) Equity (including the voices of marginalised and minorities.) Ownership Capacity development of Rights Holders and Duty Bearers Sustainability Back to Basics Let’s Walk the Talk !!