Save the Children has brought out a brief overview of the project, detailing the process and achievments.
Further Information
Visit the website of The Saving Newborn Lives Initiative, led by Save the Children US.
PD is 'working' in the rural district of Haripur Pakistan to improve practices surrounding pregnancy, delivery and the neonatal period. Positive Deviance has allowed Saving Newborn Lives (SNL) to mobilize communities for behavior change, identify people who are able to carry out positive practices, and to identify pre-existing enablers of positive behaviors.
In June 2002 community norms surrounding pregnancy and delivery were determined through a baseline survey (of eighty-four women who had delivered in the last nine months) and focus discussions with mothers, fathers, parents-in law, and traditional birth attendants. In addition a Positive Deviance Inquiry was done with 18 mothers whom, in the survey, had reported uncommon successful practices.
The baseline data showed that over half of the women did not receive antenatal care or increase their dietary intake during pregnancy. Alarmingly, although most women delivered at home (77%), few families knew the danger signs surrounding pregnancy or had considered how the mother would reach the hospital if complications arose. When the baby was delivered, 70% had their umbilical cords cut with a household utensil and 80% were bathed (usually in cold water or a in a cold room). It was also discovered that most women exerted little influence over the decisions surrounding their delivery; only 35% decided where they would deliver.
In contrast, the positive deviants had found ways to address these issues, despite the fact that they faced the same constraints as their neighbors. One PD father, Raja revealed that during pregnancy he insisted that his wife eat more. He also knew some of the danger signs during pregnancy. Over the course of the pregnancy he had saved some money in case an emergency arose. One week before delivery, he asked his neighbor if he could use their vehicle when the time of delivery came. His wife delivered the baby on a clean plastic sheet that he had purchased. Raja knew that the baby should be kept warm, so after the baby was washed it was wrapped in a warm cloth. Within one hour after birth colostrum was given to the baby.
Raja revealed that he received most of his knowledge on health and pregnancy from an educational television channel. By sharing Raja's PD behaviors with the community, others have been able to see that it is possible to make improve maternal and newborn care. Further, once PD behaviors such as Raja's are identified, organizations can design activities (such as role playing and games) that allow people to practice these behaviors.
From 2002 to 2004, under its SNL initiative, Save the Children piloted the use of the Positive Deviance Approach to improve maternal and newborn care in 6 villages. The impact of the pilot project which lasted less than a year in each village, resulted in the following change in practices regarding maternal and newborn care:
More importantly, through the community mobilization process, husbands' role and attitude towards maternal and newborn care underwent a radical change as well as mothers-in-laws, resulting in a new openness about maternal and newborn care issues and the community's ability to address the in a sustainable way.
The presentation 'Positive Deviance Approach to Improved Newborn Care Behaviors in Rural Pakistan' was originally preented during the 6th World Congress of Perinatal Medicine in 2003 in Japan. Those who are considering implementing a PD program may find this presentation useful as it outlines the basic PD approach that was followed. In addition, it compares the baseline survey with monitoring data that has been collected.