In recent times, public health has made significant progress in maternal and newborn health outcomes, including accessible, safe, institutional deliveries, expanded antenatal care and clearer clinical guidelines for safe motherhood. Yet, despite these medical improvements, unsafe deliveries and preventable maternal and neonatal health complications continue inside homes and communities, especially in middle- and low-income households across the country. This is often due to the gap between the delivery of healthcare services during childbirth and what happens at home once the care providers leave—inside the kitchen, the bedroom and in family conversations. It is here that behaviour, shaped by culture, power and lived realities, plays a decisive role.
As the Indian Development Review report argues, supporting maternal and newborn health requires moving beyond information dissemination to actively enabling behaviour change within households and communities. Hence, it is essential to understand why behaviour change is central to maternal and newborn care, the challenges that complicate it, and how community-rooted initiatives often hold the transformative potential of what can be called “mom-talk” — empathetic, contextual and action-oriented engagement with mothers and families.
Why Behaviour Change Matters in Maternal & Newborn Care
At its core, behaviour change matters because knowledge alone does not save a mother and a child, but how it is translated into practice is the most crucial. Post-delivery, mothers are generally aware of healthy practices such as breastfeeding for the first six months, immediate skin-to-skin contact, adequate postnatal nutrition, etc. as advised by doctors, yet they struggle to maintain these practices. As the report points out, newborn care is rarely provided solely by mothers; instead, it is shaped by elders, spouses and family, who often adapt deeply entrenched social norms that define what is “good” or “safe” care.
For instance, while a mother could be completely aware, only to continue breastfeeding, often many families insist on giving water or honey to newborns as part of traditional practices. In such a case, for a mother, the denial does not only mean ignorance but also carries the social cost of defying collective expectations of elders and the community.
Challenges to Behaviour Change
This often leads to significant barriers to behaviour change and reveals why such interventions usually have to work against power and patriarchal agency. Several maternal health programmes are implemented under the assumption that individuals act as rational decision-makers who will adopt the practices advised and the information provided by health experts. However, in reality, mothers in most households across the country function within constrained environments where questioning elders or resisting age-old customs leads to conflict and emotional distress.
Behaviour change, therefore, is not a simple process of persuasion but a negotiation between evidence-based guidance and social belonging.
Rational Choice vs Situational Realities
A major challenge in supporting behaviour change lies in the tension between rational choice and the realities of the situation. Clinical advice may be logically sound, but it often fails to account for the emotional, relational and practical pressures mothers face at home. We often fail to consider how mothers, who are convinced and aware of the importance of exclusive breastfeeding, find it difficult to refuse family members who insist on supplementary feeding, especially when these relatives frame their advice as care or concern. In such cases, behaviour change efforts must extend beyond mothers to include family influencers, recognizing that health decisions are collective rather than individual.
Traditional Knowledge vs Critical Health Information
A second challenge arises from the conflict between traditional knowledge and biomedical advice. Many postpartum practices around food, rest and infant care have existed in our society for generations, and carry deep meaning within communities. However, health workers often recommend diverse, nutritious diets for new mothers, while families restrict certain foods they believe may harm recovery or milk production, driven by their beliefs. When health programmes dismiss these beliefs outright, families may reject medical advice entirely. Effective behaviour change does not require rejecting tradition, but engaging with it thoughtfully.
Designing for Information vs Designing for Action
The third and perhaps most critical challenge is the tendency of programmes to design for information rather than action. Last-mile delivery workers and awareness campaigns often assume that repeated exposure to messages and information will make it easy to see natural behavioural shifts. However, knowing what to do does not automatically enable people to do it. Mothers may lack the confidence, support or practical strategies needed to translate advice into daily routines. Behaviour-centred design approaches, such as linking new practices to existing habits, are therefore essential to making change sustainable.
Behaviour Change in Practice: Community Interventions
Community-based health programmes offer valuable insights into how these challenges can be addressed in practice. At Smile Foundation, through our maternal and child health initiatives, we practice what we believe which is the importance of meeting families where they are. Through programmes like Smile on Wheels, we deliver mobile healthcare services that combine clinical care with preventive counselling for mothers and children.
Moving beyond regular check-ups, these mobile units create recurring touchpoints for dialogue on nutrition, breastfeeding, immunization and postnatal care. By engaging directly with mothers and caregivers in familiar settings, such initiatives help normalize healthier behaviours over time.
Crucially, Smile Foundation’s approach recognizes that behaviour change is relational. Through our programme, we train health workers and volunteers to communicate with empathy, acknowledge the societal and mental barriers mothers face and gradually introduce alternatives. Our maternal health programmes emphasize awareness, early intervention and community participation, ensuring that mothers are supported rather than judged for their choices. Such practices often reflect and emphasize the design of interventions that respect agency and lived experience rather than imposing prescriptive solutions.
Community interventions must promote maternal and newborn health through education, peer support and household-level engagement, and empower mothers with practical knowledge while involving families and communities in conversations about care practices. By fostering trust and collective responsibility, health programmes can help formulate sustainable behaviour change by embedding them within social structures rather than delivering them as isolated messages.
Designing Behaviour Change for Lasting Impact
These examples underscore the importance of designing behaviour change interventions that are culturally sensitive, inclusive and action-oriented. Effective programmes must shift from simply communicating what mothers should do to supporting how they can do it within their specific contexts. This includes engaging household decision-makers, adapting messages to local realities and recognizing that small, incremental changes are often more achievable than sweeping behavioural shifts.
Ultimately, the brilliance of behaviour change lies in its humanity. It acknowledges that maternal and newborn care is not practised solely in clinics but is negotiated daily within families and communities. “Mom-talk”, conversations that listen as much as they instruct, offers a powerful framework for bridging the gap between knowledge and practice. As initiatives like those led by the Smile Foundation demonstrate, when mothers are supported through respectful dialogue, practical guidance and collective engagement, healthier behaviours become not only possible but sustainable.
In conclusion, improving maternal and newborn health requires more than medical expertise and often demands a deep understanding of behaviour, culture and agency. Behaviour change is not a supplementary component of healthcare delivery but its connective tissue, linking clinical knowledge to lived reality. By centering mothers’ experiences and designing interventions that work with — rather than against — social norms, programmes can transform everyday practices and, in doing so, save lives. The future of maternal and newborn health depends not just on what we know, but on how well we listen, adapt and talk with mothers where it matters most.
