In a patriarchal rural ecosystem, a school going adolescent girl between the ages of 14 and 16 is the only time she makes decision about her health. At least that is what we found in this research. Beyond this teenage years, it is only after they are older (around 40 and over) upon bearing children, when they get back the power to make decisions about their health.
From adolescence to womanhood, it is only a fleeting time when rural women are their own decision-makers. In this context, what interventions would effect behavioural change towards improving self-health? What will make them not exclude themselves when they take decisions on the nutrition uptake within the family?
In this low control decision matrix, there were a few key behavioural barriers to IFA uptake:
low saliency of benefits,
cultural neglect of symptoms (bandwagon effect), except when pregnancy induced regret aversion and promoted health seeking behaviours,
perceived low self-efficiency and low agency to comply with new practices, and
absence of compliance rituals that could help sustain health promotion behaviours.
These insights helped develop behavioural and systems level interventions: communication & reward based interventions to enhance motivation among ASHA workers & women,
trans-media interventions to enhance ability and self-efficacy of ASHA workers and anaemic women, and
environmental cues and activity based rituals to trigger routines within the communities.