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This research draws on more than 64 focus group discussions, 139 in-depth interviews and survey interviews with more than 9,687 people to explore the following research questions:
- What have we learned about current practices around key maternal health behaviours in Bangladesh, Ethiopia, India and South Sudan?
- What have we learned about the potential drivers of and barriers to these health behaviours?
Publication date: March 2014
Author: Laura Smethurst
Findings:
- There is considerable scope for programmes to help improve practices around antenatal care and birth preparedness. In all four countries the majority of women interviewed failed to attend the recommended four antenatal check-ups and did not attend in the first trimester. The most commonly made preparations are related to home deliveries, while other preparations for birth, such as planning transport, were often inadequate across the four countries.
- There are still knowledge gaps around antenatal care, in particular in Bangladesh and South Sudan. Unsupportive attitudes and social norms are also barriers to uptake of appropriate antenatal care in the four countries. This includes the attitude in some communities that pregnancy is a 鈥渘ormal process鈥� and requires no medical intervention, and the social norm that women should not disclose their pregnancy outside of their family until the fourth month. An increase in the uptake of antenatal care in recent years has been associated with the rollout of government services. A key driver of attending antenatal care services in all countries is the perceived need to check the baby鈥檚 health.
- A good understanding of birth preparedness positively influences practice, but knowledge gaps remain. Knowledge around the recommended components of a birth plan is especially low in Ethiopia and South Sudan. Social norms appear to influence the strong preference for home deliveries across Bangladesh, Ethiopia and South Sudan. Even though the vast majority of respondents understand that a facility delivery is safer for the mother and baby, the normative belief that a 鈥渘ormal birth鈥� takes place at home and a home birth is something that women should be proud of prevails across the four countries.
Key implications for programming include the need to:
- Address important knowledge gaps around the appropriate timeframes for antenatal care and birth preparedness
- Tackle unsupportive attitudes, especially among the key decision-makers, men and older women
- Consider potential barriers and people鈥檚 concerns around service provision