This working paper draws on more than 64 focus group discussions, 139 in-depth interviews and survey interviews with more than 10,800 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 these health behaviours
What have we learned about the cross-cultural measurement of maternal health behaviours and their potential drivers?
There is considerable scope for programming 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. Uptake of the recommended antenatal care practices was especially poor in Bangladesh and South Sudan. Preparations for birth such as planning transport were often made inadequately across the four countries.
Uptake of antenatal care has increased in recent years in Ethiopia and India. In Ethiopia this is strongly associated with the roll out of the health extension worker (HEW) scheme. And in India with the Janani Suraksha Yojana (JSY) scheme, which offers families financial incentives for registering pregnancies and delivering in a health facility. However the tendency for women to conceal their pregnancy until the second trimester is a major barrier to early attendance of antenatal care across all four countries.
A good understanding of birth preparedness positively influences practice. However, many families do not make the appropriate preparations. In India this is possibly due to an attitude that preparations need only be made at the “last minute”. In Ethiopia and South Sudan as well as in India, many people believe that planning has little impact on whether a birth is successful. The belief that a \"normal birth\" takes place at home appears to influence the preference for home deliveries in Bangladesh, Ethiopia and South Sudan.
Some drivers of practice are amenable to quantitative measurement with standardised questionnaire items. Others such as social norms and attitudes are less amenable to quantitative measurement. Quantitative data collection in a post-conflict setting such as South Sudan presents particular challenges as it is difficult to assure the quality of the data. As a result, careful consideration is being given as to whether conducting further quantitative research in such a setting represents value for money.
Smethurst, L. Improving maternal health practices in four countries: insights and lessons learned. Bridging Theory and Practice Research Dissemination Series: Working Paper Issue 06. BBC Media Action, UK (2013) 74 pp.