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
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
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.