Improving Maternal Health Practices in Four Countries: Insights and Lessons Learned

This working paper draws on research findings from BBC Media Action’s health projects in Bangladesh, Ethiopia, India, and South Sudan, funded by Department for International Development (DFID), in order to identify poor uptake of recommended maternal health practices as well as to explore the reasons behind this in specific audience segments.

The paper draws on more than 64 focus group discussions, 139 in-depth interviews, and survey interviews with 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?"

The report presents formative and baseline data from the beginning of BBC Media Action's health projects in 2012 and 2013, including qualitative research and baseline quantitative with plans for future measures of the impact of broadcast programmes on audiences' behaviours and drivers of these behaviours through comparison of midline and endline results against these baseline measures.

Findings include the following:

• "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...." Improved practices might include increasing available knowledge, as well as discussion, around antenatal care and birth preparedness. Discussion can often influence uptake of these practices and is more effective when women and key decisionmakers in families are included or women are sharing advice or experiences among peers.
• "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..." However, low levels of self-efficacy, along with barriers of money and transportation, can prevent women from acting on a desire to access an institutional delivery. Where home delivery is the norm, programming might focus on information regarding hygienic home delivery with a skilled birth attendant (SBA).
• "A good understanding of birth preparedness positively influences practice..." Men in many areas control family resources, consume broadcast media more than women, and control household access to it; thus, they are a key audience for programming. In Ethiopia, for example, there are areas with few female radio listeners.
• "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..."