Transforming maternal and newborn health social norms and practices to increase utilization of health services in rural Bangladesh: a qualitative review

Abstract

BackgroundSince 2008, Participatory Action for Rural Development Innovation (PARI) Development Trust, with the support of Enfants du Monde, has been implementing a maternal and newborn health (MNH) program based on the World Health Organization’s (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH in Netrokona district, Bangladesh. This program aims to empower women and families and increase utilization of quality health services, thereby helping women realize their rights related to maternal health. Birth preparedness and complication readiness and working with traditional birth attendants (TBAs) to exercise a new role in MNH and have formed key interventions of this program. The purpose of this study was to explore how the program has contributed to changing social norms and practices surrounding MNH at midpoint.MethodsThis study relied primarily on qualitative data collection. Two focus group discussions (FGDs) were conducted with women who were pregnant or had recently given birth and one FGD with each of the following groups: husbands, family members, TBAs, and health workers. In-depth interviews were conducted with women who were pregnant or had recently given birth, family members of these women, health care providers, TBAs and community health workers in selected intervention areas.ResultsSince implementation of interventions informants report an increase in planning for birth and complications and a shift in preference toward skilled care at birth. However, women still prefer to receive services at home. TBAs report encouraging women to access skilled care for both routine and emergency services. While community members’ understanding of rights related to maternal health remains limited, they report increased women’s participation in household decision- making processes, an important indicator of the realization of rights.ConclusionResults suggest that community-level interventions aiming to affect change in social norms and practices surrounding MNH can influence knowledge and practices even after a short period of time. Further evaluations will be required to quantify the degree to which these changes are having an impact on health services utilization.

Community perceptions towards the new role of traditional birth attendants as birth companions and nutrition advocates in Kakamega County, Kenya

“…Women reported a positive view of the new roles of re‐oriented TBAs, who were said to respond holistically to the women's needs through practical, material, and emotional support during pregnancy, delivery, and postpartum. This is consistent with other studies in Africa, Asia, and Latin America that also observed the potential role of TBAs in providing maternal and child health care service, emotional support, and advice during the antenatal, delivery, and post‐partum period (Bergström & Goodburn, ; Kayombo, ; Saravanan, Turrell, Johnson, & Fraser, ; Taleb et al, ). The CBMNH‐N project found that it is possible to change the behaviour and care practices of TBAs with an appropriate strategy.…”

Factors influencing implementation of interventions to promote birth preparedness and complication readiness

“…BPCR messages were easily understood by women respondents in Nepal and Burkina Faso [ 23 , 52 ]. Studies that used visual aids such as cards, posters or booklets were positively received and understood [ 32 , 42 , 43 , 45 , 50 ].…”

Opting for home birth in rural Bangladesh: An assessment of the current status and reasons

“…31,46,47 Although this is a contested topic within the international community, many stakeholders agree that traditional birth attendants can play an important role in maternal and newborn health. Studies exploring local-level perceptions have found generally positive perceptions regarding traditional birth attendants in rural communities.…”

“…Studies exploring local-level perceptions have found generally positive perceptions regarding traditional birth attendants in rural communities. 31,46,47 Although this is a contested topic within the international community, many stakeholders agree that traditional birth attendants can play an important role in maternal and newborn health. 48 In addition, WHO recommends that in areas where traditional birth attendants continue to be the primary health care providers around the time of birth, that the health systems should partner with traditional birth attendants to define and agree on alternative roles for them in supporting the health of women and newborns.…”