Changes in attitudes and behaviors supportive of maternal and newborn health in Ethiopia: an evaluative case study

BMC Pregnancy and Childbirth

Halkeno Tura¹  William T. Story¹  Abeba Bekele²  Yared Amare³  Gail Snetro⁴  Heather Gardner⁴  Lara M.E. Vaz⁴  Mary V. Kinney⁴  Steve Wall⁴ 

[1]Department of Community and Behavioral Health, University of Iowa, 52242, Iowa City, IA, USA

[2]Ethiopia Country Office, Save the Children International, Addis Ababa, Ethiopia

[3]Independent Consultant, Addis Ababa, Ethiopia

[4]Save the Children US, 20001, Washington, DC, USA

关键词: Ethiopia;    Maternal, newborn, and child health;    Community-based;    Demand creation;    Evaluation;    Case studies;   

DOI  :  10.1186/s12884-021-03865-8

来源: Springer

【 摘 要 】

BackgroundEthiopia’s high neonatal mortality rate led to the government’s 2013 introduction of Community-Based Newborn Care (CBNC) to bring critical prevention and treatment interventions closer to communities in need. However, complex behaviors that are deeply embedded in social and cultural norms continue to prevent women and newborns from getting the care they need. A demand creation strategy was designed to create an enabling environment to support appropriate maternal, newborn, and child health (MNCH) behaviors and CBNC. We explored the extent to which attitudes and behaviors during the prenatal and perinatal periods varied by the implementation strength of the Demand Creation Strategy for MNCH-CBNC.MethodsUsing an embedded, multiple case study design, we purposively selected four kebeles (villages) from two districts with different levels of implementation strength of demand creation activities. We collected information from a total of 150 key stakeholders across kebeles using multiple qualitative methods including in-depth interviews, focus group discussions, and illness narratives; sessions were transcribed into English and coded using NVivo 10.0. We developed case reports for each kebele and a final cross-case report to compare results from high and low implementation strength kebeles.ResultsWe found that five MNCH attitudes and behaviors varied by implementation strength. In high implementation strength kebeles women felt more comfortable disclosing their pregnancy early, women sought antenatal care (ANC) in the first trimester, families did not have fatalistic ideas about newborn survival, mothers sought care for sick newborns in a timely manner, and newborns received care at the health facility in less than an hour. We also found changes across all kebeles that did not vary by implementation strength, including male engagement during pregnancy and a preference for giving birth at a health facility.ConclusionsFindings suggest that a demand creation approach—combining participatory approaches with community empowering strategies—can promote shifts in behaviors and attitudes to support the health of mothers and newborns, including use of MNCH services. Future studies need to consider the most efficient level of intervention intensity to make the greatest impact on MNCH attitudes and behaviors.

【 授权许可】

CC BY