Ideational predictors of ANC and FP use among women in the DRC

Summary:

The Democratic Republic of the Congo (DRC) has some of the world's highest maternal and under-5 mortality rates in the world. Contributing factors include low rates of 4 or more antenatal care (ANC) visits during pregnancy, low adequate dosage of Intermittent Preventive Treatment for malaria in pregnancy (IPTp), and low use of family planning (FP). Nationally, half of women report 4+ ANC visits, and only 14% of women who gave birth report taking two doses of IPTp. Although there is a one-year median duration of post-partum insusceptibility to pregnancy due to amenorrhea and abstincne, further birth spacing is not well supported given the national rate of 8% use of modern FP methods. Understanding the predictors of ANC and FP use is critical for effectively generating demand and utilization of these services. However, one size may not fit all, and predictors of these practices likely vary by region. But there is a dearth of population-based, provincially representative health data from the DRC to guide the development of locally adapted, comprehensive interventions to address Reproductive Maternal and Child Health (RMCH). This presentation will examine individual-level, interpersonal communication and social normative factors affecting service utilization and the practice of RMCH behaviors. The presentation will provide regionally specific data in order to compare the predictors of service utilization across geographies. The presentation will highlight which psychosocial constructs are most predictive of positive RMCH behaviors to guide locally adapted SBC intervention development.

Background/Objectives:

This presentation will describe the psychosocial factors that are associated with priority RMCH behaviors in nine provinces of the DRC. The presentation will start with a summary of frequencies by province for RMCH behavioral outcomes such as 4+ ANC visits, receipt of IPTp, and use of modern FP. Next, the analysis will examine the psychosocial factors that most strongly predict these behaviors, unpacking province-level variation in these predictors. The presentation will conclude with recommendations for the province-adapted factors that SBC interventions should address to improve RMCH outcomes in Eastern DRC.

Description of Intervention and/or Methods/Design:

This presentation uses data from USAID IHP's baseline household and women's surveys, conducted in 9,000 households. The data were collected in October-November 2019, sampling equally from nine provinces in the DRC. Questions in the household survey asked about ideational factors predictive of care-seeking and preventive health behaviors. Questions in the women's survey included a wide range of questions about knowledge, attitudes, interpersonal communication, sources of health information, and self-efficacy to use health services and practice RMCH preventive behaviors. The survey also asked about health practices such as number of ANC visits during a most recent pregnancy and use of FP. This presentation will employ exploratory data analyses, simple and multi-variate linear and logistic regressions. Data will be presented visually to offer easy interpretation of differences across provinces.

Results/Lessons Learned:

These survey data are being collected; collection will be completed in mid-November 2019. We expect that this study will find, similar to results of the 2013 Demographic and Health Survey (DHS), significant regional variation in behavioral outcomes related to healthy pregnancy and FP use, though the variation in outcomes per province within a region may be less pronounced. Unlike the DHS, this study will explore demographic and ideational factors underlying regional variation. These may include household wealth, and differences in knowledge, attitudes, or popular misconceptions. Based on our qualitative work in the region, we anticipate that the greatest predictors of ANC visits and FP use will be factors linked to couple communication and self-efficacy to seek care. We expect that there will be some regional variation in the influence of each of these factors on healthy pregnancy and FP behaviors, perhaps linked with religious and tribal differences.

Discussion/Implications for the Field:

This presentation demonstrates how the information women have, the feelings they hold, and the support they receive from others contribute to shaping the actions they take related to RMCH. The presentation updates and deepens our understanding of predictors of RMCH service use by drawing from a DHS-like survey with rich batteries of psychosocial questions added. Rather than relying on data from 2013, this presentation allows SBC practitioners working in eastern provinces of the DRC recent, rich and regional data to establish a rich picture of the demand-side factors affecting RMCH outcomes and direct the development of SBCC interventions.

Abstract submitted by:

Radha Rajan - Johns Hopkins Center for Communication Programs (JHU CCP)
Sara Berthe - JHU CCP 
Shannon McAfee - JHU CCP