Antenatal Care as a gateway behavior to increase birth at a health facility: Opportunity for SBCC programs
Summary:
In Bangladesh, despite a sharp increase in health facility delivery and receipt of ANC checkups by women, achieving Sustainable Development Goals for these health indicators will require focused and realistic social and behavior change communication (SBCC) programs. Quantitative baseline survey data, conducted for the USAID Ujjiban SBCC project in Sylhet and Chattogram divisions of Bangladesh among 1500 married women of reproductive age who were nulliparous or with a child under five years and 750 husbands, was informed by the socio-ecological framework to emphasize how individual, household, community, health system and socio-cultural factors intersect to challenge and/or facilitate individuals' health behaviors. Of the women with a child under two years, 55% had their first ANC visit within the first trimester, 38% had at least four ANC visits during their last pregnancy, and 50% had a facility delivery. Logistic regression analysis found knowledge of four ANC visits and three danger signs after birth influences early initiation of ANC visit (< 12 weeks); knowledge of four ANC visits, high maternal self-efficacy and early initiation of ANC predicts four ANC visits; and social norm about health facility delivery, high gender norms related to FP, early initiation of ANC and four ANC visits were significantly associated with health facility delivery. Early ANC visits, identified as a potential gateway behavior, may trigger adoption of four other maternal and newborn health behaviors. Together, these findings offer detailed guidance on specific knowledge items, priority health behaviors, and influencing factors that SBCC messaging can promote.
Background/Objectives:
In Bangladesh, hemorrhage and eclampsia account for more than half of all maternal deaths, many of which can be prevented by timely and appropriate care during childbirth at health facilities with skilled providers. Despite a sharp increase in health facility delivery and receipt of ANC checkups by women in Bangladesh, achieving Sustainable Development Goals for these health indicators will require focused and realistic social and behavior change communication (SBCC) programs. Quantitative data collected by the USAID-funded Ujjiban SBCC project in Bangladesh was analyzed to identify opportunities for innovative SBCC programs that promote health facility delivery with skilled providers.
Description of Intervention and/or Methods/Design:
A quantitative baseline survey for the USAID-funded Ujjiban SBCC project in Sylhet and Chattogram divisions of Bangladesh was conducted in 2018. The baseline study was informed by the socio-ecological framework, which emphasizes how factors at the individual, household, community, and health system and socio-cultural levels intersect to challenge and/or facilitate individuals' health behaviors. Quantitative data were collected to prioritize health behaviors and identify cross-cutting factors, such as socio-cultural norms, communication patterns, community strengths, and prevalent myths, that influence health behaviors related to family planning, maternal and neonatal health, nutrition, and tuberculosis using a multi-staged sampling design. Computer-Assisted Personal Interview (CAPI) software was used to collect data electronically from 1500 married women of reproductive age who were nulliparous or with a child under five years (15-49 years) and 750 husbands. Data were analyzed using Stata.
Results/Lessons Learned:
Of the women with a child under two years, 55% had their first ANC visit within the first trimester, 38% had at least four ANC visits during their last pregnancy, and 50% had a facility delivery. Lack of perceived need was the main reason given by 80% of women who delivered their last child at home. Logistic regression analyses found knowledge of four ANC visits (p< 0.001) and three danger signs after birth (p< 0.05) as significant influencers of early initiation of ANC visit (< 12 weeks). Knowledge of four ANC visits (p< 0.01), high maternal self-efficacy (p< 0.001), and early initiation of ANC (p< 0.001) were also positively associated with four ANC visits. Strong social norms about health facility delivery (p< 0.001), high gender norms related to male provider can conduct delivery (p< 0.05), early initiation of ANC (p< 0.01), and four ANC visits (p< 0.001) were significantly associated.
Discussion/Implications for the Field:
Findings suggested that early ANC visits are a potential gateway behavior that may trigger adoption of four other maternal and newborn health behaviors. It is therefore essential to promote timely and effective health services. To facilitate facility delivery, knowledge on the need for early ANC visits and at least four ANC check-ups is essential. During ANC visits, the concept of birth preparedness can be introduced, which would facilitate the process of planning for delivery, transportation, and medical emergencies. Together, these findings offer detailed guidance on specific knowledge items, priority health behaviors, and influencing factors that SBCC messaging can promote.
Abstract submitted by:
Yasmin Siddiqua - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
Nandita Kapadia Kundu - Johns Hopkins Center for Communication Programs (CCP)
Sanjanthi Velu - Johns Hopkins Center for Communication Programs (CCP)
Zoe Hendrickson - Johns Hopkins Center for Communication Programs (CCP)
Sabina Shahnaz - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
Syed Jafar Raza Rizvi - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
In Bangladesh, despite a sharp increase in health facility delivery and receipt of ANC checkups by women, achieving Sustainable Development Goals for these health indicators will require focused and realistic social and behavior change communication (SBCC) programs. Quantitative baseline survey data, conducted for the USAID Ujjiban SBCC project in Sylhet and Chattogram divisions of Bangladesh among 1500 married women of reproductive age who were nulliparous or with a child under five years and 750 husbands, was informed by the socio-ecological framework to emphasize how individual, household, community, health system and socio-cultural factors intersect to challenge and/or facilitate individuals' health behaviors. Of the women with a child under two years, 55% had their first ANC visit within the first trimester, 38% had at least four ANC visits during their last pregnancy, and 50% had a facility delivery. Logistic regression analysis found knowledge of four ANC visits and three danger signs after birth influences early initiation of ANC visit (< 12 weeks); knowledge of four ANC visits, high maternal self-efficacy and early initiation of ANC predicts four ANC visits; and social norm about health facility delivery, high gender norms related to FP, early initiation of ANC and four ANC visits were significantly associated with health facility delivery. Early ANC visits, identified as a potential gateway behavior, may trigger adoption of four other maternal and newborn health behaviors. Together, these findings offer detailed guidance on specific knowledge items, priority health behaviors, and influencing factors that SBCC messaging can promote.
Background/Objectives:
In Bangladesh, hemorrhage and eclampsia account for more than half of all maternal deaths, many of which can be prevented by timely and appropriate care during childbirth at health facilities with skilled providers. Despite a sharp increase in health facility delivery and receipt of ANC checkups by women in Bangladesh, achieving Sustainable Development Goals for these health indicators will require focused and realistic social and behavior change communication (SBCC) programs. Quantitative data collected by the USAID-funded Ujjiban SBCC project in Bangladesh was analyzed to identify opportunities for innovative SBCC programs that promote health facility delivery with skilled providers.
Description of Intervention and/or Methods/Design:
A quantitative baseline survey for the USAID-funded Ujjiban SBCC project in Sylhet and Chattogram divisions of Bangladesh was conducted in 2018. The baseline study was informed by the socio-ecological framework, which emphasizes how factors at the individual, household, community, and health system and socio-cultural levels intersect to challenge and/or facilitate individuals' health behaviors. Quantitative data were collected to prioritize health behaviors and identify cross-cutting factors, such as socio-cultural norms, communication patterns, community strengths, and prevalent myths, that influence health behaviors related to family planning, maternal and neonatal health, nutrition, and tuberculosis using a multi-staged sampling design. Computer-Assisted Personal Interview (CAPI) software was used to collect data electronically from 1500 married women of reproductive age who were nulliparous or with a child under five years (15-49 years) and 750 husbands. Data were analyzed using Stata.
Results/Lessons Learned:
Of the women with a child under two years, 55% had their first ANC visit within the first trimester, 38% had at least four ANC visits during their last pregnancy, and 50% had a facility delivery. Lack of perceived need was the main reason given by 80% of women who delivered their last child at home. Logistic regression analyses found knowledge of four ANC visits (p< 0.001) and three danger signs after birth (p< 0.05) as significant influencers of early initiation of ANC visit (< 12 weeks). Knowledge of four ANC visits (p< 0.01), high maternal self-efficacy (p< 0.001), and early initiation of ANC (p< 0.001) were also positively associated with four ANC visits. Strong social norms about health facility delivery (p< 0.001), high gender norms related to male provider can conduct delivery (p< 0.05), early initiation of ANC (p< 0.01), and four ANC visits (p< 0.001) were significantly associated.
Discussion/Implications for the Field:
Findings suggested that early ANC visits are a potential gateway behavior that may trigger adoption of four other maternal and newborn health behaviors. It is therefore essential to promote timely and effective health services. To facilitate facility delivery, knowledge on the need for early ANC visits and at least four ANC check-ups is essential. During ANC visits, the concept of birth preparedness can be introduced, which would facilitate the process of planning for delivery, transportation, and medical emergencies. Together, these findings offer detailed guidance on specific knowledge items, priority health behaviors, and influencing factors that SBCC messaging can promote.
Abstract submitted by:
Yasmin Siddiqua - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
Nandita Kapadia Kundu - Johns Hopkins Center for Communication Programs (CCP)
Sanjanthi Velu - Johns Hopkins Center for Communication Programs (CCP)
Zoe Hendrickson - Johns Hopkins Center for Communication Programs (CCP)
Sabina Shahnaz - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
Syed Jafar Raza Rizvi - Johns Hopkins Center for Communication Programs (CCP) Bangladesh
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Amy Fowler, USAID