Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery
Delivery in well-equipped facilities is important to prevent the major causes of maternal mortality. Social and structural barriers are well established across low-resource contexts; less understood is the interaction between the psychological dimensions of behavior and a pregnant woman's envir...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-06-01
|
| Series: | SSM: Qualitative Research in Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667321524000180 |
| _version_ | 1797304409059753984 |
|---|---|
| author | Sara V. Flanagan Allison Schachter Sophie T. Parwon Mbalu W. Jusu Thon Okanlawon Jana Smith |
| author_facet | Sara V. Flanagan Allison Schachter Sophie T. Parwon Mbalu W. Jusu Thon Okanlawon Jana Smith |
| author_sort | Sara V. Flanagan |
| collection | DOAJ |
| description | Delivery in well-equipped facilities is important to prevent the major causes of maternal mortality. Social and structural barriers are well established across low-resource contexts; less understood is the interaction between the psychological dimensions of behavior and a pregnant woman's environment to either facilitate or hinder facility delivery. We conducted formative research applying the behavioral design approach to explore this context shaping decision-making and behavior of pregnant women, and others with influence, in Grand Cape Mount, Liberia. In-depth interviews (n = 58) were conducted in 2021 with pregnant and postpartum women, family members, facility-based providers, trained traditional midwives, community health assistants, and community leaders. Our findings highlight that while most women intend to deliver in a facility, poverty compounds difficulties at each step of the continuum of care, with the cumulative impact making facility-based delivery more difficult for lower-income, rural women to achieve. Delivering in a facility requires extensive planning and saving to overcome these difficulties and we present insights into the context contributing to a series of delays across the course of a woman's pregnancy – from initial care seeking through preparing and seeking care for childbirth, to arriving and receiving care at the facility. Our findings reveal the importance of delays earlier in pregnancy, as poor families have to weigh trade-offs of various aspects of planning and saving more carefully while also faced with chronic scarcity and competing demands for attention. Behavioral solutions that support women to make these difficult decisions and empower communities to address local challenges are still sorely needed. |
| first_indexed | 2024-03-08T00:09:09Z |
| format | Article |
| id | doaj.art-6241435e2ce64efbbd5acc6944e6d43d |
| institution | Directory Open Access Journal |
| issn | 2667-3215 |
| language | English |
| last_indexed | 2024-03-08T00:09:09Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Qualitative Research in Health |
| spelling | doaj.art-6241435e2ce64efbbd5acc6944e6d43d2024-02-17T06:42:25ZengElsevierSSM: Qualitative Research in Health2667-32152024-06-015100409Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility deliverySara V. Flanagan0Allison Schachter1Sophie T. Parwon2Mbalu W. Jusu3Thon Okanlawon4Jana Smith5ideas42, 80 Broad St Fl 30, New York, NY 10004, USA; Corresponding author.ideas42, 80 Broad St Fl 30, New York, NY 10004, USACenter for Population & Reproductive Health, LiberiaCenter for Population & Reproductive Health, LiberiaBreakthrough ACTION, Liberiaideas42, 80 Broad St Fl 30, New York, NY 10004, USADelivery in well-equipped facilities is important to prevent the major causes of maternal mortality. Social and structural barriers are well established across low-resource contexts; less understood is the interaction between the psychological dimensions of behavior and a pregnant woman's environment to either facilitate or hinder facility delivery. We conducted formative research applying the behavioral design approach to explore this context shaping decision-making and behavior of pregnant women, and others with influence, in Grand Cape Mount, Liberia. In-depth interviews (n = 58) were conducted in 2021 with pregnant and postpartum women, family members, facility-based providers, trained traditional midwives, community health assistants, and community leaders. Our findings highlight that while most women intend to deliver in a facility, poverty compounds difficulties at each step of the continuum of care, with the cumulative impact making facility-based delivery more difficult for lower-income, rural women to achieve. Delivering in a facility requires extensive planning and saving to overcome these difficulties and we present insights into the context contributing to a series of delays across the course of a woman's pregnancy – from initial care seeking through preparing and seeking care for childbirth, to arriving and receiving care at the facility. Our findings reveal the importance of delays earlier in pregnancy, as poor families have to weigh trade-offs of various aspects of planning and saving more carefully while also faced with chronic scarcity and competing demands for attention. Behavioral solutions that support women to make these difficult decisions and empower communities to address local challenges are still sorely needed.http://www.sciencedirect.com/science/article/pii/S2667321524000180Facility-based deliveryChildbirthMaternal healthLiberiaBehavioral science |
| spellingShingle | Sara V. Flanagan Allison Schachter Sophie T. Parwon Mbalu W. Jusu Thon Okanlawon Jana Smith Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery SSM: Qualitative Research in Health Facility-based delivery Childbirth Maternal health Liberia Behavioral science |
| title | Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery |
| title_full | Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery |
| title_fullStr | Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery |
| title_full_unstemmed | Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery |
| title_short | Applying a behavioral science lens to maternity care in Liberia: How scarcity, salience, and structural factors impact likelihood of facility delivery |
| title_sort | applying a behavioral science lens to maternity care in liberia how scarcity salience and structural factors impact likelihood of facility delivery |
| topic | Facility-based delivery Childbirth Maternal health Liberia Behavioral science |
| url | http://www.sciencedirect.com/science/article/pii/S2667321524000180 |
| work_keys_str_mv | AT saravflanagan applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery AT allisonschachter applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery AT sophietparwon applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery AT mbaluwjusu applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery AT thonokanlawon applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery AT janasmith applyingabehavioralsciencelenstomaternitycareinliberiahowscarcitysalienceandstructuralfactorsimpactlikelihoodoffacilitydelivery |