Applying a behavioral science lens to maternity care in Liberia

How scarcity, salience, and structural factors impact likelihood of facility delivery

Dados Bibliográficos

ID21258405
AutoresSara V Flanagan (0000-0003-1707-608X, Ideas42, autor correspondente), Allison Schachter (0009-0009-0017-1858, Ideas42), Sophie T Parwon (Liberian Institute for Biomedical Research), Mbalu W Jusu (Liberian Institute for Biomedical Research), Thon Okanlawon, Jana Smith (0000-0001-6400-8050, Ideas42)
Ano2024
Volume5
Páginas100409
Data de publicação2024-06-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoSSM - Qualitative Research in Health (JOURNAL)
Identificadores do periódicoISSN: 2667-3215 • E-ISSN: 2667-3215
EditoraElsevier BV (PUBLISHER)
DOI10.1016/j.ssmqr.2024.100409
OpenAlexW4391692989
IdiomaEN
Citações recebidas1
Referências citadas39

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

Cognitive psychology · Economics · Microeconomics · Scarcity · Applied Psychology · Engineering · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms · Psychology