Applying a behavioral science lens to maternity care in Liberia

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

Datos Bibliográficos

ID21258405
AutoresSara V Flanagan (0000-0003-1707-608X, Ideas42, autor de correspondencia), 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)
Año2024
Volumen5
Páginas100409
Fecha de publicación2024-06-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSSM - Qualitative Research in Health (JOURNAL)
Identificadores de la revistaISSN: 2667-3215 • E-ISSN: 2667-3215
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.ssmqr.2024.100409
OpenAlexW4391692989
IdiomaEN
Citas recibidas1
Referencias 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