Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Background: Nigeria has made major progress towards MDGs 4 and 5, however its contribution to global maternal and child mortality is still substantial. To generate service demand, and build on recent improvements in availability and quality of Maternal and Child Health (MCH) services at sites supported by the Nigerian government’s Subsidy Reinvestment and Empowerment Program (SURE–P). Pathfinder Nigeria and Praekelt are partnering with Mobile Alliance for Maternal Action (MAMA) and Baby Center to provide stage-based messages to pregnant women and other influential family members.
Methods: In order to go beyond simple information provision, and successfully support changes in behavior, health promotion interventions must consider the range contextually specific behavioral influences. To prepare for message content adaptation and locally appropriate delivery design in MAMA Nigeria, formative research is now being conducted using Pathfinder International’s Pathways to Change Methodology (PtC). This theory-based game-centered rapid research tool is played with small homogeneous groups of the target audiences and stakeholders (i.e. younger/older mothers, husbands, health workers, birth attendants, elders and community leaders, from communities closer and farther from health facilities). Using fictional character profiles, players identify the individual, socio-cultural and structural factors that make home-based MCH behaviors and service-seeking behaviors (including facility delivery) harder or easier.
Results: Emergent themes from six initial PtC sessions include: need to engage husbands in behaviors requiring resources allocation, including birth planning; concerns of women and influential gatekeepers about the safety and utility of many biomedical maternal health practices; home-based birth as the ‘normal’ and preferred option for most women.
Conclusions: Findings suggest that the intervention should include: client education about what to expect during the service encounter, followed by opportunities for clients to provide feedback on service quality, linked in turn to mechanisms for health system utilization of feedback. Twelve additional PtC sessions will be conducted.