2. Introduction
• Maternal and newborn health remains a critical health issue of developing countries
• Every year 300,00 women die of maternal causes-
• Additionally; relevant neonatal death toll is also high
• Fifty times higher Maternal mortality in Rural areas/ underprivileged communities
• Maternal and neonatal deaths prevented by proven cost-effective interventions —such as
interventions —such as prenatal care, institutional delivery, postpartum and newborn care,
3. Introduction
• The impact of these cost-effective interventions, however, is limited
• Public Health focus Improvement of maternal/ neonatal health in rural/
poor areas
• Change in behavioural patterns related to maternity and childbirth is MUST
needed
• To promote the use of health services that can reduce maternal and
neonatal deaths
• Achieving this kind of behavioural change is not an easy task in any
context
4. PAKISTAN: a case
• The prevalence of high maternal mortality is deeply alarming in Pakistan
• National Institute of Population Studies conducted
• “Pakistan Maternal Mortality Survey 2019”
• Sania Omer in a recent qualitative study found that;
• Poor socioeconomic status
• Limited knowledge about maternal care
• Financial constraints among rural people were the main barriers to seeking care
• The low status of women and male domination
• The preference for Traditional Birth Attendants
• Early marriages and lack of Family Planning
• Religion and Traditions
• The influence of traditional or spiritual healers
MMR 186/ per 100,000 LB
NMR 42/ 1,000 LB,
IMR 62/ 1,000 LB
6. Themes: Factors affecting RMNCH
• Impact of Social risk factors on individual outcomes
• Early marriages
• Religion and Traditions
• The influence of traditional or spiritual healers
• Impact of behavioral risk factors contribute to public heath outcomes
• Limited knowledge about maternal care
• Minimal uptake of Family Planning/ birth spacing
• The preference for Traditional Birth Attendants
7. Themes: Factors affecting RMNCH
• Social Inequalities in community
• Financial constraints among rural people as main barriers to seeking care
• Rich Poor difference
• Gender discrimination in health
• Early marriages and lack of Family Planning
• The low status of women and male domination
• Health disparities among marginalized and underprivileged population
• Poor socioeconomic status
8. Themes: Factors affecting RMNCH
• Individual Behavior change versus community empowerment
• F
• Roel of Civil Society Organizations and Non-governmental Organization in
behavior change
• E
• T
9.
10. Promote Social & Behavioral Changes: Strategies
• Campaign—public announcements on television and radio, billboards, pamphlets,
etc.
• But the change is not supported and after three years knowledge decays and
behavior returns to previous patterns (mcdowell and mcdivitt 1990; naugle and
hornick 2014
• The distribution of vouchers to women in rural areas who accessed prenatal care
services and/ or had an institutional delivery/ including transportation costs
• Other initiatives that cover direct costs can be promising, such as community based
loan funds for transport in the event of obstetrical emergencies.
11. Promote Social & Behavioral Changes: Strategies
• Local change agents—trained women in the community or a “health community
agent”—so that women have access to individual counselling as well as the support
of women’s groups.
(Lassi, Haider, and Bhutta 2010; Haroon et al. 2013; Prost et al. 2013; Adam et al. 2014)
• Community-based interventions seem to have especially positive impacts on
indicators related to social norms such as contraceptive use and institutional
delivery
• Institutional birth and Community Midwife Program
• Increasing use of family planning, use of wireless technology and social media to
educate women and promote social change in rural communities
