Some years ago I found myself surrounded by saree clad women attending a nutrition counseling session in a remote Bangladeshi village. The women were all young mothers who were participating in a World Bank funded program that provided food supplements to pregnant women and undernourished children. The program, which amongst other things aimed at improving maternal health and combating low birth weight, also presented women with information on issues such as care during pregnancy and the importance of antenatal health visits. 

The idea was novel - surely women would do ‘the right thing’ if only they had the knowledge. Alas, while women’s knowledge of what to do did increase, practices frequently didn’t change. The list of reasons for this is long. For one, young women in Bangladesh usually have very little say in decision-making, even concerning their own health. Instead these decisions are left to their husbands or mother-in-laws who are often more prone to favor traditional practices such as that of eating less during pregnancy, to ensure an easier child birth, or giving birth at home to keep the women safe from spirits and treatment by male doctors. Moreover, even if women were able to make such decisions themselves, many simply lack time and resources to prioritize their health. While most women who participated in the program understood the importance of issues such as taking rest during pregnancy they were often not able to do so, especially during the labor intensive agricultural seasons. 

Perhaps then, simply supplying women with knowledge of ‘proper’ practices isn’t the best way to improve maternal health. In Rwanda the government recently decided to try a different approach in form of a ‘pay for performance’ system, which provides incentives for doctors to increase efforts by paying them a bonus for each appropriate maternal and child health care service performed. A recent evaluation found a large and significant positive impact on deliveries in health centers and improved quality of prenatal care, showing improvements especially for services that yielded large bonuses. 

Neither of this is to say that behavioral change communication programs are useless, nor that cool cash is the only way forward. Rather, it indicates that policies which aim at improving maternal health must properly address the underlying mechanisms that interact to promote poor maternal health - be it lack of antenatal care due to social norms or time constraints, doctor absenteeism, or something else.

Check out other solutions for improving maternal health or to participate in the global call to solutions, please visit Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health. www.changemakers.com/maternalhealth