Why Do Some Lao Mothers Have Good Practices During Pregnancy? A Qualitative Positive Deviance Study

Sysavanh Phommachanh,E Pamela Wright,Mayfong Mayxay,Jacqueline E.W Broerse,Dirk R Essink

doi:10.15296/ijwhr.2020.45

Abstract

Objectives: Optimal antenatal care (ANC) visits help improve health outcomes and decrease perinatal mortality but they are often not optimal in low and middle-income countries (e.g., few mothers attend the recommended four or more ANC visits). The aim of this study was to identify determinants that influenced mothers who did make sufficient visits for ANC in rural Lao in order to inform the design of more effective interventions to change the behavior of mothers who do not make such visits. Materials and Methods: A qualitative study was conducted using semi-structured interviews with mothers who made four or more ANC visits during their last pregnancy in rural Lao. Manual analysis was used for open and thematic coding of the interview data. Results: All mothers reported taking special care of themselves during pregnancy. They perceived the clear benefits of ANC visits regarding reassuring them of their health and reducing the risk of negative events. Family members, particularly husbands, played a key role in making decisions to seek more ANC when they were aware of its benefits. In addition, friends and neighbors were an important source of information for mothers. The quality of ANC provision and the provision of incentives such as an information booklet, along with soap and mosquito net were directly influencing factors in increasing ANC visits. Conclusions: In general, feeling a need for taking special care during pregnancy was a common factor among pregnant women who did use ANC in rural Laos. Accordingly, improving the quality of ANC and increasing appreciation in communities regarding the need for good ANC are strongly recommended to increase attendance by all mothers.

Highlights

Antenatal care (ANC) is a core healthcare function, including health promotion, screening, diagnosis, and disease prevention,[1] which women receive throughout their pregnancy and the postpartum period.[2]
The selection criterion was the availability of mothers who had made the recommended four or more ANC visits living in a specific rural area, identified by the baseline study of the larger project
Determinants of Positive ANC Practices of Lao Mothers: Reflections on Negative Practices Individual Level Three motivations to access ANC were identified on an individual level, including the belief or attitude toward ‘special care’ during pregnancy, the benefit of ANC for maternal and child health (MCH) as part of ‘special care’, and a fear of risk-taking

Summary

Introduction

Antenatal care (ANC) is a core healthcare function, including health promotion, screening, diagnosis, and disease prevention,[1] which women receive throughout their pregnancy and the postpartum period.[2]. Women with a history of stillbirth, a highrisk medical or obstetric history, or those who are in a first pregnancy may be more likely to seek ANC.[5,10] Other factors included an urban residence, women’s education, family wealth, and few household occupants.[6,11,12] Receiving maternal and child health (MCH) information from a lady health worker, a nurse/midwife, the motherin-law or other relatives/friends, or mass media has been strongly associated with at least four or more ANC visits.[7,11] In addition, the quality of the provided ANC, the accessibility of the service, and the behavior of health care providers are significantly associated with women making four or more ANC visits.[3,7,10]

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Conclusion