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Behavior Profile Sample: Antenatal Care

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating Behavior Profiles.

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Health Goal	Improve maternal and child survival
Accelerator Behavior	Pregnant women complete a full course of quality antenatal care (ANC) Indicator: Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits

Behavior Analysis	Strategy
STEPS What steps are needed to practice this behavior? Recognize signs and symptoms of pregnancy Decide to seek ANC early, before the end of the first trimester Plan transport, resources, and logistics Attend all recommended ANC visits Obtain all required services from qualified provider at each visit Adhere to provider instructions during and following each visit, including when to return for the next visit Click on any box to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior. of the behavior.	FACTORS What factors may prevent or support practice of this behavior? These should be analyzed for each country context. Structural Accessibility: Pregnant women cannot access health facilities because they are too far Accessibility: Pregnant women do not attend multiple ANC visits because they struggle to afford the costs that come in addition to on-going essential expenditures Service Provider Competencies: Pregnant women cannot obtain quality ANC because providers neither respect them nor effectively communicate relevant technical information or explain the benefits of the different services, tests, and medications given during ANC Service Experience: Pregnant women do not go for ANC because the health facilities often lack the tests, medications, or supplements that women need, or payment is required when services and products should be free Social Family and Community Support: Many pregnant adolescents and unmarried women are reluctant to seek early care because of stigma or the risk that they will be asked to leave school or quit their job Family and Community Support: Pregnant women do not plan to attend, or attend ANC because family and community members do not encourage or support their attendance Norms: Pregnant women do not seek ANC because many societies have strict cultural or traditional practices around disclosure of pregnancy Internal Attitudes and Beliefs: Pregnant women do not always perceive a value to multiple ANC visits if they have already had one or more healthy pregnancies Attitudes and Beliefs: Pregnant women do not always comply with provider's instructions particularly related to medications, supplements, or foods because of beliefs about the adverse effects of the medication or foods on their fetus Knowledge: Most pregnant women attend at least one ANC visit because they understand its benefits	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior? Institutional Policymakers: Ensure pregnant adolescents can still attend school Policymakers: Ensure maternity care is accessible via insurance schemes, conditional cash transfers (CCTs) or other financing Providers: Offer counseling and support to pregnant women during ANC visits, including thorough explanations of services provided as well as the importance of multiple visits and adherence to supplements or medications given Logistics Personnel: Monitor and properly forecast stock of essential tests, medicines, and supplements Managers: Provide effective supervision and on-site support to ensure quality ANC services Community Community and Religious Leaders: Publicly support or promote ANC including programs that attempt to reduce stigma and encourage women to talk to their partners about early pregnancy care Community Health Workers/Peer Educators: Encourage or actively support women to seek a full course of ANC and to continue following provider's instructions once at home. Household Family Members: Actively participate in ANC and support women, especially first-time mothers and adolescents, in all aspects of pregnancy and delivery planning Male Partners: Actively support finances, planning, and transportation for ANC for pregnant women	POSSIBLE PROGRAM STRATEGIES How might we focus our efforts based on this analysis? Enabling Environment Financing: Expand free or low-cost access to products and services through vouchers or fee exceptions to ensure access to ANC Financing: Finance task-shifting and explore community-based service delivery such as iron and folic acid supplements Policies and Governance: Adopt and enforce policies to permit pregnant adolescents to attend school Policies and Governance: Establish a policy for areas with poor health facility access to have the most basic ANC services, such as iron and folic acid supplement resupply managed at the community level Systems, Products and Services Supply Chain: Strengthen supply chains for essential drugs, supplements, and preventative medicines for ANC Quality Improvement: Train and support providers to emphasize value of completing all ANC visits as well as active birth planning Quality Improvement: Expand services and improve structures, including hours offered, types of services available, transparent costing of services when appropriate and use of ANC outreach services to encourage pregnant women to use ANC Quality Improvement: Ensure that services are client- and family-friendly and that counseling on follow-up care is provided to both the pregnant women and any family members accompanying her Demand and Use Communication: Use targeted media, including SMS where possible, to send tailored reminders and tips for pregnant women and their families on both ANC attendance and adherence to supplements like iron and folic acid Communication: Create pregnancy and new-mother groups to help mothers understand the benefit of care throughout pregnancy and the post-partum period Collective Engagement: Train and use traditional leaders and traditional birth attendants to encourage women to seek early and multiple ANC visits

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?

Recognize signs and symptoms of pregnancy
Decide to seek ANC early, before the end of the first trimester
Plan transport, resources, and logistics
Attend all recommended ANC visits
Obtain all required services from qualified provider at each visit
Adhere to provider instructions during and following each visit, including when to return for the next visit

Click on any box
to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.
of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.

Structural

Accessibility: Pregnant women cannot access health facilities because they are too far

Accessibility: Pregnant women do not attend multiple ANC visits because they struggle to afford the costs that come in addition to on-going essential expenditures

Service Provider Competencies: Pregnant women cannot obtain quality ANC because providers neither respect them nor effectively communicate relevant technical information or explain the benefits of the different services, tests, and medications given during ANC

Service Experience: Pregnant women do not go for ANC because the health facilities often lack the tests, medications, or supplements that women need, or payment is required when services and products should be free

Social

Family and Community Support: Many pregnant adolescents and unmarried women are reluctant to seek early care because of stigma or the risk that they will be asked to leave school or quit their job

Family and Community Support: Pregnant women do not plan to attend, or attend ANC because family and community members do not encourage or support their attendance

Norms: Pregnant women do not seek ANC because many societies have strict cultural or traditional practices around disclosure of pregnancy

Internal

Attitudes and Beliefs: Pregnant women do not always perceive a value to multiple ANC visits if they have already had one or more healthy pregnancies

Attitudes and Beliefs: Pregnant women do not always comply with provider's instructions particularly related to medications, supplements, or foods because of beliefs about the adverse effects of the medication or foods on their fetus

Knowledge: Most pregnant women attend at least one ANC visit because they understand its benefits

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?

Institutional

Policymakers: Ensure pregnant adolescents can still attend school

Policymakers: Ensure maternity care is accessible via insurance schemes, conditional cash transfers (CCTs) or other financing

Providers: Offer counseling and support to pregnant women during ANC visits, including thorough explanations of services provided as well as the importance of multiple visits and adherence to supplements or medications given

Logistics Personnel: Monitor and properly forecast stock of essential tests, medicines, and supplements

Managers: Provide effective supervision and on-site support to ensure quality ANC services

Community

Community and Religious Leaders: Publicly support or promote ANC including programs that attempt to reduce stigma and encourage women to talk to their partners about early pregnancy care

Community Health Workers/Peer Educators: Encourage or actively support women to seek a full course of ANC and to continue following provider's instructions once at home.

Household

Family Members: Actively participate in ANC and support women, especially first-time mothers and adolescents, in all aspects of pregnancy and delivery planning

Male Partners: Actively support finances, planning, and transportation for ANC for pregnant women

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?

Enabling Environment

Financing: Expand free or low-cost access to products and services through vouchers or fee exceptions to ensure access to ANC

Financing: Finance task-shifting and explore community-based service delivery such as iron and folic acid supplements

Policies and Governance: Adopt and enforce policies to permit pregnant adolescents to attend school

Policies and Governance: Establish a policy for areas with poor health facility access to have the most basic ANC services, such as iron and folic acid supplement resupply managed at the community level

Systems, Products and Services

Supply Chain: Strengthen supply chains for essential drugs, supplements, and preventative medicines for ANC

Quality Improvement: Train and support providers to emphasize value of completing all ANC visits as well as active birth planning

Quality Improvement: Expand services and improve structures, including hours offered, types of services available, transparent costing of services when appropriate and use of ANC outreach services to encourage pregnant women to use ANC

Quality Improvement: Ensure that services are client- and family-friendly and that counseling on follow-up care is provided to both the pregnant women and any family members accompanying her

Demand and Use

Communication: Use targeted media, including SMS where possible, to send tailored reminders and tips for pregnant women and their families on both ANC attendance and adherence to supplements like iron and folic acid

Communication: Create pregnancy and new-mother groups to help mothers understand the benefit of care throughout pregnancy and the post-partum period

Collective Engagement: Train and use traditional leaders and traditional birth attendants to encourage women to seek early and multiple ANC visits

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Antenatal Care

Key Points from Global Research