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Behavior Profile Sample: Delivery in Health Facility

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 deliver in a health facility with an equipped, qualified provider Indicator: Percentage of live births in the three years preceding the survey delivered at a health facility

Behavior Analysis	Strategy
STEPS What steps are needed to practice this behavior? Identify appropriate health facility for delivery Plan transport, resources, and logistics required for delivery in health facility Obtain all required services before, during and after delivery from qualified provider Adhere to provider instructions during and following birth of infant 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 do not deliver in a health facility, especially in an emergency, because facilities are often far from households and transportation is difficult to find Accessibility: Pregnant women are unable to deliver in a health facility because maternity care is not always free Service Provider Competencies: Pregnant women do not receive all required services from a health facility because they want to avoid negative provider attitudes and treatment Service Experience: Pregnant women cannot deliver in a health facility because not all clinics are open or staffed 24 hours Social Gender: Pregnant women do not have support from their partners to pursue and mobilize resources for delivery in a health facility because due to tradition, lack of information, lack of accommodation, and the exclusion of men in the maternal health system Norms: Pregnant women do not deliver in a facility because traditional birthing practices and preferences differ from experiences in clinics Internal Attitudes and Beliefs: Pregnant women choose to deliver at a health facility because they want a healthy baby Attitudes and Beliefs: Pregnant women do not deliver in a facility because many women perceive the quality of care from a clinic as no better than care from a traditional birth attendant at home	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior? Institutional Policymakers: Review staffing policy to ensure maternity care is accessible 24 hours Policymakers: Ensure affordability of care for most vulnerable via insurance schemes, CCTs, or other financing Managers: Explore ways to offer more of what women want for their delivery in clinic setting Providers: Actively engage men in pregnancy and delivery decisions Providers: Offer respectful care to clients Community Community Leaders: Support women with transport costs and logistics, including facilitation of community solutions like building maternity waiting shelters Household Male Partners: Actively participate in childbirth related decisions and encourage partners to deliver in a facility	POSSIBLE PROGRAM STRATEGIES How might we focus our efforts based on this analysis? Enabling Environment Financing: Create national insurance schemes, use conditional cash transfers (CCTs) or establish community savings schemes to ensure all are able to access maternity services Partnerships and Networks: Expand delivery of labor and delivery as well as EMONC services beyond formal system via avenues like social franchising Policies and Governance: Strengthen human resources allocation to ensure 24 hour coverage at all EmONC sites and referral systems Policies and Governance: Allow non-harmful traditional birthing practices at clinics Systems, Products and Services Infrastructure: Explore creation of waiting shelters for mothers Quality Improvement: Ensure providers are well-trained in and offer respectful maternity care Demand and Use Communication: Leverage traditional birth attendants for counseling, referrals and support to women and families in planning for and delivering in a facility, including distribution of birthing kits Communication: Use targeted media, including SMS where possible, to promote the improved quality of care and tailor reminders and tips for pregnant women and their families, self-created locally appropriate or picture-based birth plans Collective Engagement: Engage community leaders and men to diffuse responsibility for women's health care

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?

Identify appropriate health facility for delivery
Plan transport, resources, and logistics required for delivery in health facility
Obtain all required services before, during and after delivery from qualified provider
Adhere to provider instructions during and following birth of infant

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 do not deliver in a health facility, especially in an emergency, because facilities are often far from households and transportation is difficult to find

Accessibility: Pregnant women are unable to deliver in a health facility because maternity care is not always free

Service Provider Competencies: Pregnant women do not receive all required services from a health facility because they want to avoid negative provider attitudes and treatment

Service Experience: Pregnant women cannot deliver in a health facility because not all clinics are open or staffed 24 hours

Social

Gender: Pregnant women do not have support from their partners to pursue and mobilize resources for delivery in a health facility because due to tradition, lack of information, lack of accommodation, and the exclusion of men in the maternal health system

Norms: Pregnant women do not deliver in a facility because traditional birthing practices and preferences differ from experiences in clinics

Internal

Attitudes and Beliefs: Pregnant women choose to deliver at a health facility because they want a healthy baby

Attitudes and Beliefs: Pregnant women do not deliver in a facility because many women perceive the quality of care from a clinic as no better than care from a traditional birth attendant at home

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?

Institutional

Policymakers: Review staffing policy to ensure maternity care is accessible 24 hours

Policymakers: Ensure affordability of care for most vulnerable via insurance schemes, CCTs, or other financing

Managers: Explore ways to offer more of what women want for their delivery in clinic setting

Providers: Actively engage men in pregnancy and delivery decisions

Providers: Offer respectful care to clients

Community

Community Leaders: Support women with transport costs and logistics, including facilitation of community solutions like building maternity waiting shelters

Household

Male Partners: Actively participate in childbirth related decisions and encourage partners to deliver in a facility

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?

Enabling Environment

Financing: Create national insurance schemes, use conditional cash transfers (CCTs) or establish community savings schemes to ensure all are able to access maternity services

Partnerships and Networks: Expand delivery of labor and delivery as well as EMONC services beyond formal system via avenues like social franchising

Policies and Governance: Strengthen human resources allocation to ensure 24 hour coverage at all EmONC sites and referral systems

Policies and Governance: Allow non-harmful traditional birthing practices at clinics

Systems, Products and Services

Infrastructure: Explore creation of waiting shelters for mothers

Quality Improvement: Ensure providers are well-trained in and offer respectful maternity care

Demand and Use

Communication: Leverage traditional birth attendants for counseling, referrals and support to women and families in planning for and delivering in a facility, including distribution of birthing kits

Communication: Use targeted media, including SMS where possible, to promote the improved quality of care and tailor reminders and tips for pregnant women and their families, self-created locally appropriate or picture-based birth plans

Collective Engagement: Engage community leaders and men to diffuse responsibility for women's health care

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Delivery in Health Facility

Key Points from Global Research