Application of the Health Belief Model to Maternal Care in Pakistan

Image from Women Deliver

Studying HBM coincided with a semester long project in my International Health course. My group and I investigated Sindh, Pakistan. This province has one of the highest maternal mortality ratios (MMR) in the world. Thus, our goal is to create a program that will reduce the high MMR. We applied HBM as a foundation for our intervention program and understanding of --a maternal mobile care unit.  The following is an excerpt from our program intervention section of our program project paper.

The women in the rural Sindh province may or may not seek and receive maternal, prenatal, antenatal and postnatal care based on six components: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy (Edberg, 2007, p. 37). The existing role of Lady Health Workers (LHWs) includes dissemination of information and educating Pakistani women about the importance of receiving quality care throughout pregnancy; thus, increasing women’s awareness that they maternal death is attributed to a lack of maternal and prenatal care (Bhutta, et al, 2013). A program that provides participants with this information about pregnancy risks achieves greater participant perception of susceptibility and severity regarding maternal complications. 

            A mobile maternity care unit is likely to increase access to adequate care in Sindh’s rural communities. This also fulfills one of the LHW tasks: acting as liaisons between the federal health and public health systems, but more directly and methodically (Bhutta, et al, 2013). Ultimately, establishing mobile care units can improve access and diminish the perceived barriers of access and cost. Husbands and in-laws have a major, influential role in the care or lack of care rendered to wives. Consequently, the program will also educate relatives, especially husbands and in-laws, as well as the rest of the community about how efficacious maternal and antenatal care is, leading to the reduction of maternal mortality rates.

Image from Pakistan's Population Welfare Department

            Cues to action, or external events will motivate the women and their families in Sindh to be more proactive and willing to receive care. Such events would include required, regularly scheduled appointments with LHWs mobile maternal unit throughout pregnancy and presentation of female community members’ demises due to maternal complications. The LHWs can set small, achievable goals for the program participants to increase self-efficacy, or the belief in their ability and willingness to receive maternal care (Edberg, 2007, p. 37). Women can be given supplies a resources to continue and manage their care at home (i.e. folate supplements, prenatal vitamins, fluid intake, adequate rest). 

J. Abston, E. Bracken, & M. Smith (2013). Reducing MMR in Sindh, Pakistan by use of a mobile care unit. University of North Florida, Jacksonville, FL.

REFERENCES

Bhutta, Z., Hafeez, A., Rizvi, A., Ali, N., Khan, A., Ahmad, F., & Jafarey, S. (2013).

Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. The Lancet, 381(9884), 2207-2218. doi:10.1016/S0140-6736(12)61999-0.

Edberg, M. (2007). Individual Health Behavior Theories. In Birtcher, K. (Ed.), Essentials of

            Health Behavior: Social and Behavioral Theory in Public Health (pp. 35-47). Sudbury,

            MA: Jones & Bartlett.