Behavior Change Communications during Antenatal Visits Using Pictorial Cards Improves Institutional Delivery Rates: Evidence from Matlab, Bangladesh

Aims: Behavior change communication (BCC) has been recommended in maternal health however, little is known about its effectiveness in improving knowledge and utilization of services. This paper presents findings from Matlab, a rural area of Bangladesh to inform policy about the effect of focused BCC on maternal knowledge and institutional delivery rates.
Study Design: Cohort Study.
Place and Duration of Study: The study took place in Matlab, Bangladesh from the period 2003 to 2006.
Method: The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) introduced pictorial cards in 1996 to monitor all pregnant women in Matlab service area and to provide BCC during routine antenatal visits on pregnancy danger signs, birth planning and maternal nutrition. Maternal knowledge was measured by asking about complications shown on the pictorial cards during 1st and 2nd (or successive) antenatal visits. The pictorial card data were linked with the birth file data and the socioeconomic survey data of the year 2005 of Matlab Health and Demographic Surveillance Systems (HDSS) for analysis.
Results: HDSS recorded 11,150 births during the study period but pictorial cards covered 10,657 women, and maternal knowledge data was available from 6,624 of these. Knowledge about all 5 danger signs increased from 8.9% to 34.2% between 1st and 2nd (or successive) antenatal visits (P <.001). Women with complete knowledge of all five pregnancy danger signs were 1.13 (Adjusted Odds: 1.13, 95% CI, 1.01-1.27) times more likely to have institutional deliveries than those without knowledge when the effect of socio-demographic co-variates were held constant.
Conclusion: Focused BCC using pictorial cards during antenatal visits improves knowledge regarding 5 pregnancy danger signs which has clear implications for improving institutional delivery rates. We recommend implementation research to demonstrate the effect of focused BCC in improving knowledge and practice to address high maternal mortality in resource-poor settings.