Drivers of safe motherhood behaviors in Zambia: Facilitating factors and barriers for family planning, antenatal care, delivery, and postnatal care

Background: Zambia's maternal and child mortality ranks among the highest in the world. According to the 2007 Zambia Demographic Health Survey (ZDHS), rates of home births in rural areas are as high as 66 percent, and more than half of women do not receive any postnatal care.

Purpose: Although the ZDHS shows that safe motherhood behaviors are very low in Zambia, it does not illuminate why women are not taking up practices such as regular antenatal care (ANC) and delivery in health care settings. This study explored the barriers and facilitating factors that influence the practice of safe motherhood behaviors.

Methods: The USAID-funded Communications Support for Health project in Zambia conducted interviews in five districts for this qualitative study. Participants included women ages 18-49, fathers of children under 6 months, healthcare providers, and community health workers.

Results: The study identified facilitating factors and behavioral and structural barriers for practicing desired behaviors related to family planning, antenatal care, delivery, and postnatal care. In the case of ANC, for example, high knowledge of the benefits is not sufficient to overcome barriers such as long queues for afternoon appointments which result in women walking home after dark. Some wait to attend ANC until the second trimester because they believe providers cannot know or feel the position of the baby earlier in pregnancy, or they believe ANC is for curative rather than preventive services. Findings were used to develop the communication strategy and messages for a national safe motherhood campaign.