Research

Maternal mortality remains a pressing global concern and a top priority of the World Health Organization (WHO). As of 2020, nearly 800 women succumb daily to preventable causes related to pregnancy and childbirth, indicating an urgent need for effective targeted interventions (WHO 2023). This is particularly pronounced in India, where maternal mortality continues to remain a policy concern (NFHS-4). A critical challenge in addressing maternal mortality in India is the impact of social and cultural norms, often impeding the effectiveness of interventions (Mejía-Guevara I et. al 2021; Heyman et al. 2019; Heise et al. 2019). This paper investigates the impact of differentiated health messaging and social learning on antenatal care (ANC) visits for pregnant women co-residing with their mothers-in-law in traditional multigenerational households, characterized by low female agency, high conformity to gender norms, and collective health decision-making. In a field experiment conducted in the Indian state of Madhya Pradesh, we varied the delivery of health information on the importance of ANC visits and mother-in-law support, along two dimensions: at the household level, delivered solely to the pregnant woman or jointly with their mother-in-law, and at the village level, delivered to groups comprising of only pregnant women or jointly with their mothers-in-law. We measure outcomes at two points in time: one and a half month after the information delivery (midline), and post-birth (endline). We find that information delivery increases knowledge across all treatments, with sustained effects over time. Information to the pregnant woman alone, excluding the mother-in-law and peers, results in an increase in ANC visits in the short term. Similarly, providing information to both the pregnant woman and her mother-in-law in the absence of peers (non-group setting) also increases ANC visits. In the groups, peer effects and norms dominate, with no increases in ANC visits observed, and with the lowest effects observed in the groups with mothers-in-law. Finally, we also see that pregnant women that received our health intervention were more likely to report fewer post-delivery complications for themselves and the infant. This study makes three important contributions: 1) we demonstrate the pivotal role of the mother-in-law in health decision-making, 2) highlighting that women's groups may not necessarily enhance agency and access, and 3) emphasizing that improved access to preventative care enhances health-seeking behavior and outcomes in the medium term.

Breastfeeding promotion is a national health priority in South Africa. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in under resourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa that measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs (“mentor mothers”). The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). The videos replaced about two-fifths of CHWs’ direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services

We assess the impacts of a randomized school-based deworming intervention in Kenya on the mortality of recipients’ children using a 23-year longitudinal data set of over 6,500 original participants and their offspring. The under-5 mortality rate fell by 22% (17 deaths per 1000 live births) for children of treatment group individuals. We find that a combination of improved health, education and living standards, increased urban residence, delayed fertility, and greater use of health care in the parent generation contributed to the reduction. The results provide evidence for meaningful intergenerational benefits of child health investments.

A significant proportion of deaths and re-hospitalizations for both mothers and newborns occur in the first few weeks following birth. Family caregivers in India possess a large influence on the mothers’ decisions during their pregnancy and the postpartum period; evidence suggests that the stronger the quality of the relationship, the more likely the mother is to engage in WHO-recommended best practices. Nevertheless, the influence of different types of caregivers, especially grandparents, on health outcomes for both the mother and newborn remains poorly understood. This paper explores the dynamics within new mother and caregiver dyads, investigating the role of caregivers (primarily the father, maternal and paternal grandmother of the newborn) and their influence on postpartum care in four states in India. We find that, agreement within dyads is low. Birthing women themselves believe they don’t have agency, and are not likely to name themselves as primary caregivers for themselves and the infants. However, the reverse is true for caregivers.