What behavioural interventions increase the demand for maternal care at a primary health care centre?

Busara: Mohammed M Alhaji, Maryam Anike Yusuf, Robert Nyaga, Jaspreet Singh, Arizechukwu Okafor

NPHCDA: Laila Umar, Zarah Shayayu, Zainab Isah, Yakubu Ozohu-Suleiman

SPHCDA: Maryam Abubakar, Aisha Umar

SECTOR

Public Health

PROJECT TYPE

Field experiment

DOI

https://doi.org/10.62372/XNEH3098

Location

Nigeria | Niger

BEHAVIORAL THEME

Human-centred design | Social and behavioral science

OVERVIEW

This Aha! Moment examines the impact of behavioural interventions designed to increase demand for maternal care services at primary health care centres in Nigeria. The project applied Human-Centered Design (HCD) and Social and Behavioural Science (SBS) to identify barriers to maternal care uptake and design interventions targeting both demand- and supply-side factors. The findings show that direct and indirect costs, service quality and proximity to PHCs, as well as overconfidence bias and present bias, are important barriers to maternal care uptake.

Research Questions

What behavioural interventions increase the demand for maternal care at primary health care centres in Nigeria?
What are the main behavioural and structural barriers and enablers affecting maternal care uptake at PHCs?
Can non-digital incentivized interventions and digital behaviour change communication improve uptake of antenatal care (ANC) and delivery with a skilled birth attendant (SBA)?

Methods

The project used a proprietary SITE (Study, Ideate, Test, Extend) research framework. The study phase used qualitative research to identify barriers and enablers of maternal care uptake, while the ideation phase involved co-creating interventions with key stakeholders. Two interventions were then tested through a randomized controlled trial involving 845 participants, including 503 women and 342 men, in Dukku and Yamaltu Deba in Gombe State and Katcha and Chanchaga in Niger State.

THEMATIC AREAS

Key Findings

The incentivized ANC card tracker significantly increased the probability of ANC uptake by 24.1 percentage points in Niger and 18.2 percentage points in Gombe, relative to the control group.
The effect of the IVR intervention on ANC in both Niger and Gombe was statistically insignificant.
The probability of engagement with a skilled birth attendant (SBA) increased by an estimated 5.5 percentage points in Gombe, while the effect was statistically insignificant in Niger.
The main barriers to maternal care uptake included direct and indirect costs, service quality, and proximity to primary health care centres on the supply side, and overconfidence bias and present bias on the demand side.

Implications for Policy or Development

Non-digital personalized commitment devices, such as the ANC card tracker, can serve as salient reminders of maternal care services and communicate the consequences of neglecting maternal care.
Supplementing these commitment devices with gamified incentives such as raffles may provide a cost-effective way to bolster behaviour change in the short term, although more evidence is needed on the longevity of these effects.
Digital solutions such as behavioural messaging may improve maternal care adherence in late pregnancy, but their effectiveness depends on consistent mobile phone access and usage.
Future research should examine male-centred and spousal interventions, different incentivized and non-incentivized approaches, the role of community influencers such as traditional birth attendants, and alternative analytical approaches to better understand maternal care uptake.

How to Cite: Busara. 2026. What behavioural interventions increase the demand for maternal care at primary health care centres in Nigeria? (The aha! moment No. 37). Nairobi: Busara. DOI: doi.org/10.62372/JXBW9313