Social marketing campaign to promote childbirth in clinics
Across countries, “the most obvious competition to a normal, healthy pregnancy and birth remain cultural, ritual and social values” [
32]. Taking into consideration the complex and varied factors that prevent women from using the health system for obstetrical care, our trial will promote the advantages of institution-based delivery and the quality of care provided there, for rural Guatemalan women. Social marketing is the systematic application of marketing concepts and techniques to achieve specific behavioral goals for a social good; [
33] it can be applied to promote merit goods or to make a society avoid demerit goods and thus to promote society’s well being as a whole [
34]. Although social marketing has been used in some health related areas such as smoking prevention, condom promotion and road traffic safety, evidence is scarce regarding its application to institution-based obstetric care. Nevertheless, social marketing strategies apply because they seek to influence people’s behaviors by focusing on consumers’ preferences. In this context we aim to enhance the interface between home- and clinic-based care and through this campaign encourage women to deliver in clinics.
Programs that succeed in changing behavior are often based on scientific theories of behavior change and the results of formative research conducted prior to implementation, as strategies rooted in this kind of research tend to make them more culturally acceptable and effective. Formative research, in the form of a systematic review, will identify the main determinants of factors that could potentially enhance the care-seeking behavior of pregnant women and the information gap that needs be collected during this phase. The formative research will be conducted to understand preliminary target audience attitudes, knowledge and practices in relation to institution-based childbirth. Identifying the target audience, goals and objective will allow us to specify the marketing strategies to be applied and inform the subsequent qualitative and quantitative data collection phase. The qualitative component will consist of focus groups and individual interviews carried out with key informants in selected districts to assess attitudes, perceptions and barriers to institution-based childbirth.
Once we better understand the factors underlying the resistance to clinic-based childbirth, we can use different channels to promote its advantages.
With this information we will identify a list of possible audiences, learn about previous efforts to address low utilization of clinic-based care and identify salient issues. Thus, the formative research will help determine which type of communication channel (radio, television, community meeting, etc.) will be directed toward which audience (pregnant women, TBAs, partners of pregnant women, etc.) and which is likely to have the greatest acceptance and audience’s reach.
The design of the marketing strategy will be based on the main principles of social marketing strategy development: product (care-seeking behavior), promotion (channels, type of message), price (cost/barriers of institution-based deliveries) and place (home versus clinic) [
35]. The strategy development phase aims to specify the problem, the final target audience, the scope of the campaign and behaviors and cultural factors to be addressed; only then will potentially effective marketing strategies emerge. For example, providing elements of traditional birthing environments in clinics seems promising, but what is the most effective strategy to let people know this is available; and more importantly, make them want to use the clinic instead of their own traditional birth environment at home.?
Prior to the launch of the social marketing campaign, baseline data will be collected to evaluate community knowledge regarding institutional based delivery. A sample of pregnant women living nearby, and at intermediate and far distances from clinics in the intervention communities will be interviewed at baseline and again ten months later after the campaign launch to assess exposure to communication channels and messages. These data will help assess the exposition to the audience to the campaign and the potential impact it might have in the number of deliveries occurring in district clinics.