2.3 What social/cultural factors shape this problem?

The importance and visibility of social and cultural factors can be easily underestimated. Multi-stakeholder group work can expose hidden social and cultural barriers or assumptions that could potentially undermine activities to address the problem. Case Study 1 below investigates how social and cultural factors were an important dimension in explaining the low number of women who give birth in health facilities in Ethiopia.

Case Study 1: Problem definition in Ethiopian healthcare

In Ethiopia, delivery in a health facility is low amongst pregnant women. The government initially responded by increasing the number of health facilities in the country. But delivery in a health centre continued to be low. Redefining the problem revealed that it was not just one of accessibility and the supply of health services. Deeper social/cultural factors were at play; the problem was about demand from women.

Pregnant women did not go to health centres because of the bad things they heard about the facilities, such as insensitive treatment. The government responded by introducing a programme of respectful maternal care, where women choose their own birthing position, can bring birthing companions and can conduct their own coffee ceremony that welcomes the baby. These changes are shown in the poster depicted in Figure 4 below, which has helped change attitudes to giving birth in a health facility and increase the number of women that do so.

(Adapted from: Childs and Fawssett, 2015)

Cartoon poster of man escorting a pregnant women along path to a medical building with nurse standing in front greeting them
Figure 4: Poster encouraging women to give birth in health facilities in Ethiopia

2.2 Who is it a problem for?

2.4 What evidence do you have that this is worth the investment?