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A Behavioral Approach to Uncover Barriers to Maternal Care in Haiti (Inglês)

Haiti has the highest maternal mortality rates (MMR) in the Latin America and Caribbean region, and low rates of institutional care contribute to high MMR. Although both structural and behavioral barriers prevent pregnant women from accessing institutional care, behavioral barriers have been often overlooked. Efforts in Haiti to increase rates of institutional care operate on the assumptions that pregnant women do not access care because of the cost, distance to facilities and poor-quality infrastructure of the health centers. While these assumptions are surely at play, they do not cover all the reasons why pregnant women do not seek institutional care in Haiti. A behavioral approach was followed to uncover both structural and behavioral barriers of the decision-making process of pregnant women when thinking of accessing institutional care. The behavioral approach sheds light on other factors beyond the standard variables of prices, distance, and infrastructure, which also affect health seeking behavior, including optimism bias, uncertainty aversion, status quo, disrespectful care and discomfort with the model of care. These insights helped design solutions that have the potential to be more impactful. Policymakers must revise their assumptions about the factors that influence decision making of pregnant women and look beyond structural factors to ensure policies and programs incorporate a behavioral science lens.

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