abstract: 'Background Postpartum hemorrhage (PPH) is the leading cause of maternal

  mortality in low-income countries, and is the most common direct cause

  of maternal deaths in Madagascar. Studies in Madagascar and other

  low-income countries observe low provider adherence to recommended

  practices for PPH prevention and treatment. Our study addresses gaps in

  the literature by applying a behavioral science lens to identify

  barriers inhibiting facility-based providers'' consistent following of

  PPH best practices in Madagascar. Methods In June 2019, we undertook a

  cross-sectional qualitative research study in peri-urban and rural areas

  of the Vatovavy-Fitovinany region of Madagascar. We conducted 47

  in-depth interviews in 19 facilities and five communities, with

  facility-based healthcare providers, postpartum women, medical

  supervisors, community health volunteers, and traditional birth

  attendants, and conducted thematic analysis of the transcripts. Results

  We identified seven key behavioral insights representing a range of

  factors that may contribute to delays in appropriate PPH management in

  these settings. Findings suggest providers'' perceived low risk of PPH

  may influence their compliance with best practices, subconsciously or

  explicitly, and lead them to undervalue the importance of PPH prevention

  and monitoring measures. Providers lack clear feedback on specific

  components of their performance, which ultimately inhibits continuous

  improvement of compliance with best practices. Providers demonstrate

  great resourcefulness while operating in a challenging context with

  limited equipment, supplies, and support; however, overcoming these

  challenges remains their foremost concern. This response to chronic

  scarcity is cognitively taxing and may ultimately affect clinical

  decision-making. Conclusions Our study reveals how perception of low

  risk of PPH, limited feedback on compliance with best practices and

  consequences of current practices, and a context of scarcity may

  negatively affect provider decision-making and clinical practices.

  Behaviorally informed interventions, designed for specific contexts that

  care providers operate in, can help improve quality of care and health

  outcomes for women in labor and childbirth.'
affiliation: 'Flanagan, SV (Corresponding Author), Ideas42, 80 Broad St Fl 30, New
  York, NY 10004 USA.

  Flanagan, Sara V.; Razafinamanana, Tina; Smith, Jana, Ideas42, 80 Broad St Fl 30,
  New York, NY 10004 USA.

  Warren, Charlotte, Populat Council, 4301 Connecticut Ave NW, Washington, DC 20008
  USA.'
article-number: '320'
author: Flanagan, Sara V. and Razafinamanana, Tina and Warren, Charlotte and Smith,
  Jana
author-email: sara@ideas42.org
author_list:
- family: Flanagan
  given: Sara V.
- family: Razafinamanana
  given: Tina
- family: Warren
  given: Charlotte
- family: Smith
  given: Jana
da: '2023-09-28'
doi: 10.1186/s12884-021-03801-w
eissn: 1471-2393
files: []
journal: BMC PREGNANCY AND CHILDBIRTH
keywords: 'Maternal mortality; Postpartum hemorrhage; Healthcare provider;

  Madagascar; Facility-based birth; Behavioral barriers'
keywords-plus: '3RD STAGE; ACTIVE MANAGEMENT; RISK PERCEPTION; CONDOM USE; LABOR;

  IMPLEMENTATION; FEEDBACK'
language: English
month: APR 22
number: '1'
number-of-cited-references: '33'
papis_id: 60680c68062ab8abae46c0d29a56e8f4
ref: Flanagan2021barriersinhibiting
times-cited: '4'
title: 'Barriers inhibiting effective detection and management of postpartum hemorrhage
  during facility-based births in Madagascar: findings from a qualitative study using
  a behavioral science lens'
type: Article
unique-id: WOS:000644071000002
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '21'
web-of-science-categories: Obstetrics \& Gynecology
year: '2021'