title: Transforming maternal and newborn health social norms and practices to increase utilization of health services in rural Bangladesh: a qualitative review.
abstract: BACKGROUND
  Since 2008, Participatory Action for Rural Development Innovation (PARI) Development Trust, with the support of Enfants du Monde, has been implementing a maternal and newborn health (MNH) program based on the World Health Organization's (WHO) framework for Working with Individuals, Families and Communities (IFC) to improve MNH in Netrokona district, Bangladesh. This program aims to empower women and families and increase utilization of quality health services, thereby helping women realize their rights related to maternal health. Birth preparedness and complication readiness and working with traditional birth attendants (TBAs) to exercise a new role in MNH and have formed key interventions of this program. The purpose of this study was to explore how the program has contributed to changing social norms and practices surrounding MNH at midpoint.
  
  
  METHODS
  This study relied primarily on qualitative data collection. Two focus group discussions (FGDs) were conducted with women who were pregnant or had recently given birth and one FGD with each of the following groups: husbands, family members, TBAs, and health workers. In-depth interviews were conducted with women who were pregnant or had recently given birth, family members of these women, health care providers, TBAs and community health workers in selected intervention areas.
  
  
  RESULTS
  Since implementation of interventions informants report an increase in planning for birth and complications and a shift in preference toward skilled care at birth. However, women still prefer to receive services at home. TBAs report encouraging women to access skilled care for both routine and emergency services. While community members' understanding of rights related to maternal health remains limited, they report increased women's participation in household decision- making processes, an important indicator of the realization of rights.
  
  
  CONCLUSIONS
  Results suggest that community-level interventions aiming to affect change in social norms and practices surrounding MNH can influence knowledge and practices even after a short period of time. Further evaluations will be required to quantify the degree to which these changes are having an impact on health services utilization.
authors.affiliation: Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. fahmida_82taleb@yahoo.com.
authors.forename: Fahmida
authors.initials: F
authors.lastname: Taleb
authors.affiliation: Enfants Du Monde, Geneva, Switzerland. janet.perkins@edm.ch.
authors.forename: Janet
authors.initials: J
authors.lastname: Perkins
authors.affiliation: Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. nabeel@icddrb.org.
authors.forename: Nabeel Ashraf
authors.initials: NA
authors.lastname: Ali
authors.affiliation: Enfants Du Monde, Geneva, Switzerland. cecilia.capello@edm.ch.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Capello
authors.affiliation: Enfants Du Monde South Asia Field Office, Dhaka, Bangladesh. muzahid.ali@edm.ch.
authors.forename: Muzahid
authors.initials: M
authors.lastname: Ali
authors.affiliation: Enfants Du Monde, Geneva, Switzerland. carlo.santarelli@edm.ch.
authors.forename: Carlo
authors.initials: C
authors.lastname: Santarelli
authors.affiliation: Center for Child and Adolescent Health, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. emdad@icddrb.org.
authors.forename: Dewan Md Emdadul
authors.initials: DM
authors.lastname: Hoque
mesh_terms: D000328:Adult; D001459:Bangladesh; D005260:Female; D017144:Focus Groups; D006801:Humans; D000068104:Infant Health / Q000592:standards / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery / Q000379:methods / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D011247:Pregnancy; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods; D058996:Quality Improvement; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D016387:Women's Health / Q000592:standards / Q000706:statistics & numerical data