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Transforming Maternal Health in Bangladesh through Human-Centered Design

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October 21, 2024

Transforming Maternal Health in Bangladesh through Human-Centered Design

The mothers and newborns also meet with a doctor for one-on-one postnatal check-ups before the session begins.

In a brightly lit room at a BRAC Maternity Center in Bangladesh’s Tongi District, expectant first-time mothers sit quietly around a table. The young women are attentive, their eyes fixed on Mukta, a midwife dressed in brilliant pink, who is holding up a small green mango at the front of the room. Smiles spread across their faces as the midwife explains that, at 12 weeks’ gestation, their babies are about the size of this familiar, beloved fruit.   

For these expectant mothers, it is the first time they’ve been able to truly visualize their baby’s growth, and their excitement and wonder are palpable. This tender moment is part of the women’s first of five group antenatal care sessions held at BRAC Maternity Centers and guided by midwives trained by the Healthy Women, Healthy Families project. Led by Management Sciences for Health (MSH) in collaboration with partners BRAC, Scope Impact, and Population Council, the project aims to improve the quality, acceptability, and accessibility of care for young first-time parents in underserved areas like Tongi.  

“Due to economic constraints, the private health services in nearby Dhaka are prohibitively expensive for these families, and the government-funded rural health care systems are not readily available in these areas,” explains Anjuman Begum, a senior technical advisor for the project. “Places like Tongi often fall through the cracks, leaving women without many viable options for care.” Deeply rooted gender inequities further exacerbate these access challenges. “Young women often lack the knowledge, awareness, and decision-making autonomy within their family structure to truly advocate for their own reproductive health,” she explains.   

As part of the Healthy Women, Healthy Families project, trained midwives lead group antenatal care sessions for pregnant first-time mothers at BRAC Maternity Centers in Tongi. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
As part of the Healthy Women, Healthy Families project, trained midwives lead group antenatal care sessions for pregnant first-time mothers at BRAC Maternity Centers in Tongi. Photo credit: Jennifer Gardella for MSH.
Over the course of five sessions, the mothers-to-be learn how to best take care of themselves and prepare for birth. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
Over the course of five sessions, the mothers-to-be learn how to best take care of themselves and prepare for birth. Photo credit: Jennifer Gardella for MSH
They also play games, share stories, and engage in self-care activities—like the breathing exercise shown here—to build bonds with each other and their health providers. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
They also play games, share stories, and engage in self-care activities—like the breathing exercise shown here—to build bonds with each other and their health providers. Photo credit: Jennifer Gardella for MSH
“I learned about the danger signs to look out for,” shared one first-time mother. “If a woman has any of these signs, such as blurred vision, dizziness, or bleeding, she needs to go to the doctor.” Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
“I learned about the danger signs to look out for,” shared one first-time mother. “If a woman has any of these signs, such as blurred vision, dizziness, or bleeding, she needs to go to the doctor.” Photo credit: Jennifer Gardella for MSH
“I learned about the danger signs to look out for,” shared one first-time mother. “If a woman has any of these signs, such as blurred vision, dizziness, or bleeding, she needs to go to the doctor.” Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
“I learned about the danger signs to look out for,” shared one first-time mother. “If a woman has any of these signs, such as blurred vision, dizziness, or bleeding, she needs to go to the doctor.” Photo credit: Jennifer Gardella for MSH

In recognition of these challenges, the Healthy Women, Healthy Families project implements an innovative group-based model of care to engage and educate expectant mothers in an approachable, interactive, and cost-effective way. “The project trains midwives in delivering group antenatal and postnatal care sessions for small cohorts of first-time mothers at the maternity centers, where each woman also receives an individual checkup,” explains Anjuman. “This is offered free of charge, and the project takes care of the participants’ delivery fees once it is time for them to give birth.”   

With the project’s support, midwives also hold sessions for first-time fathers and information sessions for adolescents, caregivers, and community members. “The goal is to create a supportive network for first-time families to navigate their pregnancy journey, receive proper care, and feel better prepared for parenthood,” says Anjuman.  

A fundamental feature of the Healthy Women, Healthy Families project—and the key to its success—is its human-centered design approach. Through human-centered design principles, MSH and Scope Impact tailored and adapted the interventions to the specific feedback of program participants, ensuring that these interventions are culturally relevant and reflective of the needs of the women and families they aim to serve.   

“Utilizing a human-centered design approach has allowed us to continually identify and adapt to the needs and preferences of participants throughout the process.”

Joseph Savage, Scope Impact technical advisor 

From the start of the project, interviews and focus groups with midwives, health care providers, and community members helped shape the content and delivery of each group session. “From our early conversations with pregnant women, we learned that they desired a sister-like connection with their providers—support that goes beyond just receiving medical advice,” explains Joseph Savage, a technical advisor with Scope Impact. “This insight helped us shaped the model to foster deeper, more personal relationships by incorporating more activities, games, and other opportunities for bonding.” 

Following this feedback, the project team implemented two important modifications in the sessions for first-time mothers: creating spaces for sharing stories and experiences and incorporating the use of more props—like the green mango. “Each session topic is represented by a prop. A small fruit represents the size of the baby at various stages of pregnancy, while a money bank represents the importance of saving up for the infant’s arrival. These props help increase engagement and improve knowledge retention.” 

For first-time fathers, modifications to the group-based model took a different form. Dr. Farzana Islam, the Healthy Women, Healthy Families project director, identified the shift from facility-based sessions to community sessions. “We heard from fathers that it was difficult for them to come to the sessions because of their work obligations,” explains Dr. Farzana. “So, we adapted the approach so that we could hold sessions at community centers near their workplaces and added sessions during evening or weekend hours to help accommodate their schedules.”  

BRAC midwives also lead community sessions for first-time fathers so they can learn and better support their wives during pregnancy, birth, and the post-partum period. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
BRAC midwives also lead community sessions for first-time fathers so they can learn and better support their wives during pregnancy, birth, and the post-partum period. Photo credit: Jennifer Gardella for MSH.
“I thought my wife would deliver at home in our village,” shared one father. “As I attended these meetings, I realized the benefits of consulting with doctors and receiving medical care. We stayed here, and she delivered in a facility.” Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
“I thought my wife would deliver at home in our village,” shared one father. “As I attended these meetings, I realized the benefits of consulting with doctors and receiving medical care. We stayed here, and she delivered in a facility.” Photo credit: Jennifer Gardella for MSH
Another father reflected on how the sessions helped him and his wife plan for their family’s future. “My wife and I both learned about family planning. We have made an informed decision together.” Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
Another father reflected on how the sessions helped him and his wife plan for their family’s future. “My wife and I both learned about family planning. We have made an informed decision together.” Photo credit: Jennifer Gardella for MSH
Midwives also lead community sessions for adolescent girls to provide them with comprehensive information on women's health. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
Midwives also lead community sessions for adolescent girls to provide them with comprehensive information on women’s health. Photo credit: Jennifer Gardella for MSH
Here, a midwife shares information about the importance of good nutrition to a group of girls at a local school. Healthy Women Healthy Families Bangladesh. Photo credit: Jennifer Gardella for MSH
Here, a midwife shares information about the importance of good nutrition to a group of girls at a local school. Photo credit: Jennifer Gardella for MSH

Conversations with health care providers also offered a better understanding of their roles, skills, and aspirations and the challenges that they faced, which also influenced the development of the model. “The insight we gained enabled us to design the model in a way that reduced the health providers’ workloads while also helping them develop new skills and build that connection with the mothers in their sessions,” explains Joseph.  

The human-centered design approach also established mechanisms enabling the project to solicit and incorporate feedback from participants as the project evolved, leading to ongoing improvements to the interventions. “These reflection points were crucial as they allowed us to continuously refine the model, even after implementation had already begun,” Joseph notes. “This helped us make relevant and timely adjustments to maintain group members’ interest and commitment, ultimately leading to increased attendance and engagement—and better health outcomes for mothers and their babies.” 

The results speak to the tangible difference this human-centered design approach has made in the lives of first-time parents who participated in project. After incorporating feedback from participants, attendance at group sessions for both first-time mothers and fathers increased significantly, and nearly all first-time mothers—more than 98%—reported satisfaction with the group discussions, session topics, and care received at the maternity centers. This increased engagement translated into greater maternal health knowledge, with 41% of program participants able to name at least three pregnancy danger signs by the end of the project, compared to just 6% of mothers in the control group. Among participants, knowledge grew with session attendance: 55% of first-time mothers who attended all antenatal and postnatal care sessions could identify three or more delivery danger signs, compared to 29% of those who attended just one session.

The program’s impact also extended beyond knowledge retention to the adoption of critical maternal health practices. First-time mothers who participated in the group sessions were significantly more likely to complete four or more antenatal checkups compared to those who did not participate. They were also far better prepared for delivery, with higher rates of completing key birth preparedness steps such as saving money and planning transportation to the health facility. Beyond pregnancy and delivery, the model also supported healthier postnatal practices: rates of exclusive breastfeeding for the first six months were significantly higher among program participants than those in the control group.

Healthy Women Healthy Families Bangladesh_After the women give birth they return to the BRAC maternity centers for two postnatal care sessions to learn about important topics like vaccinations, breastfeeding
After the women give birth they return to the BRAC maternity centers for two postnatal care sessions to learn about important topics like vaccinations, breastfeeding. Photo credit: Jennifer Gardella for MSH.
Healthy Women Healthy Families Bangladesh. "I liked that they explained everything to us with much care," reflected one new mother. "The midwives explained everything very well and they are concerned about new mothers."
“I liked that they explained everything to us with much care,” reflected one new mother. “The midwives explained everything very well and they are concerned about new mothers.” Photo credit: Jennifer Gardella
Another reflected on how she left feeling better prepared for motherhood. “I didn’t know much about these things before. Now, I know how to care for my baby, and I can share this knowledge with others.”
Another reflected on how she left feeling better prepared for motherhood. “I didn’t know much about these things before. Now, I know how to care for my baby, and I can share this knowledge with others.” Photo credit: Jennifer Gardella for MSH
The mothers and newborns also meet with a doctor for one-on-one postnatal check-ups before the session begins.
The mothers and newborns also meet with a doctor for one-on-one postnatal check-ups before the session begins. Photo credit: Jennifer Gardella for MSH
“I get to follow a mother from the beginning of her pregnancy until after her child is born,” shared one BRAC service provider. “That connection is very rewarding.”
“I get to follow a mother from the beginning of her pregnancy until after her child is born,” shared one BRAC service provider. “That connection is very rewarding.” Photo credit: Jennifer Gardella for MSH

“It is very gratifying to see how these first-time mothers thrive, but the impact of these sessions and this model overall extends beyond the mothers themselves,” explains Dr. Farzana. “You can see the ripple effects on the entire family unit; the community; and ultimately, the health care system as a whole. Our hope is that this model can be scaled up and sustained, paving the way for a more equitable and effective approach to maternal health in Bangladesh and creating lasting change that helps young families flourish for years to come.”  

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