The COVID-19 pandemic disproportionately threatens vulnerable populations, including women and especially pregnant and post-partum women. Early estimates suggest that maternal and child deaths could increase by 8.7-38.6% and 9.8-44.7%, respectively, across low and middle-income countries (LMIC) due to disruptions in healthcare access and food insecurity. A global systematic review of impacts on maternal health found evidence of disruptions to healthcare services, reduced use of antenatal care, decreased access to family planning, and increased stress, anxiety, and depression related in part to isolation and fear of COVID-19 infection.3 Approximately one year into the COVID-19 pandemic, there continues to be a lack of information on the social, economic, and health impacts of the pandemic on pregnant and post-partum women and their infants, particularly from LMICs. Prior to the pandemic, Kenya, in particular, reported one of the highest rates of maternal and neonatal mortality in the world. Action-oriented research is needed to identify solutions and strategies for national and local government and communities. This policy brief provides information on the experiences of pregnant and post-partum women during COVID-19, with particular attention to healthcare access, maternal and newborn healthcare utilization, and maternal and newborn health.
In a collective effort bringing together 15 studies, researchers from over 30 institutions surveyed over 20,000 individuals between June 2020 and January 2021 on questions regarding respondents’ vaccine acceptance and hesitancy and their most trusted sources for vaccination advice. During some surveys, results from COVID-19 vaccine clinical trials had yet to be announced, and during later surveys, governments had started approving vaccines for use. The fast-moving nature of COVID-19 information may change people’s perceptions about vaccines by the time they are widely available in low- and middle-income countries (LMICs). Over the past six months, the body of evidence demonstrating the safety and efficacy of available COVID-19 vaccines, which have been given to millions of people, has become clearer. At the same time, severe, but rare, side effects may have undermined public confidence.
Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.
Mass media reaches a large and growing share of the population in developing countries, but can it be used to tackle poverty and change behaviors, such as the adoption of modern contraception? Given the low marginal costs of mass media campaigns, even small effects could be highly cost-effective. IPA partnered with researchers and Development Media International to evaluate the impact and cost-effectiveness of an intensive, 2.5-year mass media radio campaign in Burkina Faso that promoted family planning and aimed to dispel myths and misinformation about modern contraception.
Childhood immunization is one of the most successful and cost-effective public health interventions to date, preventing an estimated 2 to 3 million deaths every year and severe morbidity for millions more children from devastating diseases such as polio and the hepatitis B virus. Although there have been substantial gains in childhood immunization globally, coverage still lags in many countries, leaving millions vulnerable to disease. A particular challenge is on the demand side—low acceptance and uptake despite availability of vaccine supplies and services. Demand-side interventions target the barriers to acceptance and uptake, such as lack of awareness about the schedule and benefits, low prioritization of immunization, financial obstacles, or distrust in immunization. These interventions will only move the needle in the context of a functioning vaccine supply chain and effective health services. In this brief, Innovations for Poverty Action’s Path-to-Scale Research team has compiled the evidence for demand-side interventions to increase child immunization in low and middle-income countries (LMICs).
Empirical social sciences rely heavily on surveys to measure human behavior. Previous studies show that such data are prone to random errors and systematic biases caused by social desirability, recall challenges, and the Hawthorne effect. Moreover, collecting high frequency survey data is often impossible, which is important for outcomes that fluctuate. Innovation in sensor technology might address these challenges. In this study, we use sensors to describe solar light adoption in Kenya and analyze the extent to which survey data are limited by systematic and random error. Sensor data reveal that households used lights for about 4 h per day. Frequent surveyor visits for a random sub-sample increased light use in the short term, but had no long-term effects. Despite large measurement errors in survey data, self-reported use does not differ from sensor measurements on average and differences are not correlated with household characteristics. However, mean-reverting measurement error stands out: households that used the light a lot tend to underreport, while households that used it little tend to overreport use. Last, general usage questions provide more accurate information than asking about each hour of the day. Sensor data can serve as a benchmark to test survey questions and seem especially useful for small-sample analyses.
Evidence suggests that face masks can slow the spread of COVID-19 and save lives, but getting people to consistently and properly wear masks has been a public health challenge. In Bangladesh, researchers partnered with policymakers to design and evaluate strategies to increase mask uptake. Masks were distributed to households and in public places. Mask use was promoted through role-modeling, messages by prominent Bangladeshi leaders and personalities, informational brochures, and in-person reinforcement. The researchers also tested a number of incentives and behavioral nudges, including public commitment devices and text message reminders.
BACKGROUND: Limited evidence exists on how women’s experiences of care, specifically person-centered maternity care during childbirth, influence maternal and newborn health outcomes.
OBJECTIVE: This study aimed to examine the associations between person-centered maternity care and maternal and newborn health outcomes.
STUDY DESIGN: Longitudinal data were collected with 1014 women who completed baseline at a health facility and followed up at 2 weeks and 10 weeks after birth. A validated 30-item person-centered maternity care scale was administered to postpartum women within 48 hours after childbirth. The person-centered maternity care scale has 3 subscales: dignity and respect, communication and autonomy, and supportive care. Bivariate and multivariable log Poisson regressions were used to examine the relationship between person-centered maternity care and reported maternal complications, newborn complications, postpartum depression, postpartum family planning uptake, exclusive breastfeeding, and newborn immunizations.
RESULTS: Controlling for demographic characteristics, women with high total person-centered maternity care score at baseline had significantly lower risk of reporting maternal complications (adjusted relative risk, 0.63; 95% confidence interval, 0.42−0.95), screening positive for depression (adjusted relative risk, 0.55; 95% confidence interval, 0.38−0.81), and reporting newborn complications (adjusted relative risk, 0.74; 95% confidence interval, 0.56−0.97), respectively, than women with low total person-centered maternity care scores. Women with high scores on the supportive care subscale had significantly lower risk of reporting maternal and newborn complications than women with low scores on these subscales (adjusted relative risk, 0.52 [95% confidence interval, 0.42−0.65] and 0.74 [95% confidence interval, 0.60−0.91], respectively). Significant associations were found between all 3 subscale scores and screening positive for depression. Women with high total personcentered maternity care scores were also more likely to adopt a family planning method than those with low scores (adjusted relative risk, 1.25; 95% confidence interval, 1.02−1.52). In particular, women with high scores on the communication and autonomy subscale had significantly higher odds of adopting a family planning method than women with low scores (risk ratio, 1.15; 95% confidence interval, 1.08−1.23).
CONCLUSION: Improving person-centered maternity care may improve maternal and newborn health outcomes. Specifically, improving supportive care may decrease the risk of maternal and newborn complications, whereas improving communication and autonomy may increase postpartum family planning uptake.
Mass media can spread information and disinformation, but its impact is hard to rigorously measure. Using a two-level randomized evaluation covering 5 million people, we test both exposure to mass media (with 1,500 women receiving radios) and the impact of a high-quality, intensive 2.5 year, family planning mass media campaign in Burkina Faso (8 of 16 local radio stations received the campaign). We find women who received a radio in noncampaign areas reduced contraception use by 5.2 percentage points (p=0.039) and had more conservative gender attitudes. In contrast, modern contraceptive use rose 5.9 percentage points (p=0.046) in campaign areas and 5.8 percentage points (p=0.030) among those given radios in campaign areas. Births fell 10%. The campaign changed beliefs about contraception but not preferences, and encouraged existing users to use more consistently. We estimate the nationwide campaign scale-up led to 225,000 additional women using modern contraception, at a cost of US$7.7 per additional user.
We use a Randomized Controlled Trial in Pakistan to test whether one-on-one engagement with community religious leaders can encourage them to advise congregants to comply with public health guidelines from state authorities. We test whether religious content in this engagement increases its effectiveness. We find that simple one-on-one engagement significantly improves the advice given by religious leaders to congregants on preventing COVID transmission in the mosque. Engagement was equally effective with or without explicitly religious content. Treatment effects are driven by the subsample who are already convinced of basic information about COVID at baseline, suggesting the treatment does not work by correcting basic knowledge about the disease. Rather, it may work through the effectiveness of one-on-one engagement that reinforces existing knowledge and connects it to actions that respondents can take in their role as community leaders.
La crisis sanitaria y económica generada por la pandemia del COVID-19 ha tenido muchas repercusiones (que se han documentado extensivamente) sobre el bienestar de millones de personas en el mundo. Uno de los efectos más alarmantes de la pandemia es el deterioro en la salud mental tanto de las personas que se han contagiado del virus, como del resto de la población que se ha visto afectada por la incertidumbre asociada con una pandemia y por los efectos indirectos relacionados con medidas de contención tomadas por los gobiernos para frenar los contagios.
La pandemia del COVID-19 ha tenido un impacto económico severo en el mundo. Buscando disminuir la velocidad de propagación del virus, varios gobiernos instauraron medidas de confinamiento desde principios de 2020. Sin embargo, esto ha generado barreras al acceso de alimentos a nivel mundial, sobre todo en los grupos más vulnerables (FAO et al., 2020). La falta de una nutrición adecuada es preocupante pues tiene repercusiones negativas en la salud y el desempeño físico y mental en todas las etapas de la vida, en especial en la primera infancia. En el largo plazo, está asociada incluso con una menor productividad e ingreso de los individuos (World Bank, 2006). Desde el inicio de la pandemia, en la región latinoamericana, en México, Guatemala y Colombia alarma la disminución de los ingresos y el aumento de los precios de los alimentos (RIMISP, 2020).
Can informing people of high rates of community support for social distancing encourage them to do more of it? Our Mozambican study population underestimated the rate of community support for social distancing, believing support to be only 69%, while the true share was 98%. In theory, informing people of high rates of community support has ambiguous effects on social distancing, depending on whether a perceived-infectiousness effect dominates a free-riding effect. We randomly assigned a “social norm correction” treatment, informing people of true high rates of community support for social distancing. We examine an improved measure of social distancing combining detailed self-reports with reports on the respondent by others in the community. The treatment increases social distancing where COVID-19 case loads are high (where the perceived-infectiousness effect dominates), but decreases it where case loads are low (where free-riding dominates). Separately, randomized local-leader endorsements of social distancing are ineffctive. As COVID-19 case loads continue to rise, interventions such as the “social norm correction” treatment should show increased effectiveness at promoting social distancing.
The COVID-19 pandemic is an unprecedented global challenge that has affected the health and livelihood of billions worldwide. Citizens of low-income countries have been affected by the pandemic in nearly all areas of life, and the impacts have been particularly challenging for those with limited access to social safety nets. Bangladesh is especially susceptible to the negative economic impacts of the pandemic due to its strong ties to the global economy, and these negative demand shocks are likely to persist throughout and after the pandemic.
Researchers conducted two rounds of phone surveys in July 2020 and December 2020 with 3,125 vulnerable households with children across seven regions of Bangladesh. Across the two rounds of surveys, we find that the negative economic impacts of the COVID-19pandemic have persisted at least six months after the lifting of the general economic lockdown at the end of May 2020. Collectively, these findings point to several areas of need for vulnerable households, particularly in the area of education, mental health, and gender-based violence.
Founded in 2019, IPA Nigeria develops applicable research by building foundational research capacity and conducting evaluations in areas of pressing national concern. Examples of our work in this brief offer promising insights into critical issues that affect the lives of the Nigerian poor.