Funding alone will not reduce maternal and child mortality rates

The statistics on maternal, newborn, and child mortality around the world are staggering: 265,000 maternal deaths, 880,000 stillbirths, 1.2 million neonatal deaths, and 3.2 million infant and child deaths annually, the vast majority occurring in low-income countries.

Many maternal and child deaths are easily preventable, and the United Nations established eight Millennium Development Goals (MDGs) toward this objective and others among the world's poorest people. The MDGs set ambitious targets to reduce by two-thirds the mortality rate for children under age five between 1990 and 2015, and to reduce the maternal mortality rate by three-quarters during the same period.

Recent initiatives to reach these goals call for research-based, low-cost interventions that can reduce mortality and morbidity and argue for additional funding to increase access to and coverage of these life-saving interventions. However, funding alone will not close the gap maternal and child mortality rates, wrote Alison M. Buttenheim, PhD, MBA, assistant professor at the University of Pennsylvania School of Nursing in the Maternal and Child Health Journal.

"It will take more than funding to reduce maternal and child mortality around the world," said Dr. Buttenheim. "It will take an understanding of how people make decisions about health-related behaviors."

Even when high-quality, affordable products and services are available readily, use of them is often low, said Dr. Buttenheim. "Unfortunately, humans rarely behave as rationally as public health planners and providers hope we will. There are fundamental psychological forces that lead us to take actions that we know contradict our beliefs or our long term goals, but are hard to resist in the moment. Simple investments in child health, like immunizations or insecticide-impregnated bed nets, are no exception." These insights into human behavior from behavioral economics — a field at the intersection of psychology and economics.

Behavioral economics asks such questions as "Which message is likely to be more persuasive: 'If your child gets this treatment, her chance of surviving increases from 45 percent to 90 percent' or 'if your child gets this treatment, her chance of survival decreases from 90 percent to 45 percent'"?

"Among other things, behavioral economics encourages us to pay attention to how choices are framed.," explained Dr. Buttenheim. "Generally, messages framed as losses are more persuasive than those framed as gains or benefits from taking the same action."

Recent studies found that messages framed as losses can induce stronger intentions toward such healthy behaviors as vaccinating children and purchasing water treatment systems in areas with poor filtration. "Training community health workers and clinic staff to incorporate loss frames into promotion campaigns for maternal and child health behaviors may boost healthy behaviors and the use of health services more than current approaches," said Dr. Buttenheim.

"Behavioral economics illuminates the path toward real progress by improving our understanding of how individuals make choices under information and time constraints, and by offering new approaches to make it easier for individuals to do what is in their best interest and harder to do what is not," she said. "Among poor and rich populations alike, human behavior is the common pathway to achieve health."