Effects of a sister's death in childbirth on reproductive behaviors: Difference-in-difference analyses using sisterhood mortality data from Indonesia.

RATIONALE

Risk of maternal mortality increases rapidly during the intrapartum period making skilled care at delivery an effective intervention to reduce the risk of maternal death. Demand generation for skilled care typically focuses on institutional channels; however, much less attention has been paid to whether what women may learn through their social networks can potentially influence their choice of delivery care.

OBJECTIVE

The objective of this study was to analyze whether a sister's death in childbirth has the potential to improve delivery care choices for women who experience this event.

METHODS

This study uses retrospective reports of sister deaths - either in childbirth or from some other cause - reported in the sisterhood moratlity module from five waves of the Indonesia Demographic and Health Surveys (IDHS) spanning 1989 to 2012. A cross-sectional, difference-in-difference strategy compares delivery care behavior of women before and after losing a sister in childbirth to women before and after losing a sister of reproductive age from some other cause in an intent-to-treat framework.

RESULTS

Women are less likely to give birth at home after losing a sister in childbirth relative to women who lose a sister from some other cause. Losing a sister in childbirth may trigger behaviors that help usher women of lower socioeconomic status into formal delivery care.

CONCLUSION

This study extends the literature on health behavior change through social networks to improve delivery care. Public health campaigns should consider social networks when designing messages around maternal mortality in order to help women at risk of maternal mortality make decisions that reduce their risk of and ultimately avoid maternal death.