Transforming maternal health in Ethiopia: Leveraging human-centered design to co-create innovative behavioral interventions

A significant number of maternal and child births in Ethiopia are at elevated risk because they occur at home and/or because of low rates of antenatal care visits. This study applied a human-centered design (HCD) approach to develop contextually appropriate solutions that can promote institutional delivery and a greater number of antenatal care visits. The HCD approach (a five-step design-thinking process) was conducted in two rounds of workshops. The first-round included pregnant women living with vulnerabilities and their husbands, while the second round engaged healthcare providers and community influencers. The second round of workshops were anchored on findings from the first round. Facilitators trained in the HCD conducted these workshops. A total of 204 participants -pregnant women, husbands, healthcare providers and community influencers, organized into 16 design teams, participated in the workshops and prototype testing. Prototypes were tested and iterated to ensure feasibility and acceptability. The design teams produced stakeholder maps, personas, journey maps, and affinity clusters to deepen their understanding of the challenges and foster stakeholder empathy. Key insights harvested from both round of workshops guided the refinement of the design challenges, resulting in the formulation of twelve "How might we…" statements to facilitate ideation. The resulting prototypes -a self-paced audio program interventions featuring real-life stories and visual print materials-were implemented over four months in two Oromia districts, with Women Development Armies playing a pivotal role in facilitating the rotation of home-based audio interventions. This participatory and iterative process, guided by design thinking, emphasizes the potential of human-centered design to develop contextually appropriate and feasible solutions aimed at enhancing maternal health service utilization in resource-constrained settings.