Researchers from the Johns Hopkins Center for Communication Programs, working with local partners in Oromia, Ethiopia, have found that encouraging couples to talk openly about pregnancy and childbirth leads to meaningful improvements in maternal health outcomes.
The research, presented in early November at the American Public Health Association annual meeting, tested a couple communication intervention created using a human-centered design (HCD) framework, one that placed the lived realities of rural Ethiopian families at its heart.
“Communication is not just about information,” says CCP’s Habtamu Tamene, the study’s lead researcher. “It’s about connection. When couples talk, they better understand one another and behaviors change. And when behaviors change, so do outcomes for mothers and babies.”
The intervention used audio devices loaded with radio stories that modeled healthy, gender-equitable relationships. These stories featured real, relatable characters discussing the importance of prenatal care, birth preparedness and delivering at health facilities.
Each device was circulated among pregnant women by local health volunteers in the rural, underserved area. Women were to listen at home with their husbands and discuss what they heard.
“It’s not easy to bring the rural men to be engaged in supporting household chores, to take care of the children, to save money to deliver at a health facility,” CCP’s Tewabech Tesfalign, Sr., a project director in Ethiopia. “But this intervention brought a lot of change. Some of the women told us that their husbands, who hadn’t been around much before, were much more attentive to their needs after these conversations.”
The researchers conducted a community-based quasi-experimental study involving 470 pregnant women across intervention and comparison communities. Baseline and endline surveys were conducted four months apart, and qualitative interviews added depth to the findings. The research was supported by the Gates Foundation under its Vulnerability Project, funded through the Johns Hopkins Bloomberg School of Public Health’s Department of Health, Behavior and Society.
CCP’s research team looked at how exposure to the radio stories and couple communication influenced key outcomes: partner engagement, prenatal care attendance and health facility deliveries. They also used an analysis technique to assess the program’s impact.
The results were striking.
In the group that listened to the audio program, spousal communication increased by nearly 15 percentage points and partner engagement by 19 points compared to those who did not. Health facility deliveries rose 12 percent, and the average number of prenatal care visits also increased significantly.
Statistical analysis confirmed that communication between spouses was directly linked to improved prenatal care and delivery at health facilities, largely through greater male partner involvement.
The qualitative findings tell an equally compelling story. Women and health workers reported that more men began helping with household chores, accompanying their wives to clinics, and making joint decisions about delivery plans.
“Now husbands are engaged,” Tesfalign says. “They come to the facility with their wives. They ask questions. They sit in the waiting area together.”
The findings add to a growing body of evidence showing that gender-equitable, dialogue-based communication can drive meaningful improvements in reproductive health.
What makes this intervention stand out is simplicity. By promoting dialogue – through stories, not lectures – it helped couples recognize pregnancy as a shared responsibility.
The stories modeled behaviors such as shared decision-making, attending prenatal visits together and supporting household work. They also showed that small acts of partnership can have big effects on women’s health and well-being.
Because the approach relies on low-cost audio devices and locally produced content, it has strong potential for adaptation and scaling in other regions of Ethiopia and beyond.
“In places where pregnancy has long been seen as a woman’s burden, interventions like this are helping rewrite the story,” Tamene says, “one conversation at a time.”
“Supporting rural pregnant women with couple communication interventions to promote gender equitable practices in male partners: Results from a quasi-experimental study in Oromia, Ethiopia” was written by Habtamu Tamene, Yihunie Lakew, Nandita Kapadia-Kundu, PhD, Bee-Ah Kang, PhD, Biruk Melaku, Simon Heliso, PhD, Tewabech Tesfalign, Rajiv Rimal, PhD.
