When researchers from the Johns Hopkins Center for Communication Programs returned to a rural district in Ethiopia a year after a pilot maternal health project ended, they wanted to see what had happened after the funding stopped.

What they found was people like health extension worker Shitaye Husien and community volunteers Amanu Shuka and Aliye Feyiso still taking the project’s recorded stories from house to house, giving expecting families time to listen together and talk about pregnancy and childbirth.

No one had asked them to continue.

The CCP pilot, called Supporting Health and Reproductive Equity (SHARE) and funded by the Gates Foundation, paired vulnerability screening with recorded stories based on real experiences from the community.

During home visits, health workers identified families at higher risk for poor maternal outcomes, then left portable audio devices with them for several days so couples and other family members could listen together and talk about prenatal care and delivering at a health facility.

During the pilot, researchers found meaningful improvements in men’s supportive behaviors, prenatal care visits and women giving birth in health facilities.

But that wasn’t what CCP had come back to see.

“The evaluation showed us that the intervention could improve outcomes during the project,” said Biruk Melaku, CCP’s senior director of design and innovations in Ethiopia. “But coming back a year later showed us something different. Health workers and communities held onto the approach because they saw its value. It had become a tool they wanted to keep using.”

For the volunteers, continuing was an easy decision.

“We see real change in the community,” Amanu said. “Pregnant women who delivered at home during previous pregnancies are now going to health facilities after listening to the stories. It is highly motivating to see people changing.”

One mother said listening to the stories with her husband and mother-in-law changed the way they thought about childbirth.

She had delivered her first three children at home. During one birth, she experienced heavy bleeding but didn’t understand why.

After listening to the stories together, the family made a different decision.

“We decided together that I should deliver at the health center,” she said. “I have had three pregnancies prior to this, and I delivered all of my children at home, except the last one.”

As more families heard the stories, word spread.

“We have started this now and we don’t want to go back to the old ways of health education,” Aliye said. “People wouldn’t let us off the hook. They demand to have their turn with the audio devices and the stories.”

Shitaye said she still gets calls from families asking when it will be their turn.

“People don’t give me rest if they don’t receive the stories,” she said. “It made my work easy in some sense because the stories have really convinced people.”

Keeping the intervention going hasn’t been easy. More than half of the original audio devices have broken. The remaining devices are shared among many households, and replacement parts aren’t available.

At the local health center, the changes are still visible.

“We have seen real change in the number of women who come for prenatal care as well as to deliver at the health center,” said midwife Atakilt Tekle. “Women are also coming earlier in their pregnancy.” She now plays the stories in the waiting area each morning.

“As researchers, we often measure whether an intervention works.” Biruk said. “This visit reminded us to ask another question: Do people keep using it when no one is asking them to?”