Maternal Behavioral Health: Fertile Ground for Behavior Analysis
Use voucher reinforcement to help pregnant clients stop smoking, drinking, and couch-surfing—just be ready to defend the ethics.
01Research in Context
What this study did
Washio et al. (2018) wrote a how-to paper for BCBAs. They asked: can we use ABA reinforcers to help pregnant and new moms quit smoking, cut drinking, eat better, and move more?
The team sketched a statewide incentive program. Moms would earn vouchers or gift cards for clean drug tests, prenatal visits, or meeting step goals. The paper lists what to measure, how to train staff, and how to sell the idea to hospitals.
What they found
This is a position paper, not an experiment. The authors show that reinforcement tactics already proven in drug courts and autism clinics can transfer to maternity wards. They stress two guardrails: check social validity so moms feel respected, and hold all other variables constant so the incentive is the only thing that changes.
How this fits with other research
Saunders et al. (2005) told us to “go big” with ABA. Washio answers by showing exactly how to scale up: run the program through state health departments, not single clinics.
Friedling et al. (1979) warned that tiny weight losses are normal and we should protect client dignity. Washio echoes this for moms—set realistic goals and never shame.
Whalon et al. (2019) push ethical dissemination. Washio adds ready-made talking points to calm doctors or family members who say “paying moms feels wrong.”
Why it matters
If you work with adults or consult to medical teams, you now have a script. Offer gift cards for verified healthy choices. Track behavior weekly. Share data with OB-GYNs. You expand ABA into public health while keeping the field’s ethical core intact.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Ask your next adult client what gift card would motivate her to log 8,000 steps—then set a one-week contract and graph the results.
02At a glance
03Original abstract
The World Health Organization has identified four behavioral health priorities as risk factors for noncommunicable diseases in maternal populations: tobacco use, harmful alcohol use, poor nutrition, and lack of physical activity. These risk factors also significantly affect pregnant and immediately postpartum mothers, doubling the health risk and economic burden by adversely affecting maternal and birth or infant outcomes. Psychosocial and behavioral interventions are ideal for pregnant and immediately postpartum women as opposed to pharmacotherapy. Among other behavioral interventions, the use of incentives based on the principles of reinforcement has been a successful yet controversial way to change health behaviors. Implementing an incentive-based intervention in maternal health often brings up social validity concerns. The existing guideline on how to develop and conduct research in incentive-based interventions for maternal health lacks enough information on the specific variables to control for to maintain the intervention’s effectiveness. This article outlines some of the critical variables in implementing an effective behavior–analytic intervention and addressing social validity concerns to change maternal behaviors in a sustainable manner, along with specific research topics needed in the field to prevent adverse maternal, birth, and infant outcomes.
Perspectives on Behavior Science, 2018 · doi:10.1007/s40614-018-0143-z