Background Zambia has one of the world’s highest maternal mortality ratio (MMR) at 591 per 100,000 live births. Most maternal deaths occur amongst the poorest in rural areas. The majority (59%) of the Zambian population live below the poverty datum line. Limited access to and low utilisation of facility-based skilled delivery services are key factors contributing to the high MMR. Although the single antenatal attendance rate is high (93%), institutional deliveries are still low (48%). According to the WHO, institutional delivery by skilled birth attendants is the single most important strategy to reduce MMR. One of the important barriers to institutional delivery is demands made by health providers in health facilities for pregnant women to bring delivery supplies such as mother and baby clothes and delivery materials. The aim of this study was to determine the effect of provision of non-financial incentives accompanied by health education on increasing institutional deliveries in Monze, a rural district in Zambia.

Methods This is a prospective community intervention trial from Jan–Dec 2014. The district was divided into two comparable rural regions, intervention and control arms. The two regions were separated by a central urban region. In the intervention arm expectant women who chose to give birth at health facility received a mother-baby delivery pack at health facility containing a pair of delivery gloves, baby napkins and blanket, bottle of petroleum jelly (Vaseline gel), soap, a mother’s wrapper (chitenge) (baby carrier) and an insecticide-treated mosquito net as non-financial incentives. Women in the control arm continued with routine health services. The primary outcome measure was comparison of the number of institutional deliveries in the two arms over one year, as well as comparing institutional deliveries before (2012 and 2013) and after (2014) the intervention.

Results The primary outcome measure showed an increase in the number of institutional deliveries in the intervention arm in 2014 by 43% (p < 0.000; n = 2396) compared to 2013 (n = 1674) and 2012 (p < 0.000; n = 1680), while in the control arm the numbers of deliveries did not significantly change over the three years (2012 n = 1182; 2013 n = 1322; 2014 n = 1182; p > 0.103)

Conclusion The mother-baby delivery pack provides a high impact low cost, easier to replicate and scale up intervention addressing key hidden barriers to institutional deliveries. The  study results will provide scientific evidence for policymakers to design effective interventions to overcome reversible barriers hindering utilisation of health facilities for delivery, which is key to MMR reduction.