Indigenous beliefs and practices that influence the delayed attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa

Knowledge and attitudes of midwives towards collaboration with traditional birth attendants for maternal and neonatal healthcare services in rural communities in South Africa

OBJECTIVES

We assessed the knowledge and attitude of registered midwives towards collaborating with traditional birth attendants for maternal and neonatal healthcare services in rural communities.

DESIGN

A descriptive cross-sectional survey was followed in this study.

PARTICIPANTS

Registered midwives in selected clinics in the City of Tshwane Municipality. Participants were recruited by stratified random sampling. Data was collected at the Thirty-four primary healthcare facilities in Gauteng province, South Africa.

MEASUREMENT AND RESULTS

A self-assessment questionnaire was administered to 304 registered midwives. Two-hundred and sixty respondents returned the questionnaire representing a response rate of 86.6 % which was statistically significant. The majority of Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants). Only 30.8 % (n = 80) of midwives knew of the roles of traditional birth attendants for maternal and neonatal healthcare (MNH) services. With respect to knowledge, there was significant associated with the Professional category (p < 0.015). In terms of attitude, registered midwives displayed negative attitudes towards collaborating with traditional birth attendants (mean = 46.8, SD=2.1). Approximately half (54.2 %, n = 140) of midwives were amenable towards collaborating in the provision of antenatal care, and 70.4 % (n = 183) of midwives agreed to collaborate with traditional birth attendants for extended roles such as accompanying women to health facilities. Association of demographic data and level of attitude showed there was significant relationship (p < 0.05) between registered midwives' level of education and their attitude towards collaboration.

KEY CONCLUSIONS

Midwives demonstrated positive attitude towards collaborating with traditional birth attendants at the antenatal care level only. Midwives were not amenable to collaboration at the level of intrapartum and postpartum care.

IMPLICATIONS FOR PRACTICE

Based on our results, collaboration should be at antenatal care level to allow for early detection, treatment, and prevention of antenatal complications thus reducing maternal mortality and morbidity.

Factors associated with barriers to healthcare access among ever-married women of reproductive age in Bangladesh: Analysis from the 2017-2018 Bangladesh Demographic and Health Survey

BACKGROUND

Globally, women experience healthcare inequalities, which may contribute to excessive mortality rates at various stages of their lives. Though Bangladesh has achieved excellent progress in providing healthcare, the country still has some critical challenges that need immediate attention. The objective of this study is to examine the association between social determinants and barriers to accessing healthcare among ever-married women aged 15-49 in Bangladesh.

METHODS

The study was conducted among 20,127 women aged 15-49, using data from the 2017-2018 Bangladesh Demographic and Health Survey. Four barriers to healthcare were considered: whether women face problems with permission, obtaining money, distance, and companionship. The multivariable logistic regression analysis was used, with a broad array of independent variables (such as age, and educational level) to identify the determinants of barriers to healthcare access. The associations were expressed as adjusted odds ratios (AOR) with a 95% confidence interval (CI).

RESULTS

More than two-thirds (66.3%) of women reported having at least one perceived barrier to accessing healthcare. Women with a higher level of education (AOR = 0.49, 95% CI: 0.41-0.57), owning a mobile telephone (AOR = 0.78, 95% CI: 0.73-0.84), and those in the richest wealth quintile (AOR = 0.45, 95% CI: 0.38-0.52) had lower odds of having barriers to accessing healthcare. In addition, widowed (AOR = 1.53, 95% CI: 1.26-1.84), divorced (AOR = 1.91, 95% CI:1.47-2.48), or separated (AOR = 1.98, 95% CI: 1.46-2.69) women had higher odds of having a money barrier to accessing healthcare, than married women.

CONCLUSIONS

This study shows that individual-, household-, and community-level factors are associated with barriers to healthcare accessibility. To improve the state of women's health in Bangladesh, it is vital to consider these socio-economic factors and implement fundamental measures, such as supporting the national health policy, empowering women's socio-economic situation, and spreading the flexible way of healthcare access.

Exploring barriers to accessing healthcare services for older indigenous people in the Chittagong Hill Tract, Bangladesh

We aim to investigate the obstacles faced by elderly indigenous individuals in the Chittagong Hill Tracts, Bangladesh when accessing healthcare services. A qualitative research approach was utilized, and data collection was carried out in three distinct regions of the aforementioned area. A total of 30 in-depth, semi-structured interviews and participant observations were conducted to achieve the research objectives. Thematic analysis utilizing both a deductive and inductive approach was employed to analyze the data. The Granheim method and Nvivo-12 software were utilized to process, analyze and code the data. The study's findings indicate that a lack of knowledge about healthcare needs, geographical barriers, poor financial conditions, higher cost of medical services, scarcity of hospitals nearby and communication barriers all contribute to inadequate access to healthcare services. By recognizing the factors that impede access to healthcare services in this region, this study offers valuable insight for policymakers and healthcare providers on how to enhance healthcare services for the indigenous population, especially the elderly. Furthermore, the government can adopt a more efficient approach to include these elderly individuals in various social safety net programs.

Experiences of midwives regarding provision of culturally competent care to women receiving maternal care in South Africa

Due to the cultural diversity in South Africa, midwives are challenged to provide culturally competent, congruent, and sensitive maternal care. Using a qualitative descriptive design, this study aimed to explore and describe the experiences of midwives providing culturally competent care to women receiving maternal care within overburdened public hospitals. Purposive sampling of thirty-four (n = 34) midwives employed to provide maternal care (antenatal, intrapartum, and postpartum) at five public hospitals in the North West Province of South Africa was done. Semi-structured interviews were conducted in English and transcribed verbatim. Data was analysed thematically with the assistance of an independent co-coder. Data revealed that midwives viewed communication as a key component of cultural competence. Midwives do not necessarily understand the concept "cultural competence." It is recommended that a policy of culturally competent maternal care be developed and implemented by midwives in practice.

The Roles and Challenges of Traditional Health Practitioners in Maternal Health Services in Rural Communities of Mthatha, South Africa

Traditional health practitioners (THPs) are considered as the entry level of care in African societies and play an important role in the delivery of health services to the population. A phenomenological qualitative study was carried out among purposefully selected THPs in Mthatha to understand their roles and the challenges they face in providing maternal health services. The study included a focus group discussion with seven participants which yielded three themes and seven subthemes. The content analysis of descriptive data from the focus group discussion revealed threats posed by unregistered and counterfeit THPs to the lives of pregnant women in rural settings. The THPs' wide range of services allowed pregnant women to receive prenatal, antenatal, and postnatal care in proximity. However, this community level of care was marked by high levels of secrecy and counterfeit practitioners who used human body parts, which compromised the practice and rendered it unpopular. The South African government recommended the establishment of a register for THPs in order to protect the public, including the clarification of functional referral pathways between THPs and conventional health services.

Male partners’ experiences of early pregnancy ultrasound scans in Soweto, South Africa: The Healthy Pregnancy, Healthy Baby randomised trial

Background. Despite international evidence highlighting the benefits of male partners attending antenatal visits, including pregnancy ultrasound scans, it is unusual for South African (SA) men to attend such visits, and little is known about their experiences if they do. Objectives. To explore the experiences and antenatal attachment among male partners who attend early pregnancy ultrasound examinations in Soweto, SA. Methods. Pregnant women attending ultrasound examinations were invited to bring their partners with them. Both completed individual questionnaires, including the antenatal attachment scale. The results are based on a descriptive analysis of 102 mother-partner pairs. Results. The mean age of partners was 35 years. Only 32% of men were living with their pregnant partner. Before the ultrasound scan, 64% of men reported feeling very anxious, while 54% also felt anxious after the procedure. The ultrasound examination had a positive effect on men and their thoughts regarding their developing baby, with 30% stating that they were ready or excited to be a father. Twenty-eight percent believed their relationship with the mother was stronger as a result of participating in antenatal care. Conclusions. We found that prenatal ultrasound scans had a positive effect on male partners and their thoughts about the pregnancy, their forthcoming child and their relationship with and support for their partner. Health services in SA should accommodate partners/ fathers and encourage them to attend antenatal care, including pregnancy ultrasound scans. Interventions are needed to encourage more men to be involved – from conception – potentially addressing individual, familial, societal and structural barriers to involvement of the father in long-term maternal and child care.

Recognise and Acknowledge Us: Views of Traditional Birth Attendants on Collaboration with Midwives for Maternal Health Care Services

Background

Traditional birth attendants have since ancient time provided care to pregnant women. As such, the collaboration between midwives and traditional birth attendant (TBAs) can be an essential effort towards the reduction of the maternal and neonatal mortality and morbidity rate especially in low- and middle-income countries (LMICs). This paper argues that the collaboration between traditional and formal health systems expands the reach and improves outcomes of community health care. The study is aimed at exploring the traditional birth attendant's views on collaboration with midwives for maternal health care services at selected rural communities in South Africa (SA).

Methods

The study was conducted in two rural communities in Tshwane and Johannesburg metropolitan districts from 15 June to 31 October 2021. The study followed the qualitative explorative and descriptive research design. The sampling technique was nonprobability purposive, and snowballing technique was also used to sample the key informants who are the traditional birth attendants also known as traditional healers and who provide maternal health care services in the respective communities. The access to these participants was through the gatekeepers, the Traditional Health Organisation Council (THO) council. Data collection was through semistructured in-depth interviews. Data were analysed thematically through the eight steps of Tesch.

Results

Five main themes were identified which included the recognition of traditional birth attendants as enablers of collaboration, the envisaged value of the collaboration, processes required to foster collaboration, repositioning for new roles, and barriers to collaboration.

Conclusion

The TBAs are ready to collaborate with the formal health care system, and all they require is for their services to maternal health care to be recognised and acknowledged.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

Traditional Medicine Utilisation Among Pregnant Women in Sub-saharan African Countries: A Systematic Review of Literature

Traditional medicine has the potential to boost the health and economies of many SSA countries, especially if regulatory mechanisms are deployed to govern their protection and utilisation. There is lack of knowledge regarding traditional medicines and their impact on pregnancy. This paper reviews the literature on traditional medicine utilisation among pregnant women in Sub-Saharan African countries. The paper, determined the proportion of pregnant women utilising traditional medicines in Sub-Saharan Africa, identified the different types of traditional medicine used during antenatal care and reasons for Use in Sub-Saharan Africa and also identified challenges that are faced by women who use traditional medicine in antenatal care. A systematic exploratory review was conducted guided by the PRISMA framework. The databases that were searched included Google Scholar, PubMed, Cochrane, HINARI and the World Health Organization. Forty-one literature sources were eligible and included in the review process. Reported traditional medicine utilisation ranged between 12 and 93% among pregnant women in Sub-Saharan Africa. Different types of traditional medicines have been utilised in Sub-Saharan Africa for different purposes. Safety and poor management of usage were reported to be some of the challenges associated with traditional medicine. There is a need to determine chemical components and mode of action of these herbs as some could be beneficial, whilst others harmful, leading to severe pregnancy complications.

Are Indigenous research principles incorporated into maternal health research? A scoping review of the global literature

BACKGROUND

Indigenous women world-wide are diverse and heterogenous, yet many have similar experiences of colonization, land dispossession, and discrimination. These experiences along with inequitable access to, and quality of, maternal healthcare increase adverse maternal health outcomes. To improve health outcomes for Indigenous women, studies must be conducted with Indigenous involvement and reflect Indigenous research principles. Objectives/Aim: The aim of this review was to explore the range, extent, and nature of Indigenous maternal health research and to assess the reporting of Indigenous research principles in the global Indigenous maternal health literature.

METHODS

Following a systematic scoping review protocol, four scholarly electronic databases were searched. Articles were included if they reported empirical research published between 2000 and 2019 and had a focus on Indigenous maternal health. Descriptive data were extracted from relevant articles and descriptive analysis was conducted. Included articles were also assessed for reporting of Indigenous research principles, including Indigenous involvement, context of colonization, Indigenous conceptualizations of health, community benefits, knowledge dissemination to participants or communities, and policy or intervention recommendations.

RESULTS

Four-hundred and forty-one articles met the inclusion criteria. While studies were conducted in all continents except Antarctica, less than 3% of articles described research in low-income countries. The most researched topics were access to and quality of maternity care (25%), pregnancy outcome and/or complications (18%), and smoking, alcohol and/or drug use during pregnancy (14%). The most common study design was cross-sectional (49%), and the majority of articles used quantitative methods only (68%). Less than 2% of articles described or reported all Indigenous research principles, and 71% of articles did not report on Indigenous People's involvement.

CONCLUSIONS

By summarizing the trends in published literature on Indigenous maternal health, we highlight the need for increased geographic representation of Indigenous women, expansion of research to include important but under-researched topics, and meaningful involvement of Indigenous Peoples.

The tipping point of antenatal engagement: A qualitative grounded theory in Tanzania and Zambia

BACKGROUND

Effective antenatal care is fundamental to the promotion of positive maternal and new-born outcomes. International guidance recommends an initial visit in the first trimester of pregnancy, with a minimum of four antenatal visits in total: the optimum schedule being eight antenatal contacts. In low- and middle-income countries, many women do not access antenatal care until later in pregnancy and few have the recommended number of contacts.

AIM

To gain understanding of women's antenatal experiences in Tanzania and Zambia, and the factors that influence antenatal engagement.

METHODS

The study was underpinned by Strauss's grounded theory methodology. Interviews were conducted with 48 women, 16 partners, 21 health care providers and 11 stakeholders, and analysed using constant comparison.

FINDINGS

The core category was 'The tipping point of antenatal engagement', supported by four categories: awareness of health benefits, experiential motivators, influential support, and environmental challenges. Although participants recognised the importance of antenatal care to health outcomes, individual motivations and external influences determined attendance or non-attendance. The 'tipping point' for antenatal engagement occurred when women believed that any negative impact could be offset by tangible gain. For some women non-attendance was a conscious decision, for others it was an unchallenged cultural norm.

CONCLUSION

A complex interplay of factors determines antenatal engagement. Short-term modifiable factors to encourage attendance include the development of strategies for increasing respectful care; use of positive women's narratives, and active community engagement. Further research is required to develop innovative, cost-effective care models that improve health literacy and meet women's needs.

Influence of Cultural and Religious Practices on the Management of Pregnancy at Mbombela Municipality, South Africa: An Explorative Study

Background:

Cultural norms bring substantial weight in women’s decision-making, especially concerning the choice of the birth location. Cultural and religious practices may influence how pregnant women respond to Antenatal Care (ANC) services, feel confident about which questions to ask, or participate in the discussions about their care plan or birth options.

Purpose:

The study aimed to explore and describe the influence of cultural practices on the management of pregnancy in the Mbombela Municipality of Mpumalanga Province.

Methods:

Using a qualitative approach, pregnant women who failed to completely attend ANC services were purposively sampled, and individual unstructured in-depth interviews were employed to collect data. The study consisted of a sample size of 18 pregnant women, and data saturation was reached. Tech’s method of analysis was followed for data analysis.

Results:

Study findings revealed a significant theme: cultural practices and pregnancy management, encompassing three sub-themes: cultural practices in pregnancy, cultural medication taken by pregnant women, and the effects of cultural practices on pregnancy management.

Conclusion:

It is recommended that women should be given health education concerning ANC services every day while they wait in primary health care clinics. Accordingly, the healthcare professionals should encourage the active involvement of all pregnant women in health promotion gatherings and offer chances for clarity seeking. Despite the availability of free maternal healthcare services in primary healthcare clinics, women still consult traditional healers during pregnancy and believe in cultural practices. It is therefore important that programs developed for maternal services be congruent to the cultural practices of women to be serviced.

Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers' Perceptions

Background: We investigated pregnant women, community leaders, healthcare workers (HCWs) and programme managers' perceptions of maternal vaccination in Kampala, Uganda. Methods: We conducted focus group discussions, key informant interviews and in-depth discussions with HCWs (3), community leaders (3), pregnant women (8) and programme managers (10) between November 2019 and October 2020. Data were analysed thematically. Results: Pregnant women, community leaders and some HCWs had limited maternal immunisation knowledge. There was confusion over what constitutes a vaccine. Pregnant women may not receive vaccines because of mistrust of government; use of expired vaccines; reliance on traditional medicine; religious beliefs; fear of side effects; HCWs attitudes; and logistical issues. The key facilitators of maternal vaccination were a desire to prevent diseases, positive influences from HCWs and information about vaccine side effects. Community leaders and some pregnant women highlighted that pregnant women do not make decisions about maternal vaccination independently and are influenced by different individuals, including other pregnant women, older people, partners, relatives (parents), community leaders, HCWs and the government. Conclusions: Our results indicate that public health messaging should target all community members, including partners and parents of pregnant women as well as HCWs, to improve knowledge of and confidence in maternal vaccines.

Exploring traditional medicine utilisation during antenatal care among women in Bulilima District of Plumtree in Zimbabwe

Traditional medicine utilisation during antenatal care has been on the increase in several countries. Therefore, addressing and reinforcing the Sustainable Development Goal of maternal mortality reduction, there is a need to take traditional medicine utilisation during pregnancy into consideration. This paper explores traditional medicine utilisation during antenatal care among women in Bulilima District of Plumtree in Zimbabwe. A cross-sectional survey was conducted on 177 randomly selected women using a semi-structured questionnaire. Fisher's Exact Test, Odds Ratios, and Multiple Logistic Regression were utilised to determine any associations between different demographic characteristics and traditional medicine utilisation patterns using STATA SE Version 13. The prevalence of Traditional Medicine utilisation among pregnant women was estimated to be 28%. Most traditional remedies were used in the third trimester to quicken delivery. The majority of women used holy water and unknown Traditional Medicine during pregnancy. There was a strong association between age and Traditional Medicine utilisation as older women are 13 times more likely to use Traditional Medicine than younger ones. Women use traditional medicine for different purposes during pregnancy, and older women's likelihood to use Traditional Medicine is higher than their counterparts. The traditional system plays an essential role in antenatal care; therefore, there is a need to conduct further studies on the efficacy and safety of utilising Traditional Medicines.

Traditional food taboos and practices during pregnancy, postpartum recovery, and infant care of Zulu women in northern KwaZulu-Natal

BACKGROUND

Traditional practices and beliefs influence and support the behavior of women during pregnancy and childbirth in different parts of the world. Not much research has been conducted to examine whether and how cultural traditions continue to shape maternity experiences of Zulu women. The aim of this study is to establish the extent at which women in certain rural communities adhere to traditional food taboos and practices during pregnancy, postpartum recovery, and infants feeding, in comparison to what is recommended by health care workers.

METHODS

A survey was conducted in the rural northern KwaZulu-Natal between 2017 and 2020. A total of 140 women between the ages of 18 and 90 years were interviewed and they were chosen purposively based on their experiences in pregnancy, postpartum recovery, infant care, and their willingness to share the knowledge. Data were analyzed using descriptive statistics.

RESULTS

Most (64%) of the participants said that they adhered to these cultural food taboos and practices. The most common foods avoided were certain fruits [mango, naartjie, orange, papaya, and peach], butternut, eggs, sweets (sugar, commercial juice, sweet food, and honey), chili, ice, and alcohol. The most recommended foods during pregnancy were leafy vegetables, fruits (except the avoided ones), liver, and fish. For postpartum recovery, women mostly consumed soft porridge, all fruits and vegetables, beetroot, and tea. Food not allowed for children younger than 2 years included meat, sugar and sweets, and chewable foods.

CONCLUSION

Differences on food taboos and practices between participants who received formal education and those who did not received it were insignificant. The beliefs about the detrimental effects of some foods were not backed up by scientific research. Restriction of some orange/yellow colored fruits during pregnancy that are rich in vitamin A and/or C may affect daily requirements of these micronutrients, and the foods recommended during pregnancy and postpartum period would not provide all the essential nutrients required for successful pregnancy. However, some of the food taboos would protect women from unhealthy eating. Our findings provide a basis for developing culturally appropriate nutritional mediation programs for Zulu women with a view to provide effective nutritional counseling.

Predictors of health care practitioners' normative attitudes and practices towards sexual and reproductive health and rights: a cross-sectional study of participants from low-income countries enrolled in a capacity-building program

Background: Sexual and Reproductive Health and Rights (SRHR) is a concept of human rights applied to sexuality and reproduction. Suboptimal access to SRHR services in many low-income countries results in poor health outcomes. Sustainable development goals (3.7 and 5.6) give a new impetus to the aspiration of universal access to high-quality SRHR services. Indispensable stakeholders in this process are healthcare practitioners who, through their actions or inactions, determine a population’s health choices. Often times, healthcare practitioners’ SRHR decisions are rooted in religious and cultural influences. We seek to understand whether religious and cultural influences differ significantly according to individuals’ characteristics and work environment.

Objective: The purpose of this study was to examine the role of healthcare practitioners’ individual characteristics and their work environment in predicting normative SRHR attitudes and behaviours (practices). We hypothesized that religion and culture could be significant predictors of SRHR attitudes and practices.

Methods: A quantitative cross-sectional study of 115 participants from ten low-income countries attending a capacity-building programme at Lund University Sweden was conducted. Linear regression models were used to assess for the predictive values of different individual characteristics and workplace environment factors for normative SRHR attitudes and SRHR practices.

Results: Self-rated SRHR knowledge was the strongest predictor for both normative SRHR attitudes and normative SRHR practices. However, when adjusted for other individual characteristics, self-rated knowledge lost its significant association with SRHR practices, instead normative SRHR attitudes and active knowledge-seeking behaviour independently predicted normative SRHR practices. Contrary to our hypothesis, importance of religion or culture in an individual’s life was not correlated with the measured SRHR attitudes and practices.

Conclusion: Healthcare practitioners’ cultural and religious beliefs, which are often depicted as barriers for implementing full coverage of SRHR services, seem to be modified by active knowledge-seeking behaviour and accumulated working experience with SRHR over time.

Traditional birth attendants' experiences during the provision of post-natal care in Mopani District, Limpopo province of South Africa

Background

South African maternity care guidelines stipulate that post-natal patients can be discharged within 6 h after delivery, provided that the condition of mothers and neonates do not require medical, surgical or obstetric attention. Hence in many instances post-natal care is rendered at home by traditional birth attendants (TBAs). Traditional birth attendants play a crucial role in the care of women during pregnancy, birth and puerperium within communities.

Aim

To explore and describe the experiences of TBAs during the provision of post-natal care to mothers and their neonates in order to make recommendations to improve the quality of post-natal care delivered at home.

Setting

The community hall of a selected rural traditional community was used as a setting for data collection.

Methods

A qualitative, exploratory and descriptive design was used. Three focus groups were held with 26 TBAs whom were purposively selected. Data were analysed using qualitative content analysis.

Results

The study confirmed two categories that included: lack of supportive working relationships between TBAs and midwives and lack of respect of TBAs, by post-natal women.

Conclusion

It is evident that the TBAs experienced negative experiences. Therefore, initiation of teamwork, empowerment and confidence development are crucial to improve the working experiences of TBAs during the provision of post-natal care. Quality post-natal care might reduce maternal and neonatal morbidity and mortality rates. Teamwork between TBAs and midwives might be initiated. Continuity of care for post-natal women might be improved.

Use of traditional and complementary medicine for maternal health and wellbeing by African migrant women in Australia: a mixed method study

BACKGROUND

Traditional medicine serves as a form of primary health care for more than 80% of African populations. Currently, there is no research documenting if and how African migrant communities engage with their traditional health practices and beliefs after they resettle in Western countries. The aim of this study was to examine African migrant women's experiences and perspectives about traditional and complementary medicine use in relation to their maternal health and wellbeing in Australia.

METHODS

We conducted a mixed method study between December 2016 and October 2017. Questionnaires were completed by 319 women and 15 in-depth interviews were conducted among African migrant women residing across the Sydney metropolitan area, Australia. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by Andersen's Socio-behavioural model of health service utilisation.

RESULTS

The findings indicated that use of traditional and complementary medicine was high and continued to be well used following African women's resettlement in Australia. The survey found that 232 (72.7%) women use some form of traditional and complementary medicine for maternal health and wellbeing purposes. Most women (179, 77.2%) reported that maintaining their maternal health and wellbeing was the most common reason for use. The interview findings indicated that access to traditional medicine included making requests from relatives and friends who travelled to Africa looking for a similar medicinal plant in Australia and preparing home remedies with advice from family members and healers back in Africa. Age ≥ 35 years (OR, 16.5; 95%CI, 6.58-41.5; p < 0.001), lower education (OR, 24; 95%CI, 8.18-71.1; p < 0.001), parity (OR, 7.3; 95%CI, 1.22-42.81; p = 0.029), and lower income (OR, 2.7; 95%CI, 1.23-5.83; p = 0.013) were strong predictors of traditional medicine use.

CONCLUSION

Use of traditional and complementary medicine among African migrant women in Sydney remained high following resettlement in Australia. As noted in Andersen's sociobehavioural model of health service utilisation, specific predisposing and enabling factors including age, education and income were associated with use of traditional and complementary medicine.

Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa

Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and < 5 months, and a quarter (26.3%) attended ≥ 5 months. For those attending ≥ 5 months, 51.8% cited late recognition of pregnancy as the major reason for delayed attendance. Supply-side barriers were not identified as large contributing factors to delayed attendance. Late antenatal care access was predominantly associated with demand-side factors. Women who accessed antenatal care ≥ 5 months were more likely to be in the poorest 40% of the wealth-index distribution (p = 0.034) and to not have completed high school (p = 0.006). They were also more likely to report alcohol consumption during pregnancy (p = 0.020) and be multiparous (p = 0.035). Having completed high school was protective of late antenatal care access in stepwise logistic regression analysis (OR 0.403, CI 0.210-0.773, p < 0.01). For women who attended ≥ 3 months, late access was associated with unwanted pregnancy (p = 0.030). Conclusions for Practice Improved access to pregnancy tests could assist in earlier pregnancy identification. Interventions to increase awareness of the importance of early antenatal care attendance among vulnerable women may help.

Perceived causes of adverse pregnancy outcomes and remedies adopted by Kalenjin women in rural Kenya

Background

There have been few studies about the basis on which women in developing regions evaluate and choose traditional rather than western maternal care. This qualitative study explores the socio-cultural perceptions of complications associated with pregnancy and childbirth and how these perceptions influence maternal health and care-seeking behaviours in Kenya.

Methods

Kalenjin women (n = 42) aged 18–45 years, who were pregnant or had given birth within the last 12 months, were interviewed. A semi-structured interview guide was used for data collection. A further nine key informant interviews with Traditional Birth Attendants (TBAs) who were also herbalists (n = 6), community health workers (CHWs) (n = 3) and a Maternal and Child Health (MCH) nursing officer (n = 1) were conducted. The data were analysed using MAXQDA12 software and categorised, thematised and analysed based on the symbolic dimensions of Helman’s (2000) ill-health causation aetiologies model.

Results

Pregnancy complications are perceived as the consequence of pregnant women not observing culturally restricted and recommended behaviour during pregnancy, including diet; physical activities; evil social relations and spirits of the dead. These complications are considered to be preventable by following a restricted and recommended diet, and avoiding heavy duties, funerals, killing of animals and eating meat of animal carcasses, as well as restricting geographical mobility, and use of herbal remedies to counter evil and prevent complications.

Conclusion

Delay in deciding to seek maternal care is a result of women’s failure to recognise symptoms and maternal health problems as potential hospital cases, and this failure stems from culturally informed perceptions of symptoms of maternal morbidity and pregnancy complications that differ significantly from biomedical interpretations. Some of the cultural maternal care and remedies adopted to prevent pregnancy complications, such as restriction of diet and social mobility, may pose risks to the pregnant woman’s health and access to health facilities whereas other remedies such as restricting consumption of meat from animal carcasses and heavy duties, as well as maintaining good social relations, are cultural adaptive mechanisms that indirectly control the transmission of disease and improve maternal health, and thus should not be considered to be exclusively folk or primitive.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2041-5) contains supplementary material, which is available to authorized users.

Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

OBJECTIVE

This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.

DESIGN

Population-based cross-sectional survey.

SETTING

Nationwide representative data for women of reproductive age obtained from the 2015-2016 Tanzania Demographic and Health Survey were analysed.

PRIMARY OUTCOME MEASURES

A composite variable, 'problems in accessing healthcare', with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.

RESULTS

A total of 13 266 women aged 15-49 years, with a median age (IQR) of 27 (20-36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.

CONCLUSION

This study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women's problems associated with accessing healthcare.

Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies

BACKGROUND

The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.

METHODS

Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995-2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.

RESULTS

A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.

CONCLUSIONS

Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use.

The decision to seek care antenatally and during labour and birth - Who and what influences this in Timor-Leste? A qualitative project exploring the perceptions of Timorese women and men

BACKGROUND

While global maternal deaths have decreased significantly, hundreds of thousands of women still die from pregnancy and birth complications. Interventions such as skilled birth attendants, emergency transportation to health facilities and birth preparedness have been successful at reducing such deaths, however barriers to seeking, reaching, and receiving respectful care persist.

OBJECTIVE

This study aimed to identify what influences people's decisions to seek antenatal care and care during labour and birth in Timor-Leste, a low-middle income newly independent nation in South East Asia with a high maternal death rate. The study aimed to provide emic/local insights to help midwives and maternal health providers tailor care and resources appropriately, thus improving maternal health.

DESIGN

This qualitative study with a decolonising methodology, was designed to explore the perceptions of reproductive aged Timorese women and men, situating Timorese worldviews in the centre of the research process. Data collection occurred in four municipalities of Timor-Leste in October 2015 and included 9 focus group discussions with 80 men, and 17 individual reproductive history interviews with women.

FINDINGS

An expanded 'Three Delays' model was used to frame the findings. The study found multiple factors impacting on decisions to seek antenatal care and care during labour and birth. Husbands, history, minimal birth preparedness, ethno-physiological beliefs (personal perceptions of how the body works), infrastructure limitations, geographical location, hospital policies and staff attitudes influenced and potentially delayed the decision to seek or reach care.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE AND POLICY

Policies and programs that increase accessibility of midwives and encourage birth preparedness are vital. Given the current locus of power in families in Timor-Leste, it is imperative that men are educated regarding the importance of care from skilled providers, and supported to access such care with their partners. Culturally respectful, inclusive and quality care needs to be emphasised so that trust is established between health providers and communities.

Tanzanian Mothers' Cultural Beliefs and Misinformation Regarding the Reasons for Their Cesarean Sections

BACKGROUND

In Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers' understanding of the medical rationale for their CSs.

AIM

To identify mothers' cultural understandings of the rationale for their CSs.

METHODS

Design: A qualitative descriptive design was employed.

Setting: A government hospital in the western region in Tanzania.

Participants: A total of 117 mothers were interviewed using convenience sampling post CS.

FINDINGS

Forty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous CSs.

The emergent themes were lack of dietary knowledge, use of local herbs, delays in coming to hospital, avoiding stressful labor pains and no ability to exercise, and no personal preferences of “push or go for an operation.”

CONCLUSION

Pregnant women in Tanzania need improved health education to make informed choices about childbirth and be involved all processes of antepartum care decision making to achieve optimal birth outcomes.

Culture and Birth Outcomes in Sub-Saharan Africa: A Review of Literature

INTRODUCTION

Almost 830 women die daily in childbirth with 550 of those deaths occurring in sub-Saharan Africa. This region has the highest maternal mortality rates in the world with 546 deaths per 100,000 live births. Research must focus on understanding cultural beliefs and practices to improve maternal health outcomes. The purpose of this review is to provide evidence of relevant cultural beliefs and the impact on birth outcomes for women in sub-Saharan Africa.

METHOD

Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the literature focused on 25 articles that defined, directly or indirectly, associations of cultural values, beliefs, and lifeways to pregnancy and birth from the perspective of women of childbearing age.

RESULTS

Three relevant categories emerged from the literature: birth outcomes, maternal care-seeking, and maternal culture care.

DISCUSSION

Women's voices and an understanding of cultural constructs of care are required to encourage the use of biomedical health system along with the use of indigenous practices.

Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries

Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.

The use of traditional medicine in maternity care among African women in Africa and the diaspora: a systematic review

BACKGROUND

There is a paucity of literature describing traditional health practices and beliefs of African women. The purpose of this study was to undertake a systematic review of the use of traditional medicine (TM) to address maternal and reproductive health complaints and wellbeing by African women in Africa and the diaspora.

METHOD

A literature search of published articles, grey literature and unpublished studies was conducted using eight medical and social science databases (CINAHL, EMBASE, Infomit, Ovid Medline, ProQuest, PsychINFO, PubMed and SCOPUS) from the inception of each database until 31 December 2016. Critical appraisal was conducted using a quality assessment tool (QAT).

RESULT

A total of 20 studies conducted in 12 African countries representing 11,858 women were included. No literature was found on African women in the diaspora related to maternal use of TM or complementary and alternative medicine (CAM). The prevalence of TM use among the African women was as high as 80%. The most common TM used was herbal medicine for reasons related to treatment of pregnancy related symptoms. Frequent TM users were pregnant women with no formal education, low income, and living far from public health facilities. Lack of access to the mainstream maternity care was the major determining factor for use of TM.

CONCLUSION

TM is widely used by African women for maternal and reproductive health issues due to lack of access to the mainstream maternity care. Further research is required to examine the various types of traditional and cultural health practices (other than herbal medicine), the beliefs towards TM, and the health seeking behaviors of African women in Africa and the diaspora.

Investigating the accessibility factors that influence antenatal care services utilisation in Mangwe district, Zimbabwe

BACKGROUND

Maternal and infant mortality remains a huge public health problem in developing countries. One of the strategies to minimise the risks of both maternal and infant mortality is access to and utilisation of antenatal care (ANC) services.

AIM

This study aimed to investigate the accessibility factors that influence the use of ANC services in Mangwe district.

METHODS

A qualitative approach using explorative design was adopted to target women who have babies under 1 year of age. The study was conducted in Mangwe district, Matabeleland South province, Zimbabwe. Data were collected through semi-structured interviews and observations. Data saturation was reached after 15 women who were conveniently sampled were interviewed. Field notes were analysed thematically using Tech's steps. Lincoln and Guba's criteria ensured trustworthiness of the study findings.

RESULTS

Accessibility factors such as lack of transport, high transport costs and long distances to health care facilities, health care workers' attitudes, type and quality of services as well as delays in receiving care influence women's utilisation of ANC services in Mangwe district, Zimbabwe.

CONCLUSION

The study concluded that women were still facing problems of unavailability of nearby clinics; therefore, it was recommended that the government should avail resources for women to use.

RECOMMENDATIONS

Mangwe District Health Department should provide mobile clinics rendering ANC services in distant rural areas.

Food beliefs and practices among the Kalenjin pregnant women in rural Uasin Gishu County, Kenya

BACKGROUND

Understanding food beliefs and practices is critical to the development of dietary recommendations, nutritional programmes, and educational messages. This study aimed to understand the pregnancy food beliefs and practices and the underlying reasons for these among the contemporary rural Kalenjin communities of Uasin Gishu County, Kenya.

METHODS

Through semi-structured interviews, data was collected from 154 pregnant and post-natal Kalenjin women about restricted and recommended foods, and why they are restricted or recommended during pregnancy. Respondents were purposively selected (based on diversity) from those attending Maternal and Child Health (MCH) care in 23 rural public health facilities. Key informant interviews (n = 9) with traditional Birth Attendants (TBA) who were also herbalists, community health workers, and nursing officers in charge of MCH were also conducted. Quantitative data was analysed using SPSS software. Data from respondents who gave consent to be tape recorded (n = 42) was transcribed and qualitatively analysed using MAXQDA software.

RESULTS

The restriction of animal organs specifically the tongue, heart, udder and male reproductive organs, meat and eggs, and the recommendation of traditional green vegetables and milk was reported by more than 60% of the respondents. Recommendation of fruits, traditional herbs, ugali (a dish made of maize flour, millet flour, or Sorghum flour, sometimes mixed with cassava flour), porridge and liver, and restriction of avocadoes and oily food were reported by more than 20% of the respondents. The reasons for observing these dietary precautions were mainly fears of: big foetuses, less blood, lack of strength during birth, miscarriages or stillbirths, and maternal deaths as well as child's colic and poor skin conditions after birth.

CONCLUSION

Pregnancy food beliefs were widely known and practised mainly to protect the health of the mother and child, and ensuring successful pregnancy outcome. Given the deep-rooted nature of the beliefs, it is advisable that when nutritious foods are restricted, nutritional interventions should rather search for alternative sources of nutrition which are available and considered to be appropriate for pregnancy. On the other hand, nutritional advice that does not address these health concerns and assumptions that underlie successful pregnancy and delivery is unlikely to be effective.

Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review

BACKGROUND

Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services.

METHODS

A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria.

RESULTS

Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines.

CONCLUSIONS

Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA.

TRIAL REGISTRATION

A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .

Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana

Background

Women have experienced severe labour pain over the years and various attempts have been made to effectively manage labour pain. However, there is paucity of literature on the labour pain experience and perceptions about labour pain with the contemporary Ghanaian health system. Therefore this study sought to gain an in-depth understanding on labour pain experiences and perceptions of post-partum women.

Methods

The study adopted an exploratory descriptive qualitative approach and collected data through individual interviews. Informed consent was obtained from all the participants who were purposively sampled. After transcription of interviews, the data were analyzed inductively using content analysis techniques.

Results

Women in this study experienced pain during labour rated as mild, moderate and severe and the pain was felt at the waist area, vagina, lower abdomen and the general body. The women expressed labour pain through crying, screaming and shouting. They prayed to God to help reduce the severe pain. Some women endured the pain, cried inwardly and others showed no sign of pain. Some women believed that crying during labour is a sign of weakness. Pain reliefs such as pethidine (Meperidine) was occasionally given. Non-pharmacologic measures employed included walking around, deep breathing, side-lying, waist holding, squatting, taking a shower and chewing gum. The individuality of pain experience and expression was emphasized and the socio-cultural orientation of women made some of them stoic.

Conclusion

We concluded that it is necessary for all health professionals to manage labour pain effectively taking the socio-cultural context into consideration.

Predictors of nurses' and midwives' intentions to provide maternal and child healthcare services to adolescents in South Africa

Background

Adolescent mothers are at a much higher risk for maternal mortality compared to mothers aged 20 years and above. Newborns born to adolescent mothers are also more likely to have low birth weight, with the risk of long-term effects such as early onset of adult diabetes than newborns of older mothers. Few studies have investigated the determinants of adequate quality maternal and child healthcare services to pregnant adolescents. This study was conducted to gain an understanding of nurses’ and midwives’ intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa.

Methods

A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components on demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude towards family planning services, subjective norms regarding maternal and child healthcare and family planning services, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide maternal and child healthcare and family planning services to adolescents. Pearson’s correlation analysis was conducted to determine the association between knowledge, attitude, subjective norms, self-efficacy, and intention variables for FP and MCH services. A 2-step linear regression analysis was then conducted for both FP and MCH services to predict the intentions to provide FP and MCH services to adolescents.

Results

Self-efficacy to conduct MCH services (β = 0.55, p < 0.01) and years of experience as a nurse- midwife (β = 0.14, p < 0.05) were associated with stronger intentions to provide the services. Self-efficacy to provide FP services (β = 0.30, p < 0.01) was associated with stronger intentions to provide FP services.

Conclusions

Self-efficacy has a strong and positive association with the intentions to provide both MCH and FP services, while there is a moderate association with attitude and norms. There is a need to improve and strengthen nurses’ and midwives’ self-efficacy in conducting both MCH and FP services in order to improve the quality and utilization of the services by adolescents in South Africa.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1901-9) contains supplementary material, which is available to authorized users.

Experiences and perceptions of Ghanaian midwives on labour pain and religious beliefs and practices influencing their care of women in labour

Background

Beliefs surrounding pain during childbirth has biblical foundations that contribute to labour pain being viewed as a natural phenomenon. Contemporary health care promotes evidence-based labour pain management but the faith of the midwife may influence her midwifery practice regarding labour pain management. Therefore this study sought to gain in-depth insight into the experiences and perceptions of midwives regarding labour pain and the religious beliefs and practices influencing their care of women in labour in Ghana.

Methods

The design of the study was an interpretive phenomenology using individual in-depth interviews. The study participants were 27 Ghanaian female midwives of various religious backgrounds. Interviews were conducted in English, audio-taped and transcribed verbatim. Colaizzi’s qualitative analysis procedures were employed concurrently with data collection.

Results

Three major themes were generated: religious beliefs about labour pain, religious practices in labour and religious artefacts used in labour. The midwives’ faith and their experiences during their midwifery practice were inter-connected. The midwives believed labour pain was natural and religious practices are important to prevent complications. Religious artefacts used in labour included anointing oil and water, necklaces, rubber bands, bracelets, stickers and beads.

Conclusion

It is important that midwives provide an enabling environment for women in labour to practice their faith and they should employ context-appropriate strategies to effectively manage labour pain that takes into account the religious beliefs and practices of women.

Eating soup with nails of pig: thematic synthesis of the qualitative literature on cultural practices and beliefs influencing perinatal nutrition in low and middle income countries

BACKGROUND

The perinatal period, i.e. pregnancy, childbirth and early infancy, is a significant transition period where the biological and the social strongly intersect. In low and middle-income countries the disease burden arising from the perinatal period, is still substantial. The perinatal period is also a crucial window of opportunity for reducing undernutrition and its long term adverse effects.

METHODS

We explored qualitative research conducted in low resource settings around the perinatal continuum over the past two decades, with a particular focus on the 'cultural' realm, to identify common themes influencing maternal and infant nutrition. We systematically searched electronic databases from 1990 to 2014, including MEDLINE, EMBASE, PsycINFO, Scopus and Cumulative Index to Nursing and Allied Health Literature, using relevant search terms including traditional beliefs, practices, pregnancy, childbirth, developing countries etc. Adapted Consolidated Criteria for Reporting Qualitative Health Research and Critical Appraisal Skills Programme criteria were used to determine quality of studies. We synthesised the literature thematically, enabled by NVivo 10 software.

RESULTS

Most studies showed cultural support for breastfeeding, although most traditional societies delayed breastfeeding due to colostrum being considered 'dirty'. A range of restrictive practices through pregnancy and the post- partum period were revealed in Asia, Latin America and Africa. There was a strong cultural understanding of the healing power of everyday foods. A wide range of good foods and bad foods continued to have currency through the perinatal continuum, with little consensus between groups of what was beneficial versus harmful. Cross-cutting themes that emerged were 1) the role of the woman/mother/wife as strong and good; 2) poverty restricting women's nutrition choices; 3) change being constant, but the direction of change unpredictable.

CONCLUSIONS

A rich and diverse repertoire of cultural practices and beliefs influenced perinatal nutrition. Results from this synthesis should influence public health policymakers and practitioners, to tailor contextually specific, culturally responsive perinatal nutrition interventions to optimise health and wellbeing of mother-infant dyads. Ideally these interventions should build on culturally sanctioned life affirming behaviours such as breastfeeding, promoting post-partum rest and recovery, while modifying the potentially harmful aspects of other cultural practices in the perinatal period.

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey

Background

Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa.

Methods

Data from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents’ last pregnancy.

Results

Overall prevalence among urban women of early ANC initiation was 46 % and 84 % for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45 % and 78 % for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95 % CI 1.0–2.5) and wanted pregnancy (OR 1.8; 95 % CI 1.1–3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95 % CI 1.0–3.6) but inversely associated with high religiosity (OR 0.5; 95 % CI 0.3–0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95 % CI 1.9–9.3) and the father of the child being present in the respondent’s life (OR 3.0; 95 % CI 1.0–9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95 % CI 0.2–0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site.

Conclusion

The majority of women from both sites attended ANC frequently but less than 50 % initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women’s reproductive health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0807-1) contains supplementary material, which is available to authorized users.

The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

BACKGROUND

Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.

METHODS

A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.

RESULTS

Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.

CONCLUSIONS

The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

Barriers to early prenatal care in South Africa

OBJECTIVE

To understand the barriers delaying early prenatal care for women in South Africa.

METHODS

A mixed-methods study was conducted at a center in Pretoria.

RESULTS

Following interviews with 21 women at a prenatal clinic in Pretoria, a quantitative survey was completed by 204 postpartum women. During interviews, women described presenting late owing to contemplating induced abortion, fear of HIV testing, and fear of jealousy and bewitching. The survey results demonstrated that a majority of women (133 [65.2%]) reported knowledge of recommendations to present before 12weeks; however, the average gestational age at initial presentation was 19.1±7.7weeks. Women were more likely to present earlier if the pregnancy was planned (P=0.013) and were less likely to if they had at any point contemplated induced abortion (P=0.021). Fears of bewitching and harmful psychological stress owing to a positive HIV test result prevailed in both the interviews and the surveys.

CONCLUSION

Significant efforts should be devoted to improving access to contraception and prepregnancy counseling in order to improve early prenatal care attendance. Similarly, addressing cultural concerns and fears regarding pregnancy is imperative in promoting early attendance.

Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review

Background

High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care.

Methods

Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded.

Findings

Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients’ attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being.

Conclusions

The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12992-015-0117-9) contains supplementary material, which is available to authorized users.

Comparison between indigenous and Western postnatal care practices in Mopani District, Limpopo Province, South Africa

BACKGROUND

Postnatal care begins immediately after the expulsion of the placenta and continues for six to eight weeks post-delivery. High standard of care is required during the postnatal period because mothers and babies are at risk and vulnerable to complications related to postpartum haemorrhage and infections. Midwives and traditional birth attendants are responsible for the provision of postnatal care in different settings, such as clinics and hospitals, and homes.

METHODS

A qualitative, exploratory, descriptive and contextual research approach was followed in this study. Unstructured interviews were conducted with the traditional birth attendants. An integrated literature review was conducted to identify the Western postnatal care practices. Tesch's process was followed during data analysis.

FINDINGS

The following main categories were identified: similarities between indigenous and Western postnatal care practices, and differences between indigenous and Western postnatal care practices. Based on these findings, training of midwives and traditional birth attendants was recommended in order to empower them with knowledge and skills regarding the indigenous and Western postnatal care practices.

CONCLUSIONS

It is evident that some indigenous postnatal care practices have adverse effects on the health of postnatal women and their newborn infants, but these are unknown to the traditional birth attendants. The employment of indigenous postnatal care practices by the traditional birth attendants is also influenced by their cultural beliefs, norms, values and attitudes. Therefore, there is an urgent need to train midwives and traditional birth attendants regarding the indigenous and Western postnatal care to improve the health of postnatal women and their babies.

Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study

BACKGROUND

In western Kenya, maternal mortality is a major public health problem estimated at 730/100,000 live births, higher than the Kenyan national average of 488/100,000 women. Many women do not attend antenatal care (ANC) in the first trimester, half do not receive 4 ANC visits. A high proportion use traditional birth attendants (TBA) for delivery and 1 in five deliver unassisted. The present study was carried out to ascertain why women do not fully utilise health facility ANC and delivery services.

METHODS

A qualitative study using 8 focus group discussions each consisting of 8-10 women, aged 15-49 years. Thematic analysis identified the main barriers and facilitators to health facility based ANC and delivery.

RESULTS

Attending health facility for ANC was viewed positively. Three elements of care were important; testing for disease including HIV, checking the position of the foetus, and receiving injections and / or medications. Receiving a bed net and obtaining a registration card were also valuable. Four barriers to attending a health facility for ANC were evident; attitudes of clinic staff, long clinic waiting times, HIV testing and cost, although not all women felt the cost was prohibitive being worth it for the health of the child. Most women preferred to deliver in a health facility due to better management of complications. However cost was a barrier, and a reason to visit a TBA because of flexible payment. Other barriers were unpredictable labour and transport, staff attitudes and husbands' preference.

CONCLUSIONS

Our findings suggest that women in western Kenya are amenable to ANC and would be willing and even prefer to deliver in a healthcare facility, if it were affordable and accessible to them. However for this to happen there needs to be investment in health promotion, and transport, as well as reducing or removing all fees associated with antenatal and delivery care. Yet creating demand for service will need to go alongside investment in antenatal services at organisational, staffing and facility level in order to meet both current and future increase in demand.

Determinants of access to and use of maternal health care services in the Eastern Cape, South Africa: a quantitative and qualitative investigation

Background

The main aim of the study is to examine whether women in Mdantsane are accessing and using maternal health care services. Accessibility of maternal health care facilities is important in ensuring that lives are saved through the provision and use of essential maternal services. Therefore, access to these health care services directly translates to use – that is, if women cannot access life-saving maternal health care services, then use of such services will be limited.

Findings

The study makes use of mixed methods to explore the main factors associated with access to and use of maternal health care services in Mdantsane. For the quantitative approach, we collected data using a structured questionnaire. A sample of 267 participants was selected from health facilities within the Mdantsane area. We analyzed this data using bivariate and multivariate models. For the qualitative approach, we collected data from health care professionals (including nurses, doctors, and maternal health specialists) using one-on-one interviews. The study found that women who were aged 35–39, were not married, had secondary education, were government employees, and who had to travel less than 20 km to get to hospital were more likely to access maternal health services. The qualitative analysis provided the insights of health care professionals regarding the determinants of maternal health care use. Staff shortages, financial problems, and lack of knowledge about maternal health care services as well as about the importance of these services were among the major themes of the qualitative analysis.

Conclusion

A number of strategies could play a big role in campaigning for better access to and use of maternal health services, especially in rural areas. These strategies could include (a) the inclusion of the media in terms of broadcasting information relating to maternal health services and the importance of such services, (b) educational programs aimed at enhancing the literacy skills of women (especially in rural areas), (c) implementing better policies that are aimed at shaping the livelihoods of women, and (d) implementing better delivery of maternal health care services in rural settings.

Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya

Background

The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality. Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits.

Methods

We used survey data from 6,200 pregnant women across six districts in western Kenya to understand demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative importance of individual, household and village-level factors in relation to ANC use.

Results

There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance. Maternal age, the number of small children in the household, and ownership of livestock were important in some districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation remained in the outcome.

Conclusions

ANC attendance was consistently low across all the districts, but factors related to poor attendance varied. This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context. Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to reach women who work outside the home.

Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies

BACKGROUND

Almost 50% of women in low- and middle-income countries (LMICs) don't receive adequate antenatal care. Women's views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies.

METHODS AND FINDINGS

Using a predetermined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMICs who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line-of-argument synthesis. We derived policy-relevant hypotheses from the findings. We included 21 papers representing the views of more than 1,230 women from 15 countries. Three key themes were identified: "pregnancy as socially risky and physiologically healthy", "resource use and survival in conditions of extreme poverty", and "not getting it right the first time". The line-of-argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralised, risk-focused antenatal care programmes may be at odds with the resources, beliefs, and experiences of pregnant women who underuse antenatal services.

CONCLUSIONS

Our findings suggest that there may be a misalignment between current antenatal care provision and the social and cultural context of some women in LMICs. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences is likely to be underused, especially when attendance generates increased personal risks of lost family resources or physical danger during travel, when the promised care is not delivered because of resource constraints, and when women experience covert or overt abuse in care settings.

Rural Indonesia women's traditional beliefs about antenatal care

Background

The Indonesia Maternal Mortality Rate (MMR) of 420/100.00 live births remains among the highest in East Asia while coverage of births assisted by skilled providers is still low. Traditional beliefs have been a key factor associated with the choice between midwives or traditional birth attendants (TBA) and the low number of antenatal care visits in rural West Sumatra.

Methods

We conducted three focus groups with 16 women from rural West Java to describe their perception regarding issues related to traditional beliefs. Focus group discussions provided data for the content analysis.

Results

The majority of the 16 women interviewed was from Village Dago, West Java and had only an elementary school education. Their ages ranged from 19 to 40 years. Most were multiparous housewives with an income of IDR 918.750 per month, which was lower than the monthly income in West Java (IDR. 1.172.060). Emerging from the focus group discussion were four main themes regarding their pregnancy and traditional beliefs: 1) pregnancy was a normal cycle in women’s life (pregnancy is a natural phenomena, not a sickness; no recognition of danger signs during pregnancy and death of baby or mother during pregnancy was brought about by God’s will); 2) women followed the traditional beliefs (positive motivation to follow the traditional beliefs and fear of not following the traditional beliefs); 3) relying on TBA called paraji rather than midwife (parajis are kind, tolerant and patient and have more experience than midwives; more accessibility than midwives and encouragement of natural birth) and 4) midwives are more secure than paraji; (they use a medical standard of care).

Conclusions

Women’s beliefs grounded in religion and tradition permeated the village culture making it difficult to counter their long held health practices with practices based on recent advances in health care. Use of TBA in this village was still dominant and women believed that following traditional beliefs led to a healthy pregnancy therefore, they also followed all relatives’ suggestions. Understanding the complexities of local culture is the first step to improving women’s awareness of how to preserve their pregnancy and prevent complications.