The influence of socio-cultural interpretations of pregnancy threats on health-seeking behavior among pregnant women in urban Accra, Ghana

Abstract

BackgroundAlthough antenatal care coverage in Ghana is high, there exist gaps in the continued use of maternity care, especially utilization of skilled assistance during delivery. Many pregnant women seek care from different sources aside the formal health sector. This is due to negative perceptions resulting from poor service quality experiences in health facilities. Moreover, the socio-cultural environment plays a major role for this care-seeking behavior. This paper seeks to examine beliefs, knowledge and perceptions about pregnancy and delivery and care-seeking behavior among pregnant women in urban Accra, Ghana.MethodsA qualitative study with 6 focus group discussions and 13 in-depth interviews were conducted at Taifa-Kwabenya and Madina sub-districts, Accra. Participants included mothers who had delivered within the past 12 months, pregnant women, community members, religious and community leaders, orthodox and non-orthodox healthcare providers. Interviews and discussions were audio-taped, transcribed and coded into larger themes and categories.ResultsEvidence showed perceived threats, which are often given socio-cultural interpretations, increased women’s anxieties, driving them to seek multiple sources of care. Crucially, care-seeking behavior among pregnant women indicated sequential or concurrent use of biomedical care and other forms of care including herbalists, traditional birth attendants, and spiritual care. Use of multiple sources of care in some cases disrupted continued use of skilled provider care. Furthermore, use of multiple forms of care is encouraged by a perception that facility-based care is useful only for antenatal services and emergencies. It also highlights the belief among some participants that care from multiple sources are complementary to each other.ConclusionsSocio-cultural interpretations of threats to pregnancy mediate pregnant women’s use of available healthcare services. Efforts to encourage continued use of maternity care, especially skilled birth assistance at delivery, should focus on addressing generally perceived dangers to pregnancy. Also, the attractiveness of facility-based care offers important opportunities for building collaborations between orthodox and alternative care providers with the aim of increasing use of skilled obstetric care. Conventional antenatal care should be packaged to provide psychosocial support that helps women deal with pregnancy-related fear.

Provision and uptake of routine antenatal services: a qualitative evidence synthesis

“…Sometimes these fears were based on religious beliefs, but in most cases the influence of sinister forces, described as evil spirits or 'the evil eye', restricted or delayed ANC engagement, “It is a traditional belief; there are some people that when you tell them and they have evil eyes and mind they can destroy it [the foetus] so unless the pregnancy shows then you tell. If not when it is two or three months you cannot tell” (Dako‐Gyeke 2013, Ghana). In other contexts, faith in the knowledge of traditional or spiritual healers limited ANC engagement, "When some women conceive they always have pain.…”

“…b Andrew 2014 (PNG); Ayala 2013 (Peru); Chowdhury 2003 (Bangladesh); Dako‐Gyeke 2013 (Ghana); Griffiths 2001 (India); Mrisho 2009 (Tanzania); Mumtaz 2007 (Pakistan); Munguambe 2016 (Mozambique); Rahmani 2013 (Afghanistan); Simkhada 2010 (Nepal); Stokes 2008 (Gambia).…”

“…i Ayiasi 2013 (Uganda); Bessett 2010 (USA);Cabral 2013 (Brazil); Dako‐Gyeke 2013 (Ghana); Kabakian‐Khasholian 2000 (Lebanon); Mahiti 2015 (Tanzania); Østergaard 2015 (Burkina Faso); Worley 2004 (New Zealand).…”

Pathways Utilized for Antenatal Health Seeking Among Women in the Ga East District, Ghana

“…Firstly, based on evidence from the qualitative enquiries (reported elsewhere) 13 which demonstrated strong belief among women in the use of alternative and simultaneous antenatal care among most of the women suggests that, our estimate of alternative care seeking is likely to be less than reality. The evidence suggests further that it may be difficult to routinely obtain a true estimate of alternative care seeking using a recall survey tool, as was used in the current survey.…”

The effects of facility-related factors on perinatal outcomes-a study of mothers attending antenatal services at public and non-public health facilities in Kisii County in the context of free maternity care services

“…However, the health outcome of a pregnancy is potentially affected by the quality of service delivery received within a health facility ranging from competencies of service providers, staffing ratios to emergency response systems in the facility among other factors [5]. Most abnormal perinatal outcomes are caused by factors that can easily be prevented through skilled care during delivery and immediate neonatal period [6].Evidence also shows that timely referrals for emergency obstetric care (EmOC) and access to skilled birth attendance leads to better perinatal outcomes [7].Therefore, the longitudinal study in Kisii County in 2015/2016 delved into understanding how perinatal outcomes correlated with other determinants such as infrastructure and human resource in a context of free maternity services [8,9].…”