The Plight Of Pregnant Women In Rural Ghana

Cultural Barriers Such As Shaving Of Newborns Expose Them To Risks

Beyond later realizing how babies are born early in the teenage years after several myths, there had been several moments of wonder about the plight of pregnant women and how they cope for nine months.

It is true that pregnancy is not sickness but a condition; however, the condition itself is tilted relatively against women in the rural areas. In cities and towns in Ghana, women can easily get tested for pregnancy, undertake further tests to ascertain health of fetus and then start antenatal care with the attendant support mechanisms that can be built along the nine month journey.

Even so, the child mortality rate is at an astonishing 45 deaths per 1000 in Northern Ghana as the country makes efforts at a reduction to 25 per 1000. Pregnant women in the big towns and cities also enjoy a relatively stable transportation system (available vehicles and road network) and are also less affected by debilitating cultural barriers.

In contrast, rural women have to grapple with limited access to health services, poor road network which limits efforts to assisted delivery and unsupportive husbands who sometimes shout and beat up their pregnant wives when they ask for money to attend antenatal care or renew health insurance which affords them free medical care.

In many villages, pregnant women who deliver at the clinics or hospitals are regarded as weak, and with associated social pressure, many are forced to home deliver at the risk of their lives and babies. Delivering at home exposes mothers and babies to complications such as asphyxia, low birth weight, neonatal tetanus, and pneumonia among others.

In other cases, the pregnant women, husbands and larger family may support the idea of facility delivery but would have to reconsider due to poor road network, a situation that cuts off many communities especially during the rainy season and further discouraged by the long distance of travel to a clinic.

To address the issue of limited access to health services, the government of Ghana introduced the Community Based Health Planning Services-CHPS to bring health care closer to a larger number of people especially in the rural areas. As laudable as the initiative has been, the facilities are challenged by supply chain issues and unavailability of rapid test kits to check for malaria in pregnancy, protein urea, anemia and other prevalent conditions.

Rapid test kits deliver instant results without being referred to a laboratory which may be of considerable distance. CHPS facilities do not also undertake HIV/AIDS testing because of the unavailability of trained midwives who are expected to offer counseling services. Front line health personnel at these facilities also have to grapple with insufficient housing, work tools, and pressure of work which makes it difficult to offer appreciable services sometimes creating a hostile environment that mostly drive away pregnant women.

Complicating the situation is the fact that pregnant women in some rural communities in the Kintampo North, South, and Bole Districts are expected to perform farm duties and undertake household chores throughout the 37 weeks of pregnancy. This exposes them to a lot of dangers such as miscarriage, growth retardation of baby, and increase in the chance of maternal mortality when antenatal care is not regular.

Besides the challenges, women are often blamed and accused of witchcraft when they lose their baby without recourse to some of the challenges highlighted and unsupportive nature of the very people who accuse her. Their husbands adds insult to injury by taking up a second or third wife to spite the woman who may be nursing emotional wounds.

Realizing the effects of such challenges, the Northern Empowerment Association-NEA with support from CIDA in 2012 introduced the Leyaata Project (Leyaata means 'rescue us' in the Deg language of the Mo traditional area) to reduce maternal, infant and child mortality in 85 communities in the Bole, South Kintampo Districts, Wenchi and Kintampo Municipalities of Ghana. Program components include; establishing a prenatal and neonatal home visit system for pregnant women and infants, and a malaria control program that prioritizes mothers and infants.

For 25 years, NEA has worked in these areas through sustainable and integrated approach to development, thus helping empower thousands of households. The home visit system has been effective so far in educating families and husbands on the effects of cultural barriers to mothers and infants and has also built up support networks in several villages with residents, assembly men/women, chiefs, health centres, churches and youth groups. At the forefront of the system are trained volunteers who are empowered to educate pregnant mothers and families on need for facility delivery, care, sleeping under mosquito nets (LLINs) and checking for danger signs.

Through strategic partnerships with the Ghana Health Service-GHS, and the National Health Insurance Authority-NHIA, the intervention benefits from existing efforts whilst gathering and sharing useful grassroots health information with relevant stakeholders. The partnership is also geared towards addressing some of the constraints to assisted delivery including logistics and supply chain, capacity building for health workers as well as improving the CHPS concept.

By the end of the first quarter of this year, the Leyaata Project had achieved an unprecedented 10 per 1000 neonatal death rate which promises to go down further as efforts are underway to consolidate gains.

The home visit system is at the heart of addressing barriers against women determined to access health care and take control of their lives. With education at the household level, families are beginning to change attitudes from one of blame to providing support and encouragement. For such a laudable system that cost less in terms of resources, there is a clarion call for its wider adoption throughout the many villages of the country to enhance the initiative of taking health care to the doorsteps of Ghanaians especially in the rural areas.

Leyaata Supervisors Analyzing Field Data

Cultural Barriers Such As Shaving Of Newborns Expose Them To Risks

Yaw and Akosua Adu-Gyamfi, are project supervisors at the Northern Empowerment Association's Leyaata Project based in Carpenter in the Bole District of Ghana. Read more on project at www.grid-nea.org/leyaata-project/ . Comments can be sent via [email protected]