ABSTRACT
This study aimed at exploring the postnatal healthseeking behaviors of postpartum mothers in Teshie. The specific objectives included to (a) explore the factors that influence postpartum mothers’ decision in seeking postnatal care in Teshie, (b) find out benefits of postnatal care to postpartum mothers in Teshie, (c) ascertain barriers postpartum mothers in Teshie face while seeking postnatal care and (d) identify strategies postpartum mothers adopt to address challenges in seeking postnatal care in Teshie. Twenty postpartum mothers, five midwives and five traditional birth attendants were recruited for the study. Data was gathered through in-depth interviews and was analyzed employing Braun and Clark’s (2006) six steps of thematic data analysis. The study found out that, postpartum mothers decisions in seeking postnatal care was influenced by their perceptions and knowledge of postnatal care as well as their place of delivery and the healthcare provider.The study established that postpartum mothers recognized postnatal as being beneficial to their health and that of their infants. Financial constraints, restriction from spouses, negative attitude of midwives as well as facility- based challenges were barriers which hindered the successful utilization of postnatal care.The study further found out that, strategies adopted by postpartum mothers to cope with challenges included early or late arrival to the health facilities, savings and tolerance of the attitude of midwives. In view of these findings, the study recommended that midwives in health facilities should intensify education for postpartum mothers’ on the usefulness of postnatal care to mothers and newborns, inclusion of postnatal care in the National Health Insurance Scheme and management of the hospitals in collaboration with the Ministry of Health should ensure that facility-based challenges would be solved inorder to minimize challenges encountered by postpartum mothers and finally, seminars should be organized regularly for midwives to encourage them to relate healthily with postpartum mothers.
CHAPTER ONE INTRODUCTION
Background of the Study
Over the past decades, maternal and infant health continues to be an area of concern to countries the world over especially after delivery (Amuyunzu-Nyamongo & Nyamongo, 2006; Shaikh & Hatcher, 2004). This is because, maternal and infant mortality has a devastating effect on the development of countries due to the fact that the health of mothers and infants is mostly regarded as an indicator of the overall health of a society (World Health Organization, 2016). The survival of mothers and their newborns depends largely on the type of appropriate after delivery care they receive within six weeks after delivery to ensure their total wellbeing (Tinker & Ransom, 2002). Postnatal care involves a formal healthcare service designed to prevent and mitigate delivery complications that may affect the health of mothers and their newborns from the time of labor to six weeks after delivery (WHO, 2012).
Although, there has been noteworthy progress in maternal health outcomes of individuals globally, there is a large discrepancy among the regions of the world (WHO, 2012). For instance, a number of countries in sub-Saharan Africa, have halved their levels of maternal mortality between 1990 and 2010 and in some regions, particularly Asia and North Africa, even greater headway has been made (WHO, 2012). In addition, between 1990 and 2010, some regions have experienced decline in their maternal mortality ratios (MMR) for instance, the MMR in Eastern Asia decreased by 69% followed by Northern Africa (66%), Southern Asia (64%) as compared to sub-Saharan Africa (41%), (UNFPA, 2012).
Furthermore, 99% of the 287,000 annual maternal deaths in 2010 occurred in developing countries, and most of these deaths were as a result of unsafe abortion and the inaccessibility of or lack of access to health care services due to geographical, economic and/or socio-cultural barriers which were avoidable (WHO, 2012). The risks of maternal mortality and morbidity are highest at birth and in the period immediately after birth. For newborns and mothers, there is the danger of complications such as neonatal sepsis or post-partum haemorrhage and a delay of even a few hours before appropriate care is delivered can be fatal or result in long-term injuries or disability to the child and the mother (Lawn et al., 2010).
Postpartum mothers’ displeasure of postnatal care has been created as a result of the dissatisfaction some mothers have regarding certain aspects of medical management of child birth (Aura, 2014). Due to this dissatisfaction, in some developing countries, including Ghana, healthcare utilization has been influenced by cultural, socioeconomic, religious, and political factors, as well as health care delivery patterns (Belachew, Taye & Belachew, 2016; Bhutta, Ali, Hyder, & Wajid, 2004). Postpartum mothers in trying to restore their health may seek healthcare from multiple health service providers such as traditional birth attendants, pharmacy shops and also seek for preventive health information from relatives and friends (Varma et al., 2014 & Tarimo et.al., 2000).
According to WHO, in 2001, maternal mortality was high in Africa, with a maternal mortality ratio of about 1000 deaths per 100,000 live births. The largest parts of maternal deaths occur across most of the developing world where 450 women per every 100,000 live births die during pregnancy, childbirth or at the postpartum period (WHO, 2007). In 2010, estimates showed about ninety nine percent of maternal deaths occurred in developing countries with majority in Sub-Saharan Africa (M‘soka, Mabuza, Pretorius, 2015). Furthermore, in 2013, estimates showed that in Sub-Sahara Africa, maternal
mortality recorded 510 per 100,000 live births due to inappropriate postnatal care practices (Kyei-Nimakoh, Carolan-Olah & McCann, 2016). With regards to infant mortality, every year about four million infants die, mostly from developing countries (Sines, Syed, Wall, & Worley, 2007).
The decline of maternal morbidity and death would depend mostly on the improved use of reproductive and maternal healthcare services (McDonagh, 1996; Koblinsky et al., 2008; Singh et al., 2009). It is well recognized that countries with the maximum rates of maternal and infant mortality have pressing social issues including insufficient health care facilities and personnel to offer the required family planning services, skilled attendance at birth and postnatal care (Koblinsky et al., 2008).
According to Sines (2007), the utilization of postnatal care services affords women the opportunity of receiving information on healthy practices that are critical to maternal and child health continued existence. Essentially, it entails advice on the care of new born, use of family planning and exclusive breastfeeding practices. Postpartum mothers could be treated for health conditions like pre-eclampsia/eclampsia, postpartum haemorrhage, genital tract infections and sepsis that may be acquired during the postpartum period and babies who have thrush or jaundice can be taken care of.
In Ghana, despite the reduction in maternal mortality rate from 760 per 100,000 live births in 1990 to 570 in 2000, in the year 2013, estimates showed 380 per 100,000 live births (Kyei-Nimakoh, 2016) indicating that maternal mortality in Ghana is still on the high side in spite of the decrease. Since the days of colonial rule in Ghana, the healthcare system for postpartum mothers has been plural in nature where the average Ghanaian may opt to access healthcare from either the hospital or herbal medicine (Owusu-Daaku & Smith, 2005). Given these healthcare alternatives, postpartum mothers may choose a
suitable health service provider depending on accessibility, cost, belief system and convenience (Aura, 2014). In addition, traditional health seeking behaviors of postpartum mothers are as a result of past experiences with similar conditions that lead to situations where postpartum mothers perceive some health conditions as not for hospital (Abdulraheem & Parakoyi, 2009; D’Souza, 2003).
Furthermore, it is noted that the organization of the healthcare system of a country is a strong indicator of the health seeking behaviors of postpartum mothers (Stephenson & Tsui, 2002). In order to mitigate drastically the rate of maternal, infant and child mortality, countries globally have recognized that a focus on preventive maternal health and nutrition especially after birth is critical in reducing this problem (Shaikh & Hatcher, 2004). Ghana’s Millennium Development Goal Acceleration Framework Country Action Plan, developed in 2011, focuses on Millennium Development Goal 5, in a bid to intensify efforts to overcome barriers in reducing maternal deaths (Kyei-Nimakoh, Carolan-Olah, & McCann, 2016).
In addition, more than 800 women are losing their lives everyday due to severe complications resulting from delivery. For every woman who dies; approximately 20 others suffer severe injuries, infections or disabilities (WHO, 2015). Although the women who lost their lives each year from complications of delivery reduced drastically from 532,000 in 1990 to 303,000 in 2015, it is less than half the 5.5% annual rate necessary to achieve Sustainable Development Goal 5 2015 target aimed at a reduction in maternal death (WHO, 2015).
Ghana in an effort to promote positive health seeking behaviors among mothers and ensuring optimum maternal health has implemented a myriad of healthcare policies and programs (United Nations Development Program [UNDP], Ghana, n.d.). Some of these
programs include the Emergency Obstetric and Neonatal Care (EONC), Free Maternal Health Services and the National Health Insurance Scheme (UNDP, n.d.). In order to resolve issues regarding inaccessibility and unaffordability of healthcare, the free maternal health policy under the National Health Insurance Scheme was initiated in September 2003 in four (4) regions in Ghana-Central, Upper East, Upper West, and Northern, and later extended to the remaining six (6) regions in April 2005. It was mandatory for women to register with the National Health Insurance Scheme (NHIS) to obtain access to the free maternal health care. This policy was intended to lessen the financial costs involved in obtaining health care during pregnancy, labour and delivery (Owoo & Lambon-Quayefio, 2013).
