Dr. Patricia AnafiSOEPS SeminarSUNY Potsdam

10/22/2014

Brief Background Information Research Questions & Objectives Health Belief Model and its usefulness to the

topic Findings Conclusions

Ghana’s MMR is estimated at 451 per 100,000 live births (GMHS, 2008).

Ghana has committed to the Safe Motherhood Initiative since the 1980s & MDG-5 (Witter et al., 2007).

Since 2001, the gov’t has embarked on specific programs to improve maternal health.

2008 GDHS indicates that deliveries with MPs only increased slightly for the poorest: 19% in 2003 to 23.5% in 2008.

The big question is: What forms of health care are received my

these poor pregnant women since many are not showing up at clinics to receive delivery care with skilled medical professionals?

Pop ~ 250, 000 Ga Indigenous people & migrant workers. Ga: Men are fishermen & women fishmonger.

The migrants: traders, some sell on the street

of Accra, “kayaye.” Poorest maternal health outcome in Accra with

~ 80% of girls become pregnant before age 22.

Has one polyclinic & maternity home.

Private clinics

Use of ANC during the 1st trimester remain low (43%) in urban slums and poor communities.

Women seek untrained TBAs and spiritualist care and15% use their services during delivery.

ANC and preparation cost towards delivery is still a barrier to seeking medical care.

What are mothers’ and other community members’ perceptions and knowledge about pregnancy, childbirth and the existing care?

What forms of health care do women use during pregnancy and delivery?

Why do poor urban pregnant women fail to seek medical care?

To examine the health care decisions and choices that poor urban pregnant mothers make and make recommendations to improve maternal health outcomes in the study area.

Describe mothers’ and community members’ perception and knowledge about pregnancy & childbirth

Describe the forms of health care available to mothers during pregnancy and childbirth.

Examine the factors that influence care preference

A Qualitative Study

Data was collected in 2007 and 2010

In-depths interviews with Midwives, TBAs, Social workers and mothers (n= 17) (n=5, 12)

13 focus groups with mothers (n=82) (n 52, 30)

Health Belief Model (Hochbaum, 1958; Rosenstock, 1966)

Developed in 1950s and most widely used model in Public Health research and intervention.

Provides a framework to explain individual health behavior

Perceived Susceptibility

Behavior

Perceived Susceptibility- how individually personally feels at risk of a health condition.

Perceived Severity- has to do with a person’s belief about how serious a health condition will be if no protective health action is taken

Perceived Benefits: degree to which a person believe that taking certain protective health action will be effective in reducing the threat.

Perceived Barriers: a belief about impediments (tangible & physiological cost) for the recommended behavior.

Guided the data collection

Analysis and interpretation of data

For example: Measure pregnant women’s or

participants risk perceptions of pregnancy

Examples of Questions: 1.Are you personally vulnerable to low birth weight if you do not

seek timely or appropriate antenatal care? 2.Are you personally vulnerable to pre-term birth if you do not seek

appropriate antenatal care? 3. What makes a woman more susceptible to pregnancy and

delivery complications? 4. What are the benefits of seeking skilled care during pregnancy &

delivery? 5. What are benefits of seeking other forms of care during

pregnancy & delivery? 6.What are the cost of or barriers to seeking midwifery care or any

other forms of care

Medical Care

Traditional Birth

Attendance

Spiritual Churches

Threat Perceptions/Knowledge (Perceived Susceptibility and Severity)

- Pre-existing ill health condition ( e.g. malaria, HIV/AIDS) -Hypertension, anemia, bleeding (Magadi, 2006, WHO, 2004).

-Lack of exercise during pregnancy -Infections, pre-eclampsia, eclampsia, induced abortion -Delay in the delivery of after birth or placenta -Sleeping on back -Poor nutrition - “Asram” -Curse spell

Perceived Threat- Perceived Susceptibility/Severity to pregnancy and delivery complications.

Women who seek professional midwifery care believe they could have negative pregnancy and delivery outcomes if they do not seek timely and appropriate care

Those who seek TBAs and Spiritual care believe that they could have pregnancy or delivery complication if a curse spell is cast on them or evil eye transfers disease the unborn.

Perceived/Actual Benefits and Barriers influence health care decisions and preference

Medical care/Midwifery care- Quality care to manage or avert pregnancy and

delivery complications. - It worked for close relatives- Cost associated with seeking medical/midwifery

care as a barrier (Buabeng et al., 2007)- Negative attitude of medical staff/midwives (Muturi,

2005) - Fear of C-section- Long wait time at antenatal clinic

Perceived/Actual Benefits and Barriers influence health care decisions and preference

TBA/Spiritual care -Spiritual protection from complication or death

during delivery- Affectionate care/use of herbal medicine

(Wulandari & Whelan, 2010) -Cost can be paid in kind or cost of care can be

paid later after delivery-Worked for close relatives.

The HBM was relevant to understanding why pregnant women make certain health decision and what motivate them to take action to maintain healthy pregnancy and safe delivery.

However, there are factors such a person’s cultural and spiritual beliefs and value of social networks that directly affect maternal heath care seeking decisions and behavior the original model fails to recognize.

It also fails to address beliefs that disease like “asram” caused by evil spirit and complications due to curse spell-biomedical care is not a treatment option- such beliefs influence decisions to seek TBA and spiritual care.

Social networks such as TBAs, and parents play important roles regarding making health care seeking decisions and behavior.

The original study of this presentation was funded by DANIDA Health Sector Support, Accra. Ghana, and

The Compton Foundations International Fellowship

Thanks to Ghana Health Service Greater Accra Regional Directorate for the Technical Support.