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

Objective

to explore and describe the indigenous beliefs and practices that influence the attendance of antenatal clinics by women in the Bohlabelo district in Limpopo, South Africa

Research design and methods

a qualitative design was used to enable participants to share their beliefs and practices in their own words. Purposive sampling was used.

Setting

women who were attending antenatal clinics for the first time were targeted. Data were collected via unstructured in-depth interviews. Twelve women were interviewed.

Findings

the findings were grouped into six main categories: pregnancy is a honour; pregnancy needs to be preserved; the unborn infant is protected; the knowledge that clients have; trust in indigenous perinatal practices; and perceptions regarding clinic or hospital services. It became clear that the indigenous beliefs and practices of pregnant women have an influence on their attendance of antenatal clinics. For example, factors such as fear of bewitchment cause delayed attendance of antenatal clinics. Women use herbs to preserve and protect their unborn infants from harm. They also trust the knowledge of traditional birth attendants, and prefer their care and expertise to the harsh treatment that they receive from midwives in hospitals and clinics who look down on their indigenous beliefs and practices.

Conclusions

it is recommended that indigenous beliefs and practices should be incorporated into the midwifery curriculum, so that the health sector is able to meet the needs of all members of the community.     

Screening and Intervention Practices for Alcohol Use by Pregnant Women and Women of Childbearing Age: Results of a Canadian Survey

ObjectiveTo determine health care providers’ familiarity with and use of the Society of Obstetricians and Gynaecologists of Canada's (SOGC's) 2010 Alcohol Use and Pregnancy Consensus Clinical Guidelines and to identify barriers and enablers that affected guideline uptake.MethodsWe conducted an online pan-Canadian survey of midwives, obstetricians, family physicians, and nurses. The survey was divided into five sections: knowledge, SOGC guidelines, screening and intervention practices, attitudes and beliefs, and demographic information.ResultsJust over half of the 588 respondents who provided care to pregnant women or to women of childbearing age were familiar with and used the guidelines. Most respondents screened for alcohol use by asking women about alcohol consumption, but relatively few used a screening questionnaire. Approximately two-thirds of respondents provided brief intervention and referral to harm reduction or treatment services. Enablers of guideline adherence included knowledge about the risks of alcohol in pregnancy, perceived responsibility to identify and address at-risk drinking, and a belief that women are motivated to reduce their alcohol consumption if pregnant or planning to become pregnant. Lack of confidence in ability to use screening questionnaires and to provide brief intervention, as well as a lack of belief in the effectiveness of both practices, were barriers to use.ConclusionStrategies are needed to improve familiarity with and uptake of the Alcohol Use and Pregnancy Consensus Clinical Guidelines. Particular attention should be given to education and training regarding the use of validated screening questionnaires and brief intervention practices.     

Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives’ experience

BackgroundScreening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience.AimThe study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs.Design/settingA semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data.FindingsOf the seven themes identified under barriers, five could be categorised as “institution and provider-related”, namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as ‘client-related’, namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were “institution and provider-related.” They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding.Key conclusions and implications for practiceTo the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives’ willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.     

The influence of gender roles on health seeking behaviour during pregnancy in Turkey

Objectives To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth.

Methods The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants.

Results Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only ‘serious’ conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use.

Conclusions Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.     

Improving antenatal engagement for Aboriginal women in Australia: A scoping review

BackgroundAboriginal women have an increased risk of poor antenatal engagement in pregnancy in comparison with Caucasian women, due to inequalities in health care provision. The Pregnancy Outcome in South Australia reports Aboriginal women having 10 times the risk of non-attendance of antenatal care throughout their pregnancy, 3 times the risk of attending the initial booking appointment later than recommended in their pregnancy, and Aboriginal women have an increased risk of attending significantly less antenatal appointments than Caucasian women.ObjectiveThe primary purpose of the scoping review is to map the body of literature known about Aboriginal women engaging with antenatal care in Australia, and the factors that facilitate or cause barriers to this engagement. Secondary to this, the review will describe how culturally safe care influences antenatal engagement.MethodsScoping reviews utilise a broad range of literature, encompassing all types of studies. An online search of 6 databases was conducted to identify and critically analyse sources discussing antenatal engagement for Aboriginal women in Australia. Using the JBI framework for Scoping Reviews, the researcher was able to strengthen the rigour of the methodology.FindingsThe search produced 9 articles, relating to 6 studies addressing antenatal engagement for Aboriginal women in Australia. Several themes were prevalent in the research that impact antenatal engagement including: Smoking, Relocation, Continuity of Care, Aboriginal maternity infant care workers, home visits, birthing on country, age, family and culturally safe care.ConclusionAboriginal women have identified continuity of care, Aboriginal workforce, home visits, family involvement, birthing on country and cultural safety as factors that improve antenatal engagement. Aboriginal women have reported smoking, rural and remote location, cultural incompetence and young age as factors that deter them from engaging with antenatal care.In order to improve antenatal engagement for Aboriginal women in South Australia, culturally safe care is essential. In order to determine the factors that facilitate and/or deter Aboriginal women from antenatal engagement, further research is required.     

Promotion of adolescent sexual health in primary care: survey in Finnish health centres

Objectives To describe adolescent sexual health services in primary care in Finland, focusing on services for contraceptive counselling, sexually transmitted infections and abortion.

Methods Service provision, accessibility and practices were surveyed in all 63 health centre organizations (HCOs) in a hospital district in Western Finland via separate e-mailed questionnaires to chief physicians (n = 49, response rate 78%), directors of nursing (58, 92%), doctors (49, 78%) and nurses (62, 98%).

Results Dedicated youth clinics existed in only three HCOs. In others, services were provided in family planning, maternity or outpatient clinics. The average wait for contraceptive consultation was 4.8 days to a nurse and 12.5 days to a doctor. In 15 HCOs doctors stipulated a minimum age for combined hormonal contraception. Free supply of contraceptives was often limited to initiation. On-site instructions for chlamydia screening existed in 11 HCOs. Nurses could test for chlamydia without doctor's involvement in 46 HCOs. School nurses participated actively in sexuality education in secondary schools.

Conclusions Adolescent sexual health services were generally adequately available in the HCOs studied. However, services tailored for adolescents were rare. Some medical barriers to access to contraception were found. To improve the system, further involvement of nurses in service provision is recommended.     

Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo,Egypt

Abstract

Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt.

Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo.

Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use.

Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.     

Antenatal care for first time mothers: a discrete choice experiment of women's views on alternative packages of care

Objective

To investigate the views of women in relation to the provision of antenatal care.

Methods

A discrete choice experiment using a sample of 100 women who were nulliparous (pregnant for the first time) and attending for routine ultrasound scan in the 20th week of their pregnancy.

Results

Women preferred antenatal care visits to be provided by a community midwife at a local clinic and to have 10 visits rather than 7. In addition they favoured the provision of education/preparation for birth, the use of uterine artery Doppler screening, and the provision of a telephone advice line. The results show that women were prepared to trade-off fewer antenatal care visits to ensure access to their packages of antenatal care that reflected their preferences.

Conclusions

Whilst the number of antenatal care visits is important to women they may accept fewer visits if antenatal care is provided by midwives and they receive enhanced service provision such as a telephone advice line and uterine artery Doppler screening.     

Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo,Norway

Objectiveto explore experiences with nutrition-related information during routine antenatal care among women of different ethnical backgrounds.Designindividual interviews with seventeen participants were conducted twice during pregnancy. Data collection and analysis were inspired by an interpretative phenomenological approach.Settingparticipants were purposively recruited at eight Mother and Child Health Centres in the area of Oslo, Norway, where they received antenatal care.Participantsparticipants had either immigrant backgrounds from African and Asian countries (n=12) or were ethnic Norwegian (n=5). Participants were pregnant with their first child and had a pre-pregnancy Body Mass Index above 25 kg/m².Findingsparticipants experienced that they were provided with little nutrition-related information in antenatal care. The information was perceived as presented in very general terms and focused on food safety. Weight management and the long-term prevention of diet-related chronic diseases had hardly been discussed. Participants with immigrant backgrounds appeared to be confused about information given by the midwife which was incongruent with their original food culture. The participants were actively seeking for nutrition-related information and had to navigate between various sources of information.Conclusionsthe midwife is considered a trustworthy source of nutrition-related information. Therefore, antenatal care may have considerable potential to promote a healthy diet to pregnant women. Findings suggest that nutrition communication in antenatal care should be more tailored towards women's dietary habits and cultural background, nutritional knowledge as well as level of nutrition literacy.     

Resistance against contraception or medical contraceptive methods: a qualitative study on women and men in Istanbul

Objectives?This research was carried out to reveal the attitudes of men and women about contraception in the Umraniye district of Istanbul.

Methods?Focus group discussions were used for data collection. Data from 20 groups of married people (ten groups of men and ten of women) living in Umraniye were analyzed.

Results?Most people attending the focus groups in the study were against having ‘too many’ children. Economic constraints appear to be a leading influencing factor for limiting the number of children. Urbanization also seems to have a strong influence on people's knowledge and attitudes about contraception. Culture and religious beliefs were not found to be major barriers to contraception in general, but they would influence the selection of the type of a certain contraceptive method. More specifically, culture and religious beliefs were barriers to use of medical methods, and they were the main reasons for use of the withdrawal method, which is the most common method used in Turkey.

Conclusions?Men and women are not resistant to contraception, but they are reluctant to use medical methods. The provision of contraceptive services, with special attention to cultural and religious beliefs and values, and the inclusion of appropriate counseling and education sessions during service delivery, may give clients new options and increase the use of medical methods.     

Somali women's experiences of antenatal care: A qualitative interview study

ObjectiveTo explore Somali women's experiences of antenatal care in Norway.DesignA qualitative study based on individual semi-structured interviews conducted either face-to-face or over the phone.SettingNorway.ParticipantsEight Somali-born women living in Norway.Key findingsFour themes were generated from the analysis. From their experiences of antenatal care in Norway, the Somali women described: 1) when care was provided in a way that gained their trust, they made better use of the available health services, 2) the importance of continuity of care and of sharing commonalities with the caregiver, 3) a need for accessible information, specifically tailored to the needs of Somali women and 4) how culturally insensitive caregivers had a negative impact on the quality of care.Conclusion and implications for practiceThe Somali women in this study were grateful for the care provided, although the quality of antenatal care did not always meet their needs. This study should serve as a reminder of the importance of establishing trust between the pregnant woman and the caregiver, strengthening interpretation services and assuring tailored information is available to Somali women at an early stage. The findings further suggest that antenatal care for Somali women may be improved by offering continuity of care and improving clinical and cultural skills in clinicians. Suggestions for practice, and future research, include initiating group antenatal care especially tailored to Somali women.     

Korean Immigrant Women's Lived Experience of Childbirth in the United States

ObjectiveTo understand Korean immigrant women's common experiences and practices of utilizing health care services in the United States during childbirth.DesignA qualitative interpretive phenomenological research design.SettingRecruitment was conducted through advertisement on the MissyUSA.com website, which is the largest online community for married Korean women who live in North America.ParticipantsA purposive sample of 15 Korean immigrant women who experienced childbirth in the United States within the past 5 years was recruited.MethodsData were collected using semistructured telephone interviews and were analyzed using the Heideggerian hermeneutical methodology.ResultsDuring childbirth in the United States, participants faced multifaceted barriers in unfamiliar sociocultural contexts yet maintained their own cultural heritages. They navigated the unfamiliar health care system and developed their own strategies to overcome barriers to health care access. Korean immigrant women actively sought health information on the Internet and through social networking during childbirth.ConclusionsKorean immigrant women selectively accepted new cultural beliefs with some modifications from their own cultural contexts and developed their own distinct birth cultures. Understanding a particular culture and respecting women's traditions, beliefs, and practices about their childbirth could help nurses to provide culturally sensitive care.     

Changing models of public antenatal care in Australia: Is current practice meeting the needs of vulnerable populations?

Objectiveto investigate women's views and experiences of public antenatal care.Designpopulation-based survey in two states.SettingSouth Australia and Victoria, Australia.Participants4366 women surveyed at 5–6 months post partum.Findingsof 8468 eligible women mailed the survey, 52% returned completed questionnaires. Fifty-seven per cent of women (2496/4339) received public antenatal care. Of these, half attended a GP for some/all antenatal visits, 38% attended a public hospital clinic or midwives clinic, and 12% had primary midwife care, mostly in a midwifery group practice. Women with complex needs – young women, those experiencing multiple social health problems, women of non-English speaking background, and women at higher risk of complications in pregnancy – were the least likely to say that care met their needs. Women attending a GP or midwife as a primary caregiver were the most positive about their antenatal care: 69% and 74% respectively describing their antenatal care as ‘very good’. Women attending a standard public hospital clinic were the least positive about their antenatal care with only 48% rating their care as ‘very good’. Women enroling in GP shared care or attending a midwives clinic at a public hospital gave intermediate ratings.Conclusion and implications for practiceModels of public antenatal care involving a designated lead primary caregiver (GP or midwife) came closest to meeting women's need for information, individualised care and support.     

The use of midwife-led primary antenatal care by obese women in The Netherlands: An explorative cohort study

Objectiveto study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care.Designan explorative cohort study.Setting11 Dutch midwife-led practices.Participantsa cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014.Findingsthe mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R²) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone.Key conclusionsBMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care.Implications for practiceTaking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women.     

Perinatal Care for South Asian Immigrant Women and Women Born in Canada: Telephone Survey of Users

BackgroundPrevious research findings suggest that pregnant immigrant women receive less adequate perinatal care than pregnant non-immigrant women. This study was designed to assess the use of perinatal care services by newly immigrated South Asian women and Canadian-born women, and to determine any perceived barriers to receiving care.MethodWe conducted a telephone survey of women who delivered at an academic community hospital in Calgary, Alberta. Two groups of women were interviewed at seven weeks postpartum: South Asian women who had immigrated within the last three years, and Canadian-born women of any ethnicity. Women who spoke Hindi, Punjabi, and/or English were eligible. Interviews consisted mainly of closed-ended questions. The main outcomes we sought were the proportion of women receiving perinatal care (such as attending prenatal classes or fetal monitoring), and any perceived barriers to care.ResultsThirty South Asian and 30 Canadian-born women were interviewed. Most women in each group reported having pregnancy evaluations carried out. Fewer South Asian women than Canadian-born women understood the purpose of symphysis–fundal height measurement (60% vs. 90%, P = 0.015) and tests for Group B streptococcus (33% vs. 73%, P = 0.004). Thirteen percent of South Asian and 23% of Canadian-born women attended prenatal classes. Most women (87–97%) believed they had received all necessary medical care. Language barriers were most commonly reported by South Asian women (33–43% vs. 0 for Canadian-born women).ConclusionSouth Asian women considered language to be the most common barrier to receiving perinatal care. Such barriers may be overcome by wider availability of multilingual staff and educational materials in a variety of formats including illustrated books and videos.