Written by Literacy Bridge Program Officer Fidelis Da-uri Awonodomo
Ghana is high on the list of developing countries combating high rates of poverty and disease. With two years remaining before reaching the year 2015, Ghana has yet to be sure whether it will achieve the United Nations’ health–related Millennium Development Goals (MDG). There are still many factors affecting Ghana’s ability to overcome many health-related problems including child and maternal mortality. Some of the common reasons why maternal and child mortality remains high include: lack of health centers in the rural areas, poverty, inadequate number of health personnel, and lack of equipments at the health facilities.
It is difficult for Ghana Health Services to accurately track child and maternal deaths in Ghana’s rural communities, unless the deaths occur in a health facility. Corpses are buried in the rural communities without any checks or records. The overall statistics on child and maternal mortality in Ghana are not accurate, but, even with the known number of deaths; the figures are much too high.
Rural communities are difficult to reach by health experts because of bad road conditions. The roads become even worse during the rainy season and are inaccessible. Preventable diseases, like malaria, convulsion, diarrhea, etc., are very common during this season. This is the time that education on health behavior change needs to be intensified to avoid the causes of such illnesses.
Care for pregnancy and children are mostly in the hands of the mothers. Unfortunately, many of these women cannot read and write and therefore have no access to information and knowledge for a safe pregnancy and child care. Illiteracy and ignorance are playing a major part.
CULTURAL BARRIERS IN SEEKING HEALTH CARE: Though pregnant women in Ghana are free to enroll in Ghana’s National Health Insurance, many pregnant women prefer to deliver at homes and suffer complications. They are not aware that delivering at a health facility is free, and that delivery with trained personnel is important and can be life-saving.
These women live in societies where some of the cultural practices are not helpful to their health. Women in these communities with low or no education adhere to very traditional birthing practices. A common birthing practice is for a woman to give birth completely alone and the pregnant mother alone is the one who decides if outside help is needed. Women are considered to be strong and independent if they can deliver themselves without external help. These beliefs at times lead to very dangerous circumstances as the women delay assistance, which can cost them their lives or the life of the baby!
One common issue is obstructed labor. When women realize labor is not progressing normally, they first seek help from female friends or a Traditional Birth Attendant (TBA or commonly known as a Pogtuglo), and the husband will consult the gods and oracles to seek answers for causes of the delay. This can result in further delay in seeking medical attention from someone who is trained to handle such complications.
The incidences of skilled delivery could improve if men are knowledgeable about the birthing process and could help in making decisions about obstructed labor or other complications that women suffer during delivery. There would be a great change if both husbands and wives have access to quality, on demand information about maternal and child health.
RELIGIOUS BARRIERS IN SEEKING HEALTH CARE: Many people believe in superstition and witchcraft. These religious beliefs make some of these women go to a priest for prayers or rituals when they are sick and/or during pregnancy. They only seek medical assistance when these prayers fail. In these rural communities, if a person is sick or not getting pregnant, they attribute it to witchcraft, the lesser gods or their ancestors. Their belief in witchcraft and ancestors makes them consult fetish priests, pastors and Mallams for prayers rather than going to a professional medical doctor for checks and a cure. During pregnancy, women in these communities prefer going to priests to pray for protection from witchcraft than going to the clinics.
I think there are a lot of solutions to this problem but the most basic to me is education and cultural sensitization in how the messages are delivered to the targeted groups. Also, education needs to be available in local languages and any time they want and need it.
RELIANCE ON TRADITIONAL MEDICINE: In many of the rural communities in Ghana, pregnant women seek help from old women, many of whom are TBAs. The women trust TBAs with all matters related to pregnancy and delivery because they believe TBAs have experience with childbirth and they embody the cultural and social life of women in the community.
However, these TBAs lack medical knowledge and training. Many use traditional practices that lead to risky medical procedures resulting in high maternal and infant mortality. In the remote communities of the Upper West Region of Ghana, herbal remedies are used to induce labor and some of these plants or concoctions can be toxic. It is common to give a woman substances like “Mansugo” and “Akpeteshe” (a locally gin with very high alcoholic content) with the aim of inducing labor and to aid fast delivery. The danger lies in the level of dosage as to whether or not these substances could potentially bring harm to the mother and the baby. But, these herbs are socially acceptable in societies in which they are used.
In general, women in rural Ghana are disadvantaged because of the patriarchal system in many communities. Women have little or no control of resources and in most cases have poorer health. There is the need to implement innovative health programs that use collaborative approaches involving traditional herbal practitioners especially the TBAs. It is possible that a lack of knowledge on plant species used to induce labor and speed up delivery could be one of the main factors that contribute to complications and sometimes death.
LIMITED REPRODUCTIVE HEALTH LITERACY: Many women, because of illiteracy and ignorance, rely on myths, rumors and misconceptions that discourage them from using reproductive health services, particularly family planning. Some communities also frown upon this or think it could later prevent the woman from giving birth. The majority of the rural women who go for antenatal care (ANC) do not have or have had very little education on health issues, like this, while others feel too shy to ask questions because they are not comfortable asking questions in the public.
Most times, the clinics are full of nursing mothers and pregnant women with only one or two nurses attending to them. No education is given them for that month. Another problem to deal with is the stigma on childlessness. Many women are forced to have children by the society. In some of these communities, a husband will leave his wife if she does not give birth as soon as they get married or if she did not give birth to a male child. Often times, the wife will continue giving birth till the couple has a male child who inherits from the father later in life.
It is also considered that the more children a woman has, the more fertile she is but this also increases her chance of dying through childbirth. Many families may not want to practice family planning because they want to produce more children who can help them on their farms.
Another problem is the initiation ceremony where cooled water is poured on married women who are pregnant for the first time early in the morning by elderly women with the reason to prevent miscarriage. News will break in the village shortly thereafter that “she is now a woman or is among women”. Brothers of the husband will start to publically make fun of her pregnancy with words and gestures. Many of these newly married women feel very shy about their pregnancy and will delay clinic visits to postpone the initiation ceremony or mockery from people in the community.
NEED FOR THE TALKING BOOK
Women, their husbands and other family relatives who influence decisions of child delivery should be made aware of the likelihood of complications during pregnancy, childbirth, labor, and the danger signs in pregnancy and the postpartum periods. It is important to involve husbands in any form of maternal health education in these communities. No pregnant woman will want to die in the process of childbirth but will be vulnerable when labor starts. Husbands and other family relatives will support these women to go to the hospital if they are educated on the effects on the family if they choose not to send her to the hospital.
Maternal health education in rural communities is not an easy thing to do because it is not possible to get all family members together at a time to educate them especially in rainy season with a lot of work on their farms. These are communities without electricity and the majority of people cannot read a text message. This is why the Talking Book is a good tool for sending child and maternal health messages to women and their families in these rural villages.