Risky health seeking practice among pregnant women in rural Congo: The women's behavior of bypassing the well equipped maternity clinic, is leading to health complication,s with high rates of mortality and morbidity for both mother and child.

Bidragets oversatte titel: Kvinders risikofyldte valg i forbindelse med valg af fødested i bushen i Congo.

Laila Hørby

Publikation: Bog/antologi/rapport/kliniske retningslinjerRapportForskning

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Author: Laila Hørby, MIH, Midwife, Nurse.

Year: Masters Thesis in International Health, June, 2007

Supervisor: Supervisor Annette Sonne Nielsen. Mag.scient., ph.d.
Institute of Public Health, University of Copenhagen.

Key Words: Traditional Birth Attendant (TBA), Maternal Mortality, The three
delays, Culture, Field and Capital, Democratic Republic Congo (DRC).

Title: Risky health seeking practice, among pregnant women in rural Congo (DRC).

Background Statement: Worldwide more than half a million women still die each year of pregnancy and childbirth related reasons. Most of these women live in low income countries. Most of the deaths could have been avoided, had these women lived some where else. In the Democratic Republic of Congo (DRC) the MMR is 1300/100.000. Years of instability in the country, has run down the infrastructure,the health care system and the health of many people. Only about 60 % of the women have a professional help at birth, and even fewer delivers in a health centre, which is far from the Unicef and WHO goal trying to combat high Maternal Mortality Rate (MMR). In the southern and rural part of DRC, is a small well equipped and well staffed dispensary and maternity clinic. The women in the villages around these clinics apparently bypass the clinics and seek help with the traditional healers or birth attendants in the villages. This is a risky choice and one of the reasons for the high MMR.
Objective and methods: The desired long time outcome of this study is a more relevant ante and perinatal care practice, with lower mortality and morbidity, among the women at childbearing age, in the villages around M’shi. I wanted to analyze the health seeking practice of pregnant and birthing women, in the area around M’shi. quantify the problems of the women bypassing the clinics at M’shi., and to analyze the practice and logic of the untrained helpers, in the villages and the professional staff at M’shi. To do that I have done a fieldwork study in the area around M’shi., using qualitative methods such as Interviews, Focus Group Discussions and observations.

I have used the framework of “The three delays” to look at women’s reasons for not seeking professional help in general, when pregnant and giving birth. The framework looks at delays in the decision to seek care, including delays in recognising an obstetric complication, or delays in realising the reasonable in seeking professional assistance for normal pregnancy and delivery; delay in reaching an adequate medical facility, which includes accessibility, availability and cost of transportation and conditions of roads; and delays in obtaining the care needed to manage the situation.

Following that I have analysed these findings, along with the rest of my findings, with Pierre Bourdieu’s theory of field, capital and habitus, to try to come to understand the immanent reasons for the choices these women make.

Findings: Many incidences of maternal deaths are underreported in Congo, but the estimate of 1300 seems realistic. Women fear death in relation to pregnancy and childbirth and prefer therefore to give birth at a maternity clinic. But few village women can afford that and they often live far away from clinics because they work in the field. Then they are left with the untrained traditional birth attendants (TBA) whom they trust and use rather frequent in all other matters in life. The TBAs can offer the women a more culturally sensitive care than what they can get at the maternity. The maternity can offer increased safety why the women would choose that in spite of the quality of care they are offered at the clinics. In DRC like in many other low income countries hospital and maternity staff treat the patients in a degrading manner. Most women will accept this because they are raised as women with no symbolic capital and a habitus of an inferior.

Discussion and Conclusion: As it is hard to avoid the TBAs because they are part of the tradition and the culture. The women make a perfectly normal choice when they choose the TBAs for care as they are part of the folk sector. The TBA’s are there, culturally sensitive, trusted and respected. They have certain knowledge and skills. The professional, medical system may as well integrate the TBAs in their work and in the efforts to decrease the high MMR. RCTs in Nepal and Pakistan show a decrease in the MMR and NMR after integrating the TBAs in the Pre Natal Consultations and working with women in women’s groups to raise awareness and empower the women.

Bidragets oversatte titelKvinders risikofyldte valg i forbindelse med valg af fødested i bushen i Congo.
Antal sider45
StatusUdgivet - 2007