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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Cultural considerations and beliefs surrounding preterm birth in Kenya and South Africa
Cecilia Milford1, Emma Smith2, Kenneth Ngure3
1Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, 11th Floor, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa. cmilford@mru.ac.za.
Insights
Understanding cultural beliefs surrounding pregnancy and preterm birth (PTB) is crucial for developing effective interventions. This study highlights the need for culturally sensitive approaches to introduce new technologies for PTB risk detection in sub-Saharan Africa.
Area of Science:
- Global Health
- Sociology
- Reproductive Health
Background:
- Preterm birth (PTB) is a significant global health challenge, disproportionately affecting sub-Saharan Africa due to limited healthcare resources.
- Cultural beliefs, knowledge, and practices significantly influence the identification and management of PTB.
- This study investigates cultural perspectives on pregnancy and PTB to inform the development of risk-detection technologies.
Purpose of the Study:
- To explore knowledge, beliefs, and attitudes towards pregnancy and PTB in South Africa and Kenya.
- To assess cultural considerations for introducing an intravaginal device for PTB risk identification.
- To understand how cultural factors influence health-seeking behaviors related to pregnancy.
Main Methods:
- Qualitative research employing in-depth interviews and focus group discussions.
- Participants included women with a history of PTB, healthcare providers, health systems experts, pregnant women, and community male partners.
- Thematic analysis was used to analyze transcribed and translated data from South Africa and Kenya.
Main Results:
- Poor pregnancy knowledge and late antenatal care entry were reported, particularly among first-time mothers.
- PTB was understood by gestational age, baby's size, and associated long-term health concerns and stigma.
- Cultural beliefs, traditional medicines, pica, witchcraft, curses, and religious influences were identified as PTB risk factors.
- While intravaginal devices faced acceptance challenges, their potential use for PTB risk detection was deemed acceptable if proven effective.
Conclusions:
- Culturally informed beliefs significantly shape understandings of and attitudes towards pregnancy, pregnancy risk, and PTB.
- An inclusive, culturally sensitive approach is essential for developing and introducing products aimed at detecting PTB risk.
- Understanding local traditions and beliefs is critical for the successful implementation of new health technologies for maternal health.
Background:
Preterm birth (PTB) is a global health epidemic, sub-Saharan Africa is severely impacted due to its limited healthcare resources. Pregnancy knowledge, cultural beliefs and practices play a role in the identification of risk and management of PTB. This study explored knowledge, understandings, cultural beliefs and attitudes to pregnancy and PTB, as well as cultural considerations for the introduction of an intravaginal device which could be used to identify PTB risk.
Methods:
Qualitative research was conducted in South Africa and Kenya. In-depth interviews were conducted using semi-structured guides with women with a history of PTB (n = 10), healthcare providers (n = 16) and health systems experts (n = 10); and 26 focus group discussions with pregnant women seeking antenatal care (n = 132) and community male partners/fathers (n = 54). Interviews/discussions were transcribed, translated, and analysed thematically.
Results:
Pregnancy knowledge, especially for first time pregnancies was poor, with many reporting late entry to antenatal care. Knowledge about PTB was understood in terms of gestational age, weight or small size of baby, with concerns about long term health and stigma. Various risk factors for PTB were described, including those related to traditions and beliefs of witchcraft/curses. Cultural practices, such as the use of traditional medicines and pica, and religion and its impact on health seeking behaviour were also viewed as risk factors. Although insertion of intravaginal devices was not widely acceptable in traditional communities, especially during pregnancy, it was felt that the use of one to detect risk of PTB would be accepted if proven effective in reducing PTB risk.
Conclusions:
Various culturally-informed beliefs exist which explain understandings of and attitudes toward pregnancy, pregnancy risk, and PTB. An inclusive exploratory process is critical to facilitate an understanding of the beliefs and traditions which could impact the introduction and design of a product to detect the risk of PTB.
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