Sociocultural aspects of haemorrhage in pregnancy

Abstract

The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.

PIP: Recent observations in southern Nigeria revealed that there was a lack of knowledge of the warning signs and risk factors associated with hemorrhage during pregnancy, delivery, and the postnatal period; certain food taboos were disadvantageous to pregnant women; there was a belief that supernatural forces caused some cases of maternal hemorrhage and precluded effective modern treatment; and women suffering from hemorrhage continued to seek care from traditional sources. Therefore, focus groups were convened with women, men, and traditional birth attendants in the Ekpoma group of 13 villages from March 1989 to June 1990 to discuss local ideas about hemorrhage and the situations when a pregnant woman may bleed, use and accessibility of interventions, and strategies for community health education. After analyzing the findings, the following actions were taken by the end of 1992: facilities in the first referral hospital were upgraded; a revolving drug fund was established; an emergency transport loan scheme was established; medical officers, nursing staff, medical records officers, and laboratory technicians were given retraining and refresher courses; and the hospital staff was mobilized and reoriented. In addition, and community education and mobilization efforts were continued until 1995. Additional focus group discussions were held between 1993 and 1995. Comparison of the results of the first and second series of focus groups revealed that age, sex, and education had no effect on knowledge, attitudes, and practices. A marginal decline in traditional beliefs had occurred, but postpartum bleeding continued to be induced. The use of modern obstetric care facilities increased threefold from 1993 to 1995. In addition, midwives began referring patients for hemorrhage more readily. Sustained community educational efforts could build on these modest results.