Globalization and changes in the culture of survival and care: the case of Ghana

1. Globalization and changes in the culture of survival and care: the case of Ghana Dr Phyllis Antwi January 2007

2. Introduction • “There are certainly good and bad sides of globalisation. It is a challenge for us all to make sure it all moves in the right direction.” David Heymann-WHO

3. The Care Gap • Poverty of women and children remains one of the challenges for Ghana. • To address this issue, Ghana has adopted a Poverty reduction strategy to launch it into a middle income country by 2015 • However the strategy does not address the care gap that exist and continues to undermine human development in the country

4. Research studies being conducted on care • Patterns of child care and neglect in the Wa area in the North West of Ghana • Care of elderly women (barren and grand mothers in Teshi district of Accra • Child care by itinerant market women on the edge of the Volta Lake • Maternal care during pregnancy in the context of continuing high fertility

5. Background • Maternal mortality is a good indicator of the quality of life of women. It signifies the CARE women receive during one of the periods in their lives when they are most vulnerable

6. Introduction • Worldwide more than 500,000 women die during childbirth every year. • The major causes of all maternal deaths are: • hemorrhage • Infections • Unsafe abortion • Obstructed labour • Hypertensive disorders of pregnancy

7. What is the situation like in Ghana? • Total Fertility rate 4.4 • Contraceptive prevalence 20% • Maternal mortality Rate 214 per 100,000 • Antenatal care 90% • Supervised delivery 46% • HIV prevalence less than 3 per cent

8. What is being studied? • Making motherhood safe: Gender, culture and socio economic context of maternal care in the Ashanti region

9. Objectives of the study • To review Ashanti norms and cultural practices relating to pregnancy, childbirth and motherhood • To examine the cultural and social factor that influence the use of modern amenities, and the perception, knowledge, attitudes and practices with regard to pregnancy and delivery

10. District profile • Sekyere West is one of the 18 districts in Asanti region • The district capital is Mampong-57kilometres from Kumasi • The population is 134,116 (GSS-2000)

11. Health infrastructure • There is one District hospital, • 11 health centres • 2 MCH clinics • 8 private/mission clinics

12. The process of childbirth • Preparation during pregnacy • Labour • Delivery • Post partum care of the woman • Care of the baby

13. Preparation for child birth • The preparation starts at puberty • “Kwasi Broni mmae no na ye wo yen ammammere” We had our traditions before we were colonised. We had to stop or modify them when (they) arrived • “Nafifidee ba abonten na ya kata ne nufuso” A girl starts to dress properly and cover herself when the physical signs of maturityappears. This is about age 10 years • “Abayewa tware mprenu na kyere se wa ye bra” When a young girl begins to have her bath twice a day, it is assumed that she has had her period. • “”

14. Preparation for child birth • “Abusua pe se ye hye wo animoyam” The family wants to mark (celebrate) her entry into womanhood. This is important because among the Asantes, (matrilineal society), prolific childbearing is honoured. • “Se wo nkyima a ,yen goro wo bra” The nubility rites cannot be performed until after the onset of a girl’s first menstruation

16. Health care systems available to pregnant women • Women use multiple systems of care when pregnant • Biomedical care • Traditional herbal care • Spiritual care

17. Herbs used in pregnancy • “Busummuru adwera”-to make the baby strong.Taken from the third month until delivery • “Kookoo ahahan”- to ensure a healthy child • “Hagoro”- to make the baby strong. Taken from the sixth month

18. Herbs used in pregnancy • Easy delivery • “Bonhon”-given to women during the eight month until term to ensure easy delivery • Induction of labour • “Abooto”- used only once.This is to initiate labour • Retained Placenta • “Akandedua”-given to women with retained placenta

19. Emergency obstetric care • Availability of facilities for emergency obstetric care is in Mampong only • The hospital serves other district in Ashanti region as well as Brong Ahafo

25. Case Study 1 • Madam Afua Serwah is 32 years • Multip of one from Aframso • First child was delivered at home • Attended antenatal care at the maternity wing of the Mampong district hospital during her second pregnancy • She made eight (8) visits • Went into labour 1st January 2005 at 4.30am • Was attended by a trained TBA

27. Case study 1 • At 8.00am husband was requested to look for transport to send her to Mampong District Hospital • Got a vehicle at 3.00pm and was charged 460,000 cedis ($50).The normal fare per person is 12,000 cedis ($1.2) • At the District hospital she had a C-section however the baby was fresh still birth

28. Case Study 1 • She is currently not on any contraception • She suspects she is three months pregnant but has not told the husband • She intends going to the clinic at Mampong. • She has not been able to inform her husband that she is pregnant. She wants to be sure that this pregnancy “will stay”

29. Case study 2 • Maame Akua Addai • Multip of 14 • Last delivery had prolapsed arm • Was sent to Mampong but the nurses were on strike ( better conditions of service) • Was eventually sent to Komfo Anokye Teaching Hospital

32. Globalisation and human resource crisis • International migration for labour is the most striking manifestations of globalisation of the world economy • Global liberalisation of trade has led to an increase in the international migration of professionals, including physicians

33. Estimated vacancy levels of health professionals 1998-2002

34. No. of health professionals who left in 2003 • Doctors 166 • Professional nurses 583 • Auxiliary nurses 449

40. Implication for prevention of mother to child transmission • Few pregnant women are offered voluntary counselling and testing for HIV • Most pregnant women do not know their HIV status • Low uptake of anti-retrovirals by HIV positive pregnant mothers because they deliver at home

41. Conclusion • The Akan society is guided by the philosophy that “It is a human being that has value”. • High fertility continues to be the norm in Ghana • Women try to reach adequate services when an emergency occurs • Health system failures (major human resources crises) have been identified as a major contributory factor to maternal deaths

42. Thank you