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

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globalization and changes in the culture of survival and care the case of ghana

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

Dr Phyllis Antwi

January 2007

  • “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
the care gap
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
research studies being conducted on care
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
  • 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
  • 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
what is the situation like in ghana
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
what is being studied
What is being studied?
  • Making motherhood safe: Gender, culture and socio economic context of maternal care in the Ashanti region
objectives of the study
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
district profile
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)
health infrastructure
Health infrastructure
  • There is one District hospital,
  • 11 health centres
  • 2 MCH clinics
  • 8 private/mission clinics
the process of childbirth
The process of childbirth
  • Preparation during pregnacy
  • Labour
  • Delivery
  • Post partum care of the woman
  • Care of the baby
preparation for child birth
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.
  • “”
preparation for child birth1
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
health care systems available to pregnant women
Health care systems available to pregnant women
  • Women use multiple systems of care when pregnant
    • Biomedical care
    • Traditional herbal care
    • Spiritual care
herbs used in pregnancy
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
herbs used in pregnancy1
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
emergency obstetric care
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
case study 1
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
case study 11
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
case study 12
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”
case study 2
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
globalisation and human resource crisis
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
no of health professionals who left in 2003
No. of health professionals who left in 2003
  • Doctors 166
  • Professional nurses 583
  • Auxiliary nurses 449
implication for prevention of mother to child transmission
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
  • 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