Perspective Of Pregnant Women Research Articles

Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics

How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix of observations, focus group discussions, and interviews. In Indonesia the study was conducted in a community-based PMTCT program run by an NGO, while in Vietnam the study explored the care dynamics in routine PMTCT services, implemented by district and provincial public health facilities. In both of these PMTCT arrangements (the routine provider initiated approach in Vietnam and a more client-oriented system in Indonesia), pregnant women value the provision of HIV tests in antenatal care (ANC). Concerns are raised, however, by the unhappy few who test positive. These women are unsatisfied with the quality of counselling, and the failure to provide antiretroviral treatments. Acceptability of HIV testing in ANC is high, but the key policy issue from the perspective of pregnant women is whether the PMTCT services can provide good quality counselling and the necessary follow-up care. We find local level providers of PMTCT are pleased with the PMTCT program. In Vietnam, the PMTCT program offers health workers protection against HIV, since they can refer women away from the district health service for delivery. In Indonesia, community cadres are pleased with the financial incentives gained by mobilizing clients for the program. We conclude that achieving the global aims of reducing HIV infections in children by 50% requires a tailoring of globally designed public health programs to context-specific gendered transmission pathways of HIV, as well as local opportunities for follow-up care and social support.

Managing pregnancy disclosures: Understanding and overcoming the challenges of expectant motherhood at work

A common, complex, and underexamined aspect of women's experience at work emerges when work and motherhood intersect for the first time; pregnant workers are challenged by the need to manage their impressions and identities. Thus, the purpose of this paper is to propose a model and corresponding propositions for understanding the determinants and outcomes of pregnancy disclosure. We extend stigma theory to the case of pregnant workers and explore the antecedents and consequences associated with timing of expectant status disclosure from the perspectives of pregnant women and their colleagues. We describe negative intra- and interpersonal experiences that may be encountered by pregnant women that may account for their departure from the workforce, thereby providing insight into the issues that may exacerbate (or ameliorate) turnover among working mothers.

Ethnographic study of factors influencing compliance to intermittent preventive treatment of malaria during pregnancy among Yao women in rural Malawi

In Africa today one of the main strategies to reduce malaria infection during pregnancy is the promotion of intermittent preventive treatment (IPT). To date only a few studies have investigated the factors affecting compliance to IPT. This medical anthropology study aims to describe these factors from the perspective of pregnant women in rural Malawi. We examine women's knowledge and perceptions about the use of medication in pregnancy and the timing and motivation concerning use of antenatal clinic (ANC) services. In addition, the circumstances and interaction at the ANC and the IPT implementation process are described. The data were collected by applying an ethnographic approach, including focus group discussions (n=8), in-depth interviews (n=34), drug identification exercises, participant observation and a 'knowledge, attitudes and practices' survey (n=248). This study discovered several factors affecting IPT. These were: unclear messages about IPT with sulfadoxine-pyrimethamine (SP) from nurses; timing of SP-1; periodic shortages of SP; women's limited understanding of IPT-SP; tendency for late enrolment; and nurses' underperformance. The results of this study show that understanding of the multiple contexts affecting malaria prevention is important, and that ethnographic research is useful for discovering and solving problems beyond the scope of many other research approaches.

Vaccination for Group B Streptococcus during pregnancy: Attitudes and concerns of women and health care providers

Group B Streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality. Although intrapartum antibiotic prophylaxis (IAP) strategies are effective in preventing GBS transmission from mothers to newborns, there are growing concerns about adverse effects, and the development of antibiotic resistance. GBS vaccines targeting the most virulent neonatal disease serotypes are currently under development and may be used during pregnancy. The objective of this study was to explore the key issues and concerns that would be associated with GBS vaccination during pregnancy from the perspectives of pregnant women and health care providers. Twenty-two women and 25 health care professionals in Alberta, Canada participated in 10 focus groups, each group ranging from 2 to 20 participants. Valuable information emerged from the focus groups about the factors that would affect acceptance of a maternal GBS vaccine. This information will be essential for health systems to consider in the introduction, promotion and delivery of such a vaccine. The data may help optimize education about GBS and a putative vaccine to pregnant women.

Research Report: Antenatal HIV testing from the perspective of pregnant women and health clinic staff in South Africa—implications for pre- and post-test counselling

HIV testing is not routinely available at present in health clinics in Umtata, South Africa. However current statistics indicate that up to 25% of the population may be infected. Such findings imply that HIV testing and counselling should be introduced in health clinics as a means of promoting HIV prevention and reducing the risk of vertical transmission. However this would only be beneficial if staff are prepared to implement it and patients are willing to test. The issues are couched in a background of political activity surrounding HIV that may question approaches to HIV testing and a lack of availability of interventions to prevent mother to infant transmission. Furthermore the infrastructures of counselling training and provision may not be universally available, especially in pressured rural clinics. Therefore, a group of clinic staff and pregnant women, in rural and urban health centres in Umtata, were asked to participate in focus group discussions to elicit attitudes to HIV testing and counselling. In principal the majority of women, particularly in the rural clinic, were willing to have an HIV test, and strongly articulated the desire to test with their partners. Women who were reluctant to test emphasized their fear of receiving the result. The rural women appeared to be far more willing to disclose their HIV status to clinic staff, than urban women. Nevertheless, the discussions illustrated the impact of the stigma surrounding HIV, with clinic staff reporting cases where patients who were suspected to be positive were avoided by health workers. However staff in both clinics were willing to make the effort to implement HIV tests if they were to be made available. Despite the non-availability of rapid testing and interventions to reduce mother to child transmission most women saw advantages to HIV test provision. Pessimism and fear were underlying emotions associated with HIV for both staff and women. The implications for pre- and post-test counselling are discussed.

Herbal Healing in Pregnancy

Many women use home remedies to maintain their health during pregnancy. Here, pregnant women's perspectives on herbal medicine are exposed in a small (n = 27) non-random sample of pregnant women in British Columbia, Canada, and follow-up interviews with six mentors from the community. While many of the women were cautious about using herbs during pregnancy, they considered them to be safer-as a general rule-than pharmaceutical drugs. Herbal tonics were widely used, and simple home remedies were usually the first line of defence against common health complaints. In choosing to self-medicate with herbs, the women said they were guided by prior knowledge (32%), trusted sources of advice (56%), and intuition (12%). A reliance on prior knowledge was not strongly correlated with the woman's age (r = -0.27) or the number of pregnancies she had experienced (r = 0.21). Trusted sources of advice included books, friends, family members, maternity care providers, herbalists, herb shops, and internet. The majority of herbal advice (69%) was received by word-of-mouth. The women's mentors were an important source of herbal self-care information.

Focus groups with pregnant smokers: barriers to cessation, attitudes to nicotine patch use and perceptions of cessation counselling by care providers.

Focus group methodology was used to determine the barriers to smoking cessation for pregnant women prior to the commencement of a randomised controlled smoking cessation trial (RCT), using nicotine patches in the treatment arm. Attitudes to the use of nicotine patches and perceptions of care provider counselling were also explored. Women were identified by researcher interview in the antenatal clinics as current smokers or recent 'quitters' and recruited to one of three focus groups. A number of barriers to achieving smoking cessation were identified. Pregnancy-specific barriers included scepticism about smoking-related harms. Other barriers, such as addiction to nicotine and the smoking behaviour of others, particularly partners, are generic. The latter is magnified in pregnancy by the heightened complexities of familial relationships. Potential use of patches was acceptable to most women, although some high-risk patients expressed doubts about safety and believed continued smoking was preferable. Women recounted that care providers differed in approaches to smoking cessation. Reporting 'cutting down' generally avoided further inquiries about smoking. The knowledge gained of pregnant women's perspectives enhanced the researchers' understanding in these areas. These insights have been incorporated into staff training initiatives, have guided the planning of the RCT, and have continued to inform its conduct.

Pregnant women's perspectives on umbilical cord blood banking.

Promising clinical results suggest that umbilical cord blood (UCB) collected after delivery of a child may have many advantages over bone marrow for transplantation. As there are an increasing number of options regarding the collection of UCB, including private and public banking, more pregnant women are likely to be asked to make decisions about UCB collection. We conducted three focus groups with pregnant women to learn about their perspectives on this emerging technology. All the women in these focus groups indicated that they would choose to have UCB collected. Reasons leading to this choice were that the UCB would otherwise be discarded and altruism. Participants indicated that possible reasons to decide not to have UCB collected include concerns about the safety of the mother and neonate, beliefs about the placenta, threats against confidentiality, rejection of UCB, and the influence of fathers. While feeling confident in making an anticipatory decision about UCB collection, women expressed a clear desire to learn much more about the collection, storage (including distinctions between public and private banking), and use of UCB. In addition, they believed that recruitment for UCB collection should occur after sufficient education about UCB and certainly not after delivery and collection. These data will be useful in guiding efforts to help women make decisions about having UCB collected and in developing an appropriate recruitment and informed consent process for donating UCB to a public bank.

Pregnant women's perspectives on intendedness of pregnancy

This study examined whether intendedness is a valued characteristic of pregnancy and what factors influence women to risk unintended (unwanted or mistimed) pregnancy. Study participants were 24-34 weeks pregnant, White or Black, aged 18-30, and receiving prenatal care from a publicly funded clinic in North Carolina. Information gathered from 8 focus group sessions (14-15 participants each) revealed that: 1) the concept of a planned pregnancy had no meaning to many of the women; 2) religious beliefs helped people accept unintended pregnancy; 3) planning for pregnancy is a stressful concept because of potential disappointment; 4) unprotected intercourse without pregnancy leads to assumptions of infertility; 5) attitudes of male partners, friends, and family members influence women to risk pregnancy; 6) women adapt to unintended pregnancy very readily; 7) there are no uniform situational risks for unintended pregnancy; and 8) unintended pregnancies are more advantageous than not for some women. These results question the assumption that intendedness of pregnancy is preferred among low-income women or that the pregnancies are "subintended." While interventions to increase intendedness focus on access to contraception, study participants reported no barriers to access as a reason for conception. Health educators should consider the ramifications of teaching that pregnancy can result from a single act of unprotected intercourse without also teaching that pregnancy can occur after several acts of unprotected intercourse. These findings suggest hypotheses that should be explored with further research.