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Striving to Promote Family Health after Childbirth: Studies in Low-Income Suburbs of Dar es Salaam, Tanzania
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Maternal and Reproductive Health)
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Deeper understanding of family health and support after childbirth from the perspective of first-time parents and their informal support network is needed. Postpartum experiences and health concerns of first-time mothers and fathers and, discourses on sexuality and informal support after childbirth were explored in low-income, suburban areas in Ilala, Dar es Salaam, Tanzania. Individual qualitative interviews with first-time mothers (n=10) and fathers (n=10), and 14 focus group discussions with first-time parents (n=40) and informal support persons (n=42) provided the data, which were analyzed through qualitative content and discourse analysis.

First-time parents’ areas of concern were newborn care and hygiene, infant feeding, handling crying infant, maternal nutrition and hygiene, uncertain body changes for the mother and, sexuality. The mothers were burdened with caring responsibilities and fathers felt neglected and excluded from the care of the mother and infant after childbirth, both by the families and the health care system. Sexuality after childbirth created tension between new parents due to the understanding that abstinence would protect child health during the breastfeeding period, which could be several years. Women’s adherence to sexual abstinence was more emphasized compared to men’s. Men’s engagement with other sex partners and the risk of contraction HIV was a threat to family health.

First-time parents drew on support from both informal and formal sources. Informal support networks played a major role in providing information, materials, guidance and supervision while conveying stereotypic gender norms. Contradictions in the messages to parents within and between the support systems created uncertainties that might have negative implications for family health. Poor parents and those who did not adherence to the social norms were less likely to get informal support than others were.

There is a need for information and practical guidance on basic aspects of care for the mother and infant, male involvement, and the importance of social support to first-time parents, as new parents face physical, social and relational challenges after childbirth. The link between the health care system and informal networks need to be strengthened to enable them to complement each other in promoting family health after child health.

Place, publisher, year, edition, pages
Uppsala: Uppsala University , 2011. , 54 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 668
Keyword [en]
First-time parents, postpartum, Health promotion, sexuality, informal support, qualitative, suburban Tanzania
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-150924ISBN: 978-91-554-8065-3OAI: oai:DiVA.org:uu-150924DiVA: diva2:409334
Public defence
2011-05-24, Rosénsalen, Akademiska sjukhuset, ing 95/96, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2011-05-03 Created: 2011-04-07 Last updated: 2011-07-01Bibliographically approved
List of papers
1. Joy, struggle and support: postpartum experiences of first-time mothers in a Tanzanian suburb
Open this publication in new window or tab >>Joy, struggle and support: postpartum experiences of first-time mothers in a Tanzanian suburb
2011 (English)In: Women and Birth, ISSN 1871-5192, Vol. 24, no 1, 24-31 p.Article in journal (Refereed) Published
Abstract [en]

The first-time mothers enjoyed motherhood and the respectful status it implied. To understand and handle the infant's needs and own bodily changes were important during postpartum. The tradition of abstaining from sex up to 4 years during breastfeeding was a concern as male's faithfulness was questioned and with HIV a threat to family health. Partner relationship changed towards shared parental and household work and the man's active participation was appreciated. Support from family members and others in the neighbourhood were utilised as a resource by the mothers. In instances of uncertainties on how to handle things, their advice was typically followed. The new mothers generally had good experiences of health care during the childbearing period. However, they also experienced insufficiencies in knowledge transfer, disrespectful behaviour, and unofficial fees. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: The mothers' perspective of postpartum revealed that they actively searched for ways to attain infants' and own health needs, and family health in general. Prolonged sexual abstinence was considered a risk for the partner having other sexual partners and contracting HIV. The mothers relied heavily on the informal support network, which sometimes meant risking family health due to misinformation and harmful practices. Health care and informal support systems should complement each other to attain adequate support for the families postpartum.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-150899 (URN)10.1016/j.wombi.2010.06.004 (DOI)000208666500005 ()20674528 (PubMedID)
Available from: 2011-04-07 Created: 2011-04-07 Last updated: 2015-07-22Bibliographically approved
2. Postpartum experiences of first-time fathers in a Tanzanian suburb: A qualitative interview study
Open this publication in new window or tab >>Postpartum experiences of first-time fathers in a Tanzanian suburb: A qualitative interview study
2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 2, 174-180 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting. DESIGN, SETTING AND PARTICIPANTS: individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania. FINDINGS: these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers' and infants' nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information. CONCLUSION: these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers' concerns for family health and needs for support. RECOMMENDATIONS: these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers' active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum.

Keyword
Post partum, Fathers, Experiences, Qualitative, Interviews, Tanzania
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-129615 (URN)10.1016/j.midw.2009.03.002 (DOI)000289071200011 ()20385433 (PubMedID)
Available from: 2010-08-19 Created: 2010-08-19 Last updated: 2011-07-01Bibliographically approved
3. Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania
Open this publication in new window or tab >>Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania
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2011 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, Vol. 11, 98- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

METHODS:

Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis.

RESULTS:

The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support.

CONCLUSIONS:

Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.

Keyword
informal support, first-time parents, postpartum, sexuality, qualitative, Tanzania
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-150871 (URN)10.1186/1471-2393-11-98 (DOI)000298852600001 ()
Available from: 2011-04-07 Created: 2011-04-06 Last updated: 2012-02-10Bibliographically approved
4. Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb
Open this publication in new window or tab >>Prolonged sexual abstinence after childbirth: gendered norms and perceived family health risks. Focus group discussions in a Tanzanian suburb
Show others...
2013 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, Vol. 13, no 1, 4- p.Article in journal (Refereed) Published
Abstract [en]

Background

Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

Methods

Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania.

Results

In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the control of sexuality for ensuring family health and avoiding the social implications of non-adherence to sexual abstinence norms. Both abstinence and control were emphasised more with regard to women than to men. Although the traditional discourse on prolonged sexual abstinence for protecting child health was reproduced in Ilala, some modern aspects such as the use of condoms and other contraceptives prevailed in the discussion.

Conclusion

Discourses on sexuality after childbirth are instrumental in reproducing gender-power inequalities, with women being subjected to more restrictions and control than men are. Thus, interventions that create openness in discussing sexual relations and health-related matters after childbirth and mitigate gendered norms suppressing women and perpetuating harmful behaviours are needed. The involvement of males in the interventions would benefit men, women, and children through improving the gender relations that promote family health.

 

Keyword
sexual abstinence, first-time parents, gender relations, childbirth, FGD, Tanzania
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-150869 (URN)10.1186/1472-698X-13-4 (DOI)000317465400001 ()23316932 (PubMedID)
Available from: 2011-04-07 Created: 2011-04-06 Last updated: 2013-05-13Bibliographically approved

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