Stephen Wilkinson and Dr. Lynn Callister, Department of Nursing

The topic of my research evolved out of a desire to do a field study in Ghana through Brigham Young University’s Kennedy Center for International Studies. As I researched health care issues in the Ashanti Region, I discovered that many of the medical challenges that people in West Africa face are related to perinatal care. I was aware of Dr. Callister’s research on cultural aspects of childbirth and when I approached her about this project, she readily agreed to be my mentor, expressing her belief that this research could make a unique contribution to the growing literature regarding culturally competent care.

There is an increasing need for culturally competent care in the American health care system. Reasons for this include an increase in diversity, multicultural identity, and legal suits resulting from cultural ignorance and imposition of health care practices. Essentially, for today’s medical field to succeed, health care workers must respect patients’ cultural perspectives. With more than 28,000 Ghanaians having immigrated to the United States between 2000 and 2005, it is hoped that perinatal care given to Ghanaian women will improve as a result of this research.

Most study participants were recruited through the Salvation Army Clinic in Wiamoase, Ashanti, Ghana. Women who attended the antenatal clinic were invited to participate in the study after delivery. Snowball sampling was done to recruit study participants in surrounding villages.

I interviewed each study member for thirty to ninety minutes about her perceptions and experiences surrounding childbirth. These interviews were audio-taped and were based on a semi-structured interview guide. The interviews were conducted privately and all information has been kept in confidence. To compensate these women, each interviewed mother was given a newborn kit containing bar soap, cloth diapers with safety pins, a pair of socks, a blanket, and a layette gown. Their sincere and humble gratitude was a touching aspect of my experience.

The interviews were initially analyzed concurrently with data collection. Both Dr. Callister and I performed preliminary analysis of the transcriptions separately, and then in collaboration to identify themes. Due to technical difficulties, however, I was not able to transcribe interviews at the latter end of my research. Transcription and analysis continued after I got home.

My experience in Wiamoase included an internship at the local Salvation Army Clinic. While volunteering there, I had the opportunity to watch seven deliveries and portions of three more. This afforded me great opportunities to learn about the culture and practices of childbirth in this area. While each delivery was slightly different, there were commonalities. For example, though no anesthetics of any kind were used in the deliveries I watched, very few of the women cried out in pain as they delivered.

Regarding the giving of pain medication, the midwife at the clinic told me that it is rarely administered because childbirth is a natural process and pain is part of that process. Seen such, there were common thoughts among mothers regarding pain and crying out. One woman explained it saying, “Whether you cry or not, it doesn’t make it any easier, so there’s no need for you to cry or shout. Whether you cry or not you are going to give birth to the child. So, if there is pain or anything you don’t have to cry; you have to give birth to the child.” These women show great strength and endurance. Two ladies I interviewed actually delivered on the path in the middle of the night as they were walking from their hamlet homes to the clinic.

We found that in the Ashanti Region the nearly universal belief in witchcraft affects many aspects of life, especially childbirth. There is a saying there that goes “Bayie wô efie biara anaa abusua biara mu,” which means, “In every house, in every extended family, there is a witch.” It is believed that when these witches are given the opportunity, the will curse the pregnancy resulting in the termination of pregnancy or the death of the mother, the unborn child, or both. Most congenital diseases are viewed as the result of a cursing. While the fear is ominous, there is protection available. Most women rely on their religious devotions to grant them divine intervention. Prayers, church attendance, and righteous living are believed to provide women with the necessary protection against witchcraft.

We also found that barrenness is a condition no woman in the Ashanti Region would want and very few would wish upon another. People in the Ashanti Region assume, if the true history is not know, that a lady’s barrenness is the result of adolescent illegal herbal abortion attempts. “Most of the people…it’s not like God created them to be barren,” said another mother, “But at times, when they are young they do abortion[s] and other things. That is why …when they are old they can’t give birth to children.” Thus, since abortions are considered wicked and barrenness is caused by abortions, barren women are generally viewed by the public as being wicked and therefore are easily blamed as being the witches who are jealous of pregnant family members.

I am continuing to analyze my interviews for common themes, as is Dr. Callister. We are currently exploring the above themes as well as themes regarding the social pressures to have as many children as is economically feasible, the importance of having large newborns as a physical symbol of being a good mother, and mothers’ reliance on God to carry them through the perinatal period.

I will finish an honors thesis documenting my findings by the end of December 2007. I have applied to present my findings at both the Utah Conference on Undergraduate Research and the National Conferences on Undergraduate Research next year and will submit my findings for publication in Health Care for Women International.

References

• Andrews, M.M. & Boyle, J.S. (2003). Transcultural Concepts in Nursing Care, Fourth Edition. Philadelphia:
  Lippincott Williams & Wilkins.
• United States Department of Homeland Security. (2006). Yearbook of Immigration Statistics:
  2005. Washington, D.C.: U.S. Government Printing Office.
• I would like to express deep gratitude to and acknowledge Dr. Lynn Callister for her mentorship, Brigham Young University’s Office of Research and Creative Activities and Kennedy Center for International Studies as well as the National Honor Society of Phi Kappa Phi for sponsoring this research, the Salvation Army Clinic for its assistance, and Grace Baffour and Opoku Samuel for helping with translation.