Abstract
Objectives
Social environmental influences on pregnancy-related practices and outcomes have been studied, yet few studies explore these influences qualitatively from the perspectives of women’s personal social networks and the larger social networks that exist within their communities. This study sought to understand and describe the social environment related to pregnancy and planning for pregnancy in Harare, Zimbabwe from the perspectives of women’s social networks, and its influence on pregnancy-related decisions and practices.
Methods
Semi-structured, in-depth, qualitative interviews were conducted in both Shona and English with 24 key community stakeholders (6 healthcare workers, 6 school teachers, 6 family members of females aged 14–24 years, and 6 community leaders) who lived or worked in 2 low-income, high-density communities in Harare. Data were analyzed thematically using NVivo 10 software.
Results
The social environment related to pregnancy and planning for pregnancy described by participants was deeply rooted in culture and cultural practices and centered on four themes: (1) pregnancy importance to the role of a woman in the community and the fulfillment of marriage, (2) pregnancy silence to prevent adverse pregnancy outcomes and adolescent and out of wedlock pregnancies, (3) patriarchal pregnancy culture, and (4) community support during pregnancy.
Conclusions for Practice
Maternal health efforts in Zimbabwe should acknowledge cultural influences on pregnancy and address pregnancy silence to improve reproductive health communication, empower women to be partners in the pregnancy decision-making process, and include women’s social networks.
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References
Aguiar, C., & Jennings, L. (2015). Impact of male partner antenatal accompaniment on perinatal health outcomes in developing countries: A systematic literature review. Maternal and Child Health Journal, 19(9), 2012–2019. https://doi.org/10.1007/s10995-015-1713-2.
Airhihenbuwa, C. O., Ford, C. L., & Iwelunmor, J. I. (2013). Why culture matters in health interventions lessons from HIV/AIDS stigma and NCDs. Health Education & Behavior, 41(1), 78–84. https://doi.org/10.1177/1090198113487199.
Airhihenbuwa, C. O., & Webster, J. D. (2004). Culture and African contexts of HIV/AIDS prevention, care and support. Sahara-J: Journal of Social Aspects of HIV/AIDS, 1(1), 4–13.
City of Harare. (2014). City Health Department 2013 annual report. Harare: City of Harare.
Cohen, D. A., Scribner, R. A., & Farley, T. A. (2000). A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the population level. Preventive Medicine, 30(2), 146–154. https://doi.org/10.1006/pmed.1999.0609.
Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Scrimshaw, S. C. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65(6), 1243. https://doi.org/10.1037/0022-3514.65.6.1243.
Darnton-Hill, I. (2012). Global burden and significance of multiple micronutrient deficiencies in pregnancy. In Meeting micronutrient requirements for health and development (Vol. 70, pp. 49–60). https://doi.org/10.1159/000337421.
Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590–595. https://doi.org/10.2105/ajph.2009.185652.
Gadaga, T. H., Madzima, R., & Nembaware, N. (2009). Status of micronutrient nutrition in Zimbabwe: A review. African Journal of Food, Agriculture, Nutrition and Development, 9(1), 502–522.
Human Rights Watch. (2015). Zimbabwe: Scourge of child marriage. Retrieved November 30, 2015 from https://www.hrw.org/news/2015/11/25/zimbabwe-scourge-child-marriage.
Kim, H., Sefcik, J. S., & Bradway, C. (2017). Characteristics of qualitative descriptive studies: A systematic review. Research in Nursing and Health, 40(1), 23–42. https://doi.org/10.1002/nur.21768.
Maxwell, J. (2004). Qualitative research design: An interactive approach. Thousand Oaks, CA: Sage Publications Incorporated.
Mazrui, A. A. (1986). The Africans: A triple heritage. Boston and Toronto: Little, Brown.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education and Behavior, 15(4), 351–377.
Munjanja, S. P. (2009). Ministry of Health and Child Welfare, Zimbabwe: Maternal and perinatal mortality study 2007. Retrieved November 30, 2015 from http://www.unicef.org/zimbabwe/ZMPMS_report.pdf.
Murira, N., Lützen, K., Lindmark, G., & Christensson, K. (2003). Communication patterns between health care providers and their clients at an antenatal clinic in Zimbabwe. Health Care for Women International, 24(2), 83–92. https://doi.org/10.1080/07399330390170060.
Mutambirwa, J. M. (1984). Shona pathology, religio-medicine practices, obstetrics, paediatrics and concepts of growth and development in relation to scientific medicine. Harare: University of Zimbabwe.
Perkins, J. M., Subramanian, S. V., & Christakis, N. A. (2015). Social networks and health: A systematic review of sociocentric network studies in low- and middle-income countries. Social Science and Medicine, 125, 60–78. https://doi.org/10.1016/j.socscimed.2014.08.019.
Roulston, K. (2010). Reflective interviewing: A guide to theory and practice. Sage. Retrieved January 12, 2016 from http://books.google.com/books?hl=en&lr=&id=YIfHXeTDsTIC&oi=fnd&pg=PP6&dq=Reflective+interviewing:+A+guide+to+theory+and+practice&ots=dIYVZ2QC8d&sig=g2axS08TtD95TNDsWs6dzSXV5rA.
Saldaña, J. (2013). The coding manual for qualitative researchers (2nd ed.). London: Sage Publication Ltd.
Shamu, S., Abrahams, N., Temmerman, M., Shefer, T., & Zarowsky, C. (2012). “That Pregnancy Can Bring Noise into the Family”: Exploring intimate partner sexual violence during pregnancy in the context of HIV in Zimbabwe. PLoS ONE, 7(8), e43148. https://doi.org/10.1371/journal.pone.0043148.
Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10(4), 282–298. https://doi.org/10.4278/0890-1171-10.4.282.
Tinago, C. B., Annang Ingram, L., Blake, C. E., & Frongillo, E. A. (2016). Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe. Maternal and Child Nutrition. https://doi.org/10.1111/mcn.12350.
Tinago, C. B., Ingram, L. A., Frongillo, E. A., Blake, C. E., Engelsmann, B., & Simmons, D. (2018). Understanding conceptualizations of pregnancy and planning for pregnancy among adolescent girls and young women in Harare, Zimbabwe. Qualitative Health Research, 28(9), 1509–1519. https://doi.org/10.1177/1049732318768231.
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042.
Valente, T. W. (2010). Social networks and health: Models, methods, and applications. New York: Oxford. Retrieved January 20, 2016 from http://archpsyc.jamanetwork.com/data/Journals/JAMA/22494/jbk0321_1203_1203.pdf.
ZIMSTAT. (2013). Zimbabwe Population Census 2012. Retrieved April 3, 2015 from http://www.zimstat.co.zw/dmdocuments/Census/CensusResults2012/National_Report.pdf.
ZIMSTAT. (2016). Zimbabwe Demographic and Health Survey 2015: Final report. Rockville, MD: Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International. Retrieved March 3, 2017 from https://dhsprogram.com/pubs/pdf/FR322/FR322.pdf.
Acknowledgements
The authors would like to thank the Sackler Institute for Nutrition Science for funding this research. We also thank the key community stakeholders who participated in the interviews, Gloria Chiedza Tinago for assistance with research activities, and Professor Emmanuel Chabata and Rudo Chingono for translating and transcribing study documents. We appreciate the support of the City of Harare for welcoming us into its communities and clinics.
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Tinago, C.B., Annang Ingram, L., Frongillo, E.A. et al. Understanding the Social Environmental Influences on Pregnancy and Planning for Pregnancy for Young Women in Harare, Zimbabwe. Matern Child Health J 23, 1679–1685 (2019). https://doi.org/10.1007/s10995-019-02814-4
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DOI: https://doi.org/10.1007/s10995-019-02814-4