Postnatal Care Group Reflection

Academics

During the time in the Rakai District of Uganda, the Maternal Health Post Natal Group acquired a lot of information about standard of care in the town of Kalisizo regarding how most rural women seek post natal care. First we were directed to the Kalisizo Hosptial where we had a fruitful discussion with a midwife in charge of the antenatal care for HIV positive pregnant women. Her extensive knowledge about the entire birthing process provided our group with an inordinate amount of basic information from which a lot of our further questions were drawn. What our group was struck by at the hospital, and mentioned by the midwife, was the very apparent lack of adequate facilities and supplies. As a result of the relatively small number of beds, lack of privacy screens, and an insufficient number of staff members to take care of the maternity ward, the new mothers only stay in the ward for one to two days after delivery (barring complications with delivery).

Another major issue regarding post natal care in rural Rakai is the lack of support given by the fathers.  According to all of the sources we talked to, the absence of the fathers in the post natal process in comparison to what is typical in the United States significantly contributes to the mother’s deficiency in seeking post natal care. According to a researcher of the Rakai Health Sciences Program, many women do not seek adequate post natal care because they believe it unnecessary to pursue more care unless the mother feels abnormal. This is perpetuated by some of the fathers’ lack of support of postnatal care by not providing transportation money to the hospital for care. In addition many fathers do not respect the recovery period the mother needs after giving birth. During the six weeks after giving birth it is advised to abstain from sexual intercourse in order for the mother to heal properly; however, it is all too common that fathers do not abide by this recommendation. Without attending the birth and hearing the initial post natal instructions, many do not believe the information relayed by the wife as it goes against traditional beliefs. The outcome often involves some sort of domestic violence or abandonment of the family.

Both ANC and PNC groups at the Kalisizo Hospital

Another prevalent issue in post natal health is family planning. The birth rate is very high in rural Uganda, and many mothers opt to pursue family planning in order to control the growth of their families. However, this goes against traditional beliefs, and many times women choose to obtain birth control without telling their spouses. The main form of contraceptive chosen by rural women is the "injectable", which is virtually undetectable and it is only administered every three months. A midwife that we interviewed who runs a private clinic claims that on Saturday market days, over fifty women visit her office seeking the injectable contraceptive. Furthermore, we brought up the issue of family planning to four mothers from the village in Rakai in order to obtain their perspective on family planning. When questioned if they choose to control their family growth as well as the method of preference, three out of the four admitted to using the injectable. The major reason why the injectable is preferred over other methods such as daily tablets is the discreetness and longevity that the system affords: since one injection lasts an average of three months, there is less opportunity for a husband to find out. As such, the women feel they are less likely to be subjected to undesirable consequences such as domestic violence.

Our findings at Rakai seemed to be contrary to what is advisable. This is because it is considered to be a supportive gesture for a husband to accompany his wife to the health center for postnatal care; but this was not the case. We found out that this has been due to traditions which may control a person’s decisions and ignorance which prevents a person from knowing the impact of postnatal care on the good health of a mother and her newly born baby.

Reflection Session:

Part of the student’s activities at Rakai was taking part in a community project as a way of contributing to community development. Access to clean water for domestic use is a problem in many parts of Rakai. This is due to long distance to the clean water sources or few clean water sources. We took part in the construction of a protected well. This would provide easy access to clean water for the people of Rakai. We conducted a reflection session to inform our peers about the developments in our project and gain insight as to their opinions about this community service project.

Working on the well as a team

Our first question for the reflection session was how the students felt about physically taking part in the community development project or if they felt that providing the necessary funds or hiring highly qualified  personnel to take up the project would be more fruitful. After our discussion we conclude that physically taking part was more meaningful. This is because we had interacted with the community members on a deeper level through family homestays and doing this project would have a great impact on their families and in Rakai as a whole. Taking part in it would also permanently leave the memory of the students among the Rakai people.

Our second question was the people’s preference between seeking healthcare from a public health facility versus seeking healthcare from a private health facility. There were different views about this. Some students preferred the public health facilities for various reasons for instance the presence of well qualified personnel and the provision of services at an affordable cost. Those who prefered the private health facilities did so because provision of services was quick and the quality of service provided was better compared to the public health facilities. This is in terms of how the staff treated the patients. In general most people preferred to seek healthcare from private health facilities.