Background to the Study
During pregnancy, because of the extra demand made by the foetus on the mother and also due to hormonal influences, the mother is posed with many needs and problems. These needs and problems could be physical, emotional, social or economic in nature (Agular & Galbes, 2004). Nevertheless, there are certain factors, which serve as ingredients for personal health. These factors must be available in appropriate quantity for health to be optimal. Some of these factors are more pressing or are in greater demand at certain periods of human life, notably during pregnancy than at other periods. Therefore when these conditions or factors are absent or deficient, health needs and health problems arise because health is threatened (Adi, 1979).
Levenstein (1975) affirmed that health needs refer to all the measures adopted to safeguard and restore health, which include medical care, safety, nutrition, emergency care, exercises, rest and sleep, cleanliness and keeping of health records. This definition is considered reasonable because it is comprehensive in terms of the objectives of health needs, which are to safeguard health, prevent ill-health and to restore health when it has failed. Therefore availability of these health needs can counteract the health problems. Werner (1984) supported this claim when he stated that these health needs of people who could be pregnant women as in this present study describe optimal health requirement. Health needs as implied in the present study refers to all the measures adopted to safeguard and restore health. These measures as enumerated by Akhtar (1994) to include medical and dental care, safety, proper nutrition, exercises, rest and sleep, health record keeping, cleanliness (personal and environmental) and emergency care. He stated that failure to provide these measures or health requirements in required quantity could threaten or constitute health problems. These health needs which exist along side the various dimensions of health namely physical, social, emotional and economic aspects can pre-empt a health problem of corresponding nature. Health need therefore defines the gap between optimal health conditions or requirements and health impairment such that when the conditions for health are not satisfied, a health need is created which result in a health problem to a pregnant mother.
The time of pregnancy according to Myles (2006), is the most demanding period in a woman’s life. The demands and needs of this pregnant woman require adequate attention to avoid malformation or deformation, or retardation in foetal growth and development. During pregnancy, because of organogenesis and hormonal influences, the woman is posed with many needs and problems which are physical, emotional, social and economical in nature. According to Bermete and Brown (2001) the health needs of a pregnant women could be physical (needs concerned with the physical requirement such as good nutrition, medical care, personal hygiene, breast care, dental care, proper clothing, exercises, rest and sleep, sexual activity and traveling needs), psychological (emotional care that women need during pregnancy from their partner, other members of the family and the health workers), and socio-economic (spouse support, accessibility of health facilities, availability of good roads and transportation, level of education, economic status, customs and beliefs, availability of qualified and skilled health workers and materials.
Explaining further on the physical needs they stated that pregnancy is the most nutrition demanding period of a mother’s life because she needs enough nutrient everyday to support her health, demands from the growing foetus and many hormone induced developmental processes. Supporting this claim, the American Dietetic Association – ADA (2002) stated that a pregnant mother needs extra 300 calories daily; making it a total of 2500 to 2700 calories daily to improve the nutritional level of the women thereby averting medical problems.
The medical need also included in the physical health needs is treated under prenatal care services. Prenatal care being the series of test, examinations, diagnosis and treatment a pregnant mother gets from the time of conception as noted by a qualified medical personnel till the date of delivery. It is therefore imperative that all pregnant women should attend regular prenatal care, for proper assessment, early detection and prompt management of risk factors. It will also be a medium whereby the health care providers can help the mothers to identify their needs in pregnancy and be able to meet their according thus reducing the risks involved during pregnancy and delivery (Lerfer & Hatson, 2002). Activities involved during the prenatal care period include physical examination of the pregnant women, data collection and analysis, laboratory investigations and examinations; blood grouping, gerotype, haemoglobin estimation, urine testing, weight and height estimation history taking, blood pressure estimation and height education. All these serve as monitor for proper assessment of maternal and foetal well-being.
Exercises as one of the physical health needs of a pregnant woman is essential because it is one of the factors that pave way to successful delivery. Agurlar and Galbes (2004) affirmed that a woman that is physically fit hardly gets any complication because complication from clinical records are usually an aspect of pregnancy of those who are not physically fit. Regular exercise improves the muscular system and one of the basic needs of the pregnant mother since muscular contraction is an integral part of labour.
Although the pregnant woman needs exercises to improve the muscular system, sleep and rest (as physical needs) are also very import during pregnancy. According to Myles (2006) a pregnant mother needs one or two hours of sleep in the afternoon and a total of nine hours sleep in the night for proper development of the foetus and maternal well-being.
Pregnant women need adequate clothing as part of the physical needs. The clothing of pregnant women should be clean, loose-fitting and attractive and should be worn according to weather (Fraser, Cooper and Nolte, 2006). They submitted that maternity gowns are preferred to tight flitting gowns. Tight-fitting belts, under wears and shirts should be avoided to prevent constriction of blood vessels. According to them pregnant women should wear comfortable shoes with broad base to avoid falls and ensure proper balancing.
Many pregnant mothers experience undue distress and anxiety because they are not aware of the normal psychological upheavals, emotional changes and adjustments that are integral of the child bearing process. Myles (2006) stated that during pregnancy, woman need high level of emotional care, usually from her husband, members of her family and health personnel. She is encouraged to stay mostly in places where there are joy inducing faculties like amusement parks, places that will divert her mind from worries and tension. In the case of first pregnancy (primips) she stated that so many factors are responsible for fear and anxiety because she is so afraid of what will befall her, what will be her faith during labour. Usually one sees signs of relief on their faces following antenatal classes when solutions and answers are given to their numerous health care questions. Emotional care is therefore very important because anxiety and fear has been discovered to be responsible for high blood pressure in pregnancy. When neglected, it leads to abortion of the foctus, excessive bleeding during child birth or bleeding during pregnancy.
During pregnancy, women require social and economic health needs. Where the social and economic health needs are deficient socio-economic health problems result. According to Smith (2006), the social and economic needs of a pregnant woman include spouse support, accessible of health facilities, availability of good roads and transportation, sound education, stable economy, availability of qualified and skilled health workers and materials. Smith further pointed out that failure to provide these needs in required quantity will lead to corresponding health problems. Health need therefore defines the gap between optimal health conditions and health impairment such that when the conditions for health are not satisfied, a health need is created which results to a health problem.
Health problem has been defined severally. Some view health problem as a state of disequilibrium, others as disease conditions, and while others as factors that predispose one to disease condition. Health problem according to Prothero (1994), is a state of disequilibrium in which diseases flourish and health is impaired. Continuing, he explained that man and the environment are closely linked in a complex relationship, which frequently presents conditions of equilibrium between disease and health impairment. Impairment of health, according to him, may manifest as disease or infection. Meads (1994) posited that health problems represent something physically or emotionally distressing for which relief is sought. In this definition, she categorized health problems into dimensions, such as physical, mental or emotional and social problems. She gave examples of physical problems as skin diseases, ulcers, diarrhoea and of mental or emotional problems as stress, anxiety disorder, alcoholism and psychotic disorders. Her examples of social problems include maladoptation and maladjustment. She explained further that such health problems are so distressing that the person affected usually seeks relief. Myles (1999) defined health problems as conditions which prevent individuals from mobilizing their physical, social and mental resources for optimal living. Thus any health condition which prevent pregnant women from attaining maximum working efficiency in daily tasks, would constitute a health problem because it would not permit them to mobilize their physical, social and mental resources for optimal living. She also pointed out that in order to counteract the health problems, corresponding health needs should be provided. As implied in the present study, health problems are deficiencies in conditions of a pregnant woman necessary for attaining or promoting health. Therefore it becomes imperative that health problems of pregnant women in the process of attaining or enjoying motherhood be averted by adequate provision of health needs to ensure proper development of the foetus and maternal well being (Fraser, 2006).
Health problems are the conditions which a pregnant woman encounters whether at the on set of the pregnancy or as the pregnancy advances that give discomfort and in some cases may lead to complications or even death. These health problems could be physical, emotional, social and economic in nature. According to Myles (2006) the physical problems include heart burn, nausea and vomiting, constipation, haemorrhoids, vaginal discharge, placenta previa, premature rupture of membranes, pregnancy induced high blood pressure or pre-eclampsia, intrauterine growth retardation, urinary tract infection, indigestion, dental problems, pedal oedema and pica. She also stated that emotional problems include anxiety, fear, tension, moodswings and aggression; and that poverty, neglect, illiteracy, inadequate provision of health facilities and basic facilities like good roads, transportation, good water supply, electricity among others belong to socio-economic problems. Besides, problems pregnant women may develop a wide range of complications or disease conditions such as hepatitis, congestive heart failure, high blood pressure and aneamia in pregnancy.
Pregnancy for extremes of age (that is too young and too old) and parity should not be neglected while addressing the issue of health problems of child bearing women. Myles (1999) posited that women of less than eighteen years and over thirty five years, multparous women, previous obstetrical difficulty such as unexplained still births, premature deliveries and abortions pose a lot of health problems to the child bearing women. According to myles child birth at a very young age or old age, most of the time does not go without complications like vesico vaginal fistula (VVF), cephalopelvic disproportion (CPD), premature delivery, pre-eclampsia, post partum haemohage, abnormal babies and increased maternal mortality. Lock wood and Funai (1999) affirmed that problems of placenta praevia is more common in multiparous or multigravidae with an incidence rate of 1 in 90 deliveries. According to them placenta pravia rates rise in women with increasing age and increasing parity. These problems can be avoided as the health care solution to prevent or manage these complications are well known, especially for pregnant women in Ayamelum LGA.
Motherhood is one of the greatest aspirations of a woman, yet being pregnant demands so much from her in terms of fitness (Udoh & Amuse, 1982). They added that it requires a healthy woman to carry and bear a normal healthy baby, because she needs to be physically, emotionally and socially stable to achieve this. Pregnancy according to Roper (1999) is being with a child, that is gestation from the last normal menstrual period to parturition, normally 40 weeks or 280 days. The concept of pregnancy usually seen as a normal life event may, to a woman, appear discordant depending on her life experience. In a woman who has rarely been ill, the discomfort of heartburn, intestinal pains due to constipation and constant desire to vomit can indeed be perceived as more akin to an illness than anything previously experienced (Myles, 1999). Mittendorf, Willian and Berher (1999) asserted that pregnancy is the carrying of one or more foetuses inside the body of a female mammal such as a woman. According to them pregnancy is usually divided into three trimesters as a means of simplifying reference to the different stages of prenatal development. The first trimester is from the first month to the third month, the second trimester is from the fourth to the sixth months, and the third trimester from the seventh to the ninth month. According to Benneth and Brown, (2001) pregnancy is normally forty weeks approximately for all women, women in Ayamelum LGA inclusive.
Ayamelum is a typical rural settlement in Anambra State, Nigeria. The LGA comprises mainly the Igbo ethnic nationality. The predominant occupation of the people is farming. Most of them own large expanse of land for farming. Public utilities such as good water supply, electricity supply, good roads and hospitals do not seem adequate. Hospitals like general hospitals where referral services can be made in case of emergency are still lacking. There are only few health centres and maternity homes, managed by nurses and midwives and traditional birth attendants without resident doctors. This poor distribution of health system and qualified personnel may constitute a very big problem for childbearing women in Ayamelum LGA, hence the topic health needs and problems of child bearing women in Ayamelum LGA.
Statement of the Problem
Pregnancy and childbirth are natural processes requiring the provision of health care supervision and support because of expectant mother’s hope for a rewarding experience in pregnancy, labour and delivery. Apart from this, a pregnant mother has special needs and lack of these needs at certain stages can be dangerous. World Health Organization (WHO) identified maternal and child health care including family planning as one of the eight essential components of primary health care to be vigorously pursued, improved and implemented at all levels of care (Egwu, 1996). Although majority of women have normal pregnancies, safe delivery and healthy babies but some do develop complications during the course of pregnancy which may be minor, severe or even life threatening to the mother, baby or both. Many of these health problems and deaths encountered by mothers and children are preventable through maternal and child health care services. Way back to 1978 at the international conference on primary health care Alma Ata, maternal and child morbidity and mortality were recognized as a major public health problem that needed priority action. The conference through the Alma Ata declaration, also affirmed access to basic health services as a fundamental human right (Owuole, 2004). Access to basic health services should be the right of every human being, pregnant women inclusive.
Moreover, the health for all policy for the 21st century in African region (Agenda, 2020) calls for focus on making pregnancy safer. This addresses all levels of the health care delivery system; community, primary health care and referral levels. The interventions at community level aim at empowering pregnant women, their partners, families and communities to make appropriate decisions and take timely actions in the face of pregnancy related complications. This is because pregnant women and children represent high risk groups within the population. Maternal services are to ensure as far as possible, that these women remain healthy throughout pregnancy and delivery and recover fully from the effects of pregnancy and delivery, by making provision for the basic needs of these women.
Despite the provision of all these meternal health services aimed at making pregnancy and childbirth safe, still a lot of childbearing women especially in the developing countries like Nigeria, Ayamelum LGA inclusive do develop complications and die from pregnancy related problems. This may be due to poor distribution of health facilities by the government.
Additionally, during pregnancy, because of extra demand made by the foetus on the mother and also due to hormonal influences, the mother is posed with many problems which are health related. Amidst these health problems, it is still doubtful whether the health management board has adequate provision for the needs of these pregnant women as to counteract these health problems. Could this condition in Ayamelum LGA be a difficult one or problem to pregnant women in the area? Hence the topic health needs and problems of childbearing women in Ayamelum LGA.
Purpose of the Study
The purpose of the study was to identify the health needs and problems of pregnant women in Ayamelum LGA of Anambra State. Specifically, the objective of the study is to identify the: