Kwaleyela, Concepta Namukolo
(2016)
An interpretive phenomenological study of women's childbirth experiences in Zambia.
PhD thesis, University of Nottingham.
Abstract
Childbirth holds short and long-term physical and psychological effects for women. Yet, numerous investigations into childbirth have overlooked the delicate interrelated psychological and emotional interplay that women experience, in favour of the physical, such as the outcomes of birth, maternal mortality, and the physical skills of healthcare providers. Although quantitative measures derived from these are important to establish and evaluate maternal health, they are not adequate to explain the complexity of the human experience of childbirth. Without this understanding there is inadequate guidance about how to proceed to achieve the Sustainable Development Goals targeting maternal health.
The aim of this study was to explore childbirth experiences of women giving birth in Zambia, in order to better understand how they experience and give meaning to the phenomenon. The study was guided by an interpretive phenomenology approach. This type of phenomenology was found to be appropriate because the study sought to understand childbirth within the context of everyday lives of women birthing in Zambia. Purposive sampling was utilised to recruit 50 women aged between 16 and 38 years. The women had birthing experiences that occurred between 2005 and 2011. The birthing experiences were from all the ten provinces of Zambia. Data were collected through in-depth unstructured interviews, which were tape recorded. Data analysis was guided by van Manen’s six steps of analysis. Seven themes namely: 1) Conforming to societal norms, 2) Clash between traditional and contemporary childbirth practices, 3) Being in a dilemma, 4) Loss of dignity, 5) Feeling insecure, 6) Inadequate service provision, and 7) Being there for the woman, emerged from the analysis. Each theme had several sub-themes that provided a clearer picture of how participants experienced the phenomenon.
The embodied experiences of participants illuminated the complex context of childbirth, whereby, the phenomenon was experienced in private, behind the closed door of secrecy that encompassed difficulties and issues such as, lack of choice, sub-standard care, discrimination, fear and conflicting information. The findings revealed that there was a need for an attitudinal change in maternity care professionals towards a more caring approach, as well as a parallel need to build agency and autonomy in women. For women, the change needs to be addressed at an individual and societal level, beginning with simple things, such as assertiveness training through to educational opportunities, so that they develop economic independence. Macro-reforms (top-down change) need to be combined with micro-reforms (bottom-up change) to challenge existing discriminatory, oppressive and patriarchal attitudes and practices that impact on women’s birth experiences. Women’s voices need to be heard. Understanding maternal outcomes at a micro level can help inform decisions and influence policy at the larger macro levels of institutions and government. Overlooking this intrinsic level represented an important barrier to utilisation of skilled birth care and constituted a common cause of suffering and human rights violations for birthing women.
The key implications for practice pointed to a need for all maternity care stakeholders in Zambia to have an understanding of how women birthing in Zambia experience and give meaning to the childbirth phenomenon. This could start by re-examining current approaches to improving reproductive health, and addressing the contextual factors and community based issues that have been brought to light in this study. In the absence of such an understanding it is difficult to map out interventions that do not infringe on women’s beliefs and practices.
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