Bringing a new life into this world is a miracle, and caring for a new-born is a delicate task that requires undivided attention. However, for many mothers in Ghana, the postpartum period is a challenging time due to a lack of access to focused care. The postpartum period is a critical time when mothers need to recover from childbirth and adjust to their new role as caregivers.
According to the World Health Organization (WHO), more than 60% of maternal deaths occur during the postpartum period, with 95% of these deaths happening in low and lower middle-income countries like Ghana. Ghana’s maternal mortality ratio of 308 deaths per 100,000 live births is also higher than the global average.
However, thanks to the Focused Post-Partum Care (Focused-PPC) project, a Randomised Control Trial (RCT) being piloted by Savana Signatures and the University of Notre Dame in the United States, mothers in the Sagnarigu Municipality of the Northern Region now have access to comprehensive postpartum care that meets their clinical care, education, and social support needs. The project is being conducted in four health facilities in the municipality and aims to test and evaluate an integrated postpartum care delivery model that helps fill the gaps that put many mothers at risk of postpartum health issues.
The benefits of the Focused-PPC project, which is in its final phase, are already evident. Mothers who have received care and support tailored to their postpartum needs report increased satisfaction with their care and improved health outcomes for both themselves and their babies. Peer-to-peer support has also been a significant benefit of the programme, with mothers sharing knowledge and healthcare providers noting improved communication and collaboration. Healthcare providers have also observed improved communication and collaboration between themselves and mothers.
One significant area of benefit for the mothers in the programme is family planning. Before joining the study, many women had heard misconceptions about family planning and were hesitant to try it. However, through the Focused-PPC programme, they have learned about the different options available and discovered how safe and effective the methods are. Many women have opted for family planning methods, which allow them to space the number of children they want to have in their lifetime, make better financial, educational, and nutritional plans towards their children’s well-being and welfare, while preventing or delaying pregnancies until such a time when they are ready. Again, some women have also reported experiencing additional benefits in terms of social support and enhanced nutrition.
Project Coordinator Ethel Emefa Ehla expressed satisfaction with the positive impact of the project on the health and social lives of the 96 women in the intervention group of the clinical trial.
“We are recording behaviour change regarding women’s urgency around their health postpartum. Also, an appreciable number are already on some family planning methods,” she said, indicating that the women “now understand what is at stake especially regarding their health”.
Ms. Elha explained that because the Focused PPC strategy places a strong emphasis on postpartum social support for mothers, the groups have effectively transformed into invaluable support networks for each woman within their shared space.
These women, she said, have formed close-knit communities, creating a nurturing environment where individuals rely on one another in times of need. She indicated that by fostering a sense of camaraderie, “whenever one has a problem they fall on other members of the group for support”.
The Project Coordinator said the project has been encouraging participants to prioritize financial stability before embarking on subsequent pregnancies, something she said resulted in the formation of saving and loans associations among the group of women.
Thirty-six-year-old Abdul Rahim Salamatu, who is 11-month-old in the project, is one of the mothers who has benefited from the family planning education provided by the Focused-PPC project. Salamatu had five children but lost one. Although she had heard a lot about family planning prior to joining the intervention, she did not fully understand the importance and the need to go for a family planning option. But through the programme’s series of sessions on postpartum care, she gained knowledge that helped her make the right decision for herself and her children by opting for the implanon family planning method.
“I had heard so much about family planning, but the negativity outweighed the positives, so I decided never to take family planning. My decision later to adopt a family planning method was influenced by the level of knowledge I received from the Focused-PPC project,” she revealed in an interview.
Just like Salamatu, 23-year-old Alhassan Fakiha pointed to family planning as her most significant area of benefit in the project. Before joining the study, she had heard many misconceptions about family planning and was hesitant to try it. However, through the programme, she learned all about the different options available and discovered that they are safe and effective.
Fakiha’s newfound knowledge didn’t just benefit her alone; she also shared it with a friend who was experiencing bleeding while on family planning. Fakiha referred her friend to a health facility and provided support and encouragement throughout the process.
But perhaps most importantly, family planning has had a positive impact on Fakiha’s relationship with her husband. Before using family planning, she worried about getting pregnant while breastfeeding, which caused tension in their intimate life. However, now that she is using family planning, they no longer have any issues when it comes to sex. Thanks to the education and support she has through the programme, she is now able to make informed choices about her reproductive health and enjoy a fulfilling and happy relationship with her husband.
For Haruna Kusumi, her journey with family planning began with misconceptions that are widespread in rural Ghana especially. Her argument was that women on family planning would not be able to conceive when they wanted to and that, married women only used family planning just so they could have extra-marital affairs. These beliefs made her hesitant in opting for a family planning method until she joined the Focused-PPC programme.
Through the education provided in the sessions, she learned that family planning allows families to space the number of children they want to have in their lifetime and prevent unwanted and unplanned pregnancies. She was amazed to find out that family planning can positively impact her life as a trader, as it allows her to focus on her business while also being assured that no unplanned pregnancies would occur.
Madam Kusumi’s story shows how misconceptions and lack of knowledge can affect individuals’ decisions on family planning. She opted for the three-year family planning method after her misconceptions were cleared through the programme. She explained that she feels more empowered now than ever because the Focused-PPC project has provided her with the right education to make informed decisions about family planning and reproductive health in general.
The Focused-PPC project has also shown great strides in the areas of nutrition, breastfeeding, and social support. For 28-year-old Zakaria Latifa, the programme has taught her how to properly feed her baby and conduct breast examinations. Latifa, who was hesitant about breastfeeding before joining the programme, now feels more empowered to take care of her new-born.
“Through the study, I’ve learnt how to properly feed my baby and examine my breasts for any abnormalities,” she said in an interview. She indicated that the knowledge she has gained has allowed her to take control of her health and prevent any potential risks. According to her, she has now been teaching the women in her household how to examine their breasts, emphasizing the importance of early detection in preventing breast cancer.
“Thanks to the study, I am now more confident and empowered in my ability to care for both me and my baby,” she stated.
Alhassan Hamdia, who prior to joining the project, struggled to take care of her baby and managing household chores, said through the Focused-PPC project, learnt the importance of seeking help and support when needed. It was previously difficult for her to request for support from the other members of her household because norms consider such women to be lazy. Hamdia explained she now feels comfortable asking her husband or other family members to assist with caring for the baby while she completes house chores because she understands better what is at stake especially regarding her mental health.
“This has not only helped to alleviate my workload but has also allowed me to bond more with my family members. I’m grateful for the social support lessons and I have since been advocating for other women in my community to seek help when needed,” she said.
Susana Nasara, a 29-year-old trader from Kanvilli, noted that although she already had one child, she had never learned how to properly hold a baby for breastfeeding until joining the Focused-PPC programme.
In addition, she said she had heard of the ‘4-star diet’ but was unsure how to properly combine foods to achieve a healthy meal. Through the Focused-PPC sessions, she gained knowledge of locally available nutritious foods that promote good health for herself and her children.
Peer support from Focused-PPC mothers, according to 36-year-old Mahamadu Fuseina, has been her take-away from the programme. She explained that as mothers, they have different experiences and perspectives, and being able to hear from other mothers about their own unique ways of handling issues has been invaluable to her.
“I enjoy attending the sessions not just for the education, but also for the opportunity to see and learn from other mothers in the group. Thanks to the peer support I’ve received, I feel more confident and empowered as a mother,” she said.
The Focused-PPC project, without a doubt, is a significant step towards improving postpartum care in Ghana and reducing the maternal mortality rate. By providing comprehensive care and education that meets the specific needs of mothers during the postpartum period, the program is helping women make informed decisions about their health and well-being. The positive results of the FPPC project show the urgent need for more focused postpartum care in Ghana and other low- and lower middle-income countries.
By Stephen Kwabena Effah
The project is funded, in part, with support from the Indiana Clinical and Translational Sciences Institute, and in part from the National Institutes of Health (NIH), National Center for Advancing Translational Sciences, and Clinical and Translational Sciences Award. It is also being supported with funding from the Eck Institute for Global Health, and the Ford Program in Human Development Studies and Solidarity, University of Notre Dame.