Concealed pregnancy as an act of care, A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia
Concealed pregnancy as an act of care, A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia
Background
A barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost.
Methods
Five focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC.
Results
Two reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy’s obvious visibility to others were given by focus group participants. These were ‘pregnancy outside of marriage’ and ‘evil spirits and miscarriage.’ Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection.
Conclusion
Women’s lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women’s access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies.
Child Health, Diabetes, Maternal Health, Witchcraft, Child health, Maternal health
Parish, Sabine
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Vasan, Senthil
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Karpe, Fredrik
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Hardy-Johnson, Polly
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Jarjou, Ousman
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Bittaye, Mustapha
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Prentice, Andrew
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Ulijaszek, Stanley
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Jobe, Modou
90a53580-64c5-403f-ba7f-14df1390bf0d
24 May 2023
Parish, Sabine
b11f9fdb-9155-4ad3-9e37-92673b81258f
Vasan, Senthil
219d7ba5-8447-4c07-8b12-f206604e1382
Karpe, Fredrik
ca6fc82c-95f5-47a3-a4cd-76c2a7c7fc11
Hardy-Johnson, Polly
49276c2f-01a9-4488-9f30-dc359cf867e0
Jarjou, Ousman
3c0e1926-d121-42c2-8ea5-363e14b6b6b1
Bittaye, Mustapha
61a186e4-5d87-45fc-9b5b-3140cd3a430e
Prentice, Andrew
6d3f4226-132a-4c4f-a36d-4aa684d9498b
Ulijaszek, Stanley
5d220439-20a2-42f0-826f-ca9eeab30d37
Jobe, Modou
90a53580-64c5-403f-ba7f-14df1390bf0d
Parish, Sabine, Vasan, Senthil, Karpe, Fredrik, Hardy-Johnson, Polly, Jarjou, Ousman, Bittaye, Mustapha, Prentice, Andrew, Ulijaszek, Stanley and Jobe, Modou
(2023)
Concealed pregnancy as an act of care, A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia.
BMC Pregnancy and Childbirth, 23 (1), [374].
(doi:10.1186/s12884-023-05710-6).
Abstract
Background
A barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost.
Methods
Five focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC.
Results
Two reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy’s obvious visibility to others were given by focus group participants. These were ‘pregnancy outside of marriage’ and ‘evil spirits and miscarriage.’ Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection.
Conclusion
Women’s lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women’s access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies.
Text
s12884-023-05710-6
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More information
Accepted/In Press date: 16 May 2023
Published date: 24 May 2023
Additional Information:
Funding Information:
The authors wish to acknowledge the support and active input from the Scientific Coordinating Committee (SCC) and from the Research Governance and Support Services, MRC Unit The Gambia at LSHTM. We would like to thank the management and staff of the Ministry of Health of The Gambia and of Kanifing General Hospital for their support in conducting the study at the hospital premises. The authors thank the staff of the MRC Unit The Gambia at LSHTM and, in particular: Fatou Y. Manneh for data collection activities, Penda John and Fatou Jaiteh for valuable input in designing the protocol and focus group discussion guide. Finally, we are grateful to the many study participants who have been so willing to contribute to this study.
Funding Information:
The authors wish to acknowledge the support and active input from the Scientific Coordinating Committee (SCC) and from the Research Governance and Support Services, MRC Unit The Gambia at LSHTM. We would like to thank the management and staff of the Ministry of Health of The Gambia and of Kanifing General Hospital for their support in conducting the study at the hospital premises. The authors thank the staff of the MRC Unit The Gambia at LSHTM and, in particular: Fatou Y. Manneh for data collection activities, Penda John and Fatou Jaiteh for valuable input in designing the protocol and focus group discussion guide. Finally, we are grateful to the many study participants who have been so willing to contribute to this study.
Funding Information:
Funding for the PRIMORDIAL study is from Medical Research Council, UK (MR/R020345/1) the Global Challenges Research fund, University of Oxford, UK (0006138), and Newton Fund (BT/IN/DBT-MRC/DIFD/JM/12/2018–19).
Publisher Copyright:
© 2023, The Author(s).
Keywords:
Child Health, Diabetes, Maternal Health, Witchcraft, Child health, Maternal health
Identifiers
Local EPrints ID: 480502
URI: http://eprints.soton.ac.uk/id/eprint/480502
ISSN: 1471-2393
PURE UUID: 3b537049-1861-4aeb-8061-f9e382c39156
Catalogue record
Date deposited: 03 Aug 2023 16:42
Last modified: 18 Mar 2024 03:38
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Contributors
Author:
Sabine Parish
Author:
Senthil Vasan
Author:
Fredrik Karpe
Author:
Polly Hardy-Johnson
Author:
Ousman Jarjou
Author:
Mustapha Bittaye
Author:
Andrew Prentice
Author:
Stanley Ulijaszek
Author:
Modou Jobe
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