We are strong women : A focused ethnography of the reproductive lives of women in Belize

Belize is a small country in Central America with a unique heritage. The cultural pluralism found in Belize provides an opportunity to explore the cultures of the Maya, Mestizo and the Caribbean. Women in Belize share this cultural heritage as well as the reproductive health issues common to women throughout the developing world. The experiences of unintended pregnancy, contraceptive use and abortion were explored with women using a feminist ethnographic framework. Key informants, participant observations, secondary data sources and individual interviews provided rich sources of data to examine the impact of culture in Belize upon the reproductive lives of women. Data were collected over a two-year period and analyzed using QSRNudist qualitative data analysis software. ^ Analysis revealed that regardless of age, ethnicity or educational background, women who found themselves pregnant prior to marriage experienced marriage as a fundamental cultural norm in Belize. Adolescent pregnancy often resulted in girls\u27 expulsion from school and an inability to continue with educational goals. Within marriage, unintended pregnancy was accepted but often resulted in more committed use of contraception. All women had some knowledge and experience with contraception, although some were more successful than others in planning their families. Couples usually made decisions together regarding when to use contraception, however misinformation regarding safety and efficacy was prevalent. While abortion is illegal, most women had knowledge of abortion practices and some had personal experiences with self induced abortions using traditional healing practices common in Belize. ^ Belizean culture is evolving as Belize grows and tries to find its place in the global marketplace. Education and employment have created new opportunities for women in Belize. However, these opportunities have resulted in challenges to the traditional roles and culture of families in Belize. Women in Belize enjoy somewhat better health than their geographic and cultural neighbors yet share many of the same concerns for their health and their families. Women strive to obtain quality health services and equality in employment and relationships, and share these struggles with women throughout the developing world.

Randomized controlled pilot of a group antenatal care model and the sociodemographic factors associated with pregnancy-related empowerment in sub-Saharan Africa

Abstract Background The links between empowerment and a number of health-related outcomes in sub-Saharan Africa have been documented, but empowerment related to pregnancy is under-investigated. Antenatal care (ANC) is the entry point into the healthcare system for most women, so it is important to understand how ANC affects aspects of women’s sense of control over their pregnancy. We compare pregnancy-related empowerment for women randomly assigned to the standard of care versus CenteringPregnancy-based group ANC (intervention) in two sub-Saharan countries, Malawi and Tanzania. Methods Pregnant women in Malawi (n = 112) and Tanzania (n = 110) were recruited into a pilot study and randomized to individual ANC or group ANC. Retention at late pregnancy was 81% in Malawi and 95% in Tanzania. In both countries, individual ANC, termed focused antenatal care (FANC), is the standard of care. FANC recommends four ANC visits plus a 6-week post-birth visit and is implemented following the country's standard of care. In group ANC, each contact included self- and midwife-assessments in group space and 90 minutes of interactive health promotion. The number of contacts was the same for both study conditions. We measured pregnancy-related empowerment in late pregnancy using the Pregnancy-Related Empowerment Scale (PRES). Independent samples t-tests and multiple linear regressions were employed to assess whether group ANC led to higher PRES scores than individual ANC and to investigate other sociodemographic factors related to pregnancy-related empowerment. Results In Malawi, women in group ANC had higher PRES scores than those in individual ANC. Type of care was a significant predictor of PRES and explained 67% of the variation. This was not so in Tanzania; PRES scores were similar for both types of care. Predictive models including sociodemographic variables showed religion as a potential moderator of treatment effect in Tanzania. Muslim women in group ANC had a higher mean PRES score than those in individual ANC; a difference not observed among Christian women. Conclusions Group ANC empowers pregnant women in some contexts. More research is needed to identify the ways that models of ANC can affect pregnancy-related empowerment in addition to perinatal outcomes globally