Health and Society - Antenatal Care in the Gambia - Term Paper Example

HEALTH AND SOCIETY of Background In order for us to know well the reason behind this woman based on culture and tradition. I'd like to show a brief background regarding Gambia. The Republic of Gambia is a small country with a population of only 1.2 million and is situated on the west coast of Africa. Typical climate is hot and rainy. It was after World War II wherein the British government developed Gambia and sooner earned its independency. Gambia is considered multiethnic country having several major ethnic groups but majority of the language spoken is English. The elite ethnic group is considered as traders and shopkeepers. It has also a multiparty political system just like any other countries. Major social problems are poverty, disease and lack of economic development due to some corruptions and serious welfare problems. In terms of marriage, they practice two type of law; The Customary and the Shari'a Law. Customary law is for non-muslims which covers inheritance, land tenure, clan and tribal leaderships and is often called General Law which follows British's Law whereas the Shari'a Law is for Muslims and it covers divorce and marriage. Furthermore, these two laws does not differentiate much those unmarried to those married. Main Issues Based on the clinical scenario provided, there are so many issues that the lady might be facing; 1.) Unemployment, it will be a big issue on her part since she has no means of making money to support herself and her baby aside from the fact that during pregnancy period proper natal care - both pre and post should take place. 2.) No past medical history for 13 weeks, this will be a problem on the baby's part. As we all know that pre-natal care is really mandatory for the first trimester of pregnancy. What happened to her was she didn't pay attention to it and there could be problems that have came out which she didn't know due to her negligence. 3.) Unexpected pregnancy, I do not think it would be a problem on her parents part but the thing is she didn't have someone to stand by her and to help her with the duties and responsibilities of being a parent to a newly born child. Why I did say that First, she's already mature and old enough to know the consequence of having unprotected sex and getting pregnant without a father. Second, I think her parents would understand that their daughter is already 32 years old and can live a life of her own and can manage to bear the child. Lastly, one thing that is alarming is that she has no means to bear the child properly. This clinical scenario have raised psychosocial and personal issues. She may or she may not know the consequences she's facing given the following information relating to her pregnancy. I also believe that one factor that contributes to her being intentionally or unintentionally aware of her condition is the kind of environment she has experienced from her home town. On the other hand, North London has been fair to its society by promoting health care practices for pregnant women, thereby suggesting that it might her lack of knowledge -whether intentionally or unintentionally that's adding to the case, getting the fact as well that from her home town, men are expected to be the ones on the field working hard enough for the family. Cultural Concepts The clinical scenario has mentioned Antenatal. Prior to discussing the psychosocial theories encompassing pregnancy in Gambia and/or in North London. One should have a better understanding of what Antenatal care is Antenatal care actually given to pregnant women to further inform and educate them regarding issues related to parenting, birth and pregnancy. The program is designed to equip pregnant women regarding choice that will lead to optimum pregnancy outcome and newborn care which includes information, education and communication. Through these efforts, educated women have good outcome compare to those who didn't receive it. Banjul [2002] states that most antenatal care is provided through government facilities (80-85%) and non-Governmental Organizations (15-20%). Less than 3% of pregnant women receive antenatal care at private facilities. Table 1: Characteristics of antenatal clients Characteristic Percentage (%) Age distribution (years) N = 447 < 20 17.7 20-24 33.6 25-29 29.1 30-34 12.3 35+ 7.4 Gravidity N = 456 1 23.9 2 21.3 3 16.0 4 12.7 5 10.5 6+ 15.6 Gestational age at first visit N = 457 First trimester (0-13 weeks) 8.1 Second trimester (14-27 weeks) 62.8 Third trimester (28+ weeks) 29.1 Number of visits at interview N = 457 1 10 2-3 38 4+ 52 [Source: Anya, S.E.et all, Page 3.] Given the table above, it shows the percentages of antenatal clients on different age brackets and their frequency of visits. Given the proper information to all patients, it shows that there are high percentage of good respondents through education, information and communication efforts. Now, given the table below represents a percentage of pregnant women who attended information, education and communication in relation to antenatal care both in urban and rural areas: [Source: Anya, S.E et al. Page 6] Conclusion Given the following examples and tables, I therefore conclude that pregnant women who do not possess the right information in relation to pregnancy and child birth care would lead to irresponsible choices thereby affecting their well being as well. Furthermore, it is necessary specially on the women's first trimester of pregnancy to fully consult to her doctor regarding careful pregnancy. Therefore, there is a significant difference between studies conducted on rural and on urban. Each varies from each other depending on the characteristics. Psychosocial Theories There are so many theories development over the years relating to psychosocial. There are Freud's theories such as id, ego, superego and infantile sexuality. Erickson theory believes that personality development comes from childhood. He was the one who formulated the Epigenetic Theory wherein it states that all of the psychosocial theories are already present at birth and is dependent on up-bringing and innate scheme. It was said that psychosocial theory has different stages wherein each stage is characterized by crisis - based on physiological development and demands through society and parents. He also believes that each one of us has a mixture of traits wherein we get it on each stage. Based on the given clinical scenario I am seeing that the woman has a egoistic type of personality wherein she believes that not going to antenatal care, having no father figure and no work will help her to resolve the kind of pregnancy she is experiencing. Erickson's theory of ego psychology includes the following information: 1. That it is of utmost importance 2. That it operates independently between id and superego 3. That it is a powerful agent that adapts to situations 4. That it promotes mental health 5. Lastly, it plays a role both in personality development such as social and sexual factors. Apart from that, among the theories development past or present. Hereunder is the table wherein I am seeing very much related to the clinical scenario: Personality Stage Psychosexual Mode Psychosocial Modality "Virtue" Trust vs. Mistrust incorporative1 incorporative2 getting taking Hope Autonomy vs. Shame, Doubt retentive eliminative holding on letting go Willpower Inititative vs. Guilt intrusive making Purpose Industry vs. Inferiority Competence Identity vs. Role Confusion Fidelity Intimacy vs. Isolation Love Generativity vs. Stagnation Care Integrity vs.Despair Wisdom [Source: http://www.haverford.edu/psych/ddavis/p109g/erikson.stages.html] Midwifery Practice and Plan of Care The practice of Midwifery involves independent management of women's health care having its competency on pregnancy, childbirth, postpartum, new born care, family planning and gynecological needs. Therefore, competency and proficiency are the two key factors being considered for qualifications. Within the health care system practice we have the Certified Nurse - Midwife (CNM) and Certified Midwife (CM) which these two provides collaborative management and consultation in relation to the health status of the patient. Apart from that, they provide options, choices and practices in accordance to the practice standard of the governing health care organization. The midwifery practice provides co-management solutions and patterns of care for patients such as consultation, referral and collaboration. It was also said that midwives should not also being professional in nature but should serve as a mentor, a friend, a manager for clinical area and researchers. In the practice of Midwifery, there are so many Standards to follow such as: 1. Midwifery Care is provided by qualified practitioners. 2. Midwifery Care occurs in a safe environment within the context of the family, community and a system of health care. 3. Midwifery Care supports individual rights and self-determination within boundaries of safety 4. Midwifery Care is comprised of knowledge, skills, and judgments that foster the delivery of safe, satisfying, and culturally competent care. 5. Midwifery Care is based upon knowledge, skills, judgments which are reflected in written practice guidelines. 6. Midwifery Care is documented in a format that is accessible and complete. 7. Midwifery Care is evaluated according to an established program for quality management that includes a plan to identify and resolve problems. 8. Midwifery Practice may be expanded beyond the ACNM core competencies to incorporate new procedures that improve care for women and their families. [Source: American College of Nurse-Midwives] Implications for Practice and Planning It is important to do a wide range of research in terms of establishing whether or not that the midwives' perceptions of motherhood can really influence a wide range of options given to patients or the kind of decision making their providing their patients. On the other hand, it is necessary to set limits between patients and midwives regarding clarification of responsibilities involving decision making thus a detailed record-keeping and form-filling is advised for any form of litigation. Furthermore, we should practice to encourage both midwives and patients to express their opinions without any fear of understanding it wrong. Either way, this would welcome both to be freed from any blames, retribution, unwelcome views thereby creating a good stage of developmental process. Within the practice, the role of midwife in terms of decision making is not only confined into what is the scope of law relative to the organization but also on the responsibility that she has in terms of record-keeping. A midwifery plan of care should be well formulated in conjunction to the patient's needs, conditions, as well as with the patient's baby. With this, it only shows the midwife's ability to independently assess or attend to patient's or baby's needs, how is she going to execute the plan of care and the kind of implementation she's going to provide. Furthermore, modifications in the plan or management can be altered from the original one thereby giving her the freehand to work independently without any opinions or views which might cause to interfere in her decision making. Of course, there are times wherein midwife needs to consult other opinions such that from doctors. This is something that is inevitable specially not all cases are the same and progress of one from the other differs. References 1. Anya, S., Hydara, A., Jaiteh, L. (2008) Antenatal Care In The Gambia: Missed Opportunity For Information, Education and Communication, [Online], Available: http://www.womensnet.org.za/antenatal-care-in-the-gambia-missed-opportunity-for-information-education-and-communication [12 December 2009]. 2. Gambia, [Online], Available: http://www.everyculture.com/Cr-Ga/Gambia.html [12 December 2009] 3. Report on the national survey on maternal, perinatal, neonatal and infant mortality and contraceptive prevalence - 2001. Banjul 2002. 4. David, D., Clifton, A. (1995). Psychosocial Theory: Erikson [Online] Available:http://www.haverford.edu/psych/ddavis/p109g/erikson.stages.html [12 December 2009] 5. Clinical Practice Committee (1997).Collaborative Management in Midwifery Practice for Medical, Gynecological and Obstetrical Conditions [Online] Available: http://www.midwife.org/siteFiles/position/Collaborative_Mgmt_05.pdf Read More