Exploring the community perceptions and understanding of stillbirth in South Africa: A qualitative study

Document Type : Original Article

Authors

1 Department of Advanced Nursing, University of Venda, South Africa

2 School of Health Sciences Research Office, University of Venda, South Africa

Abstract

Background: The stillbirth rate in Mpumalanga province, South Africa, ranges from 21 to 27 per 1000 total births.
Objectives: The objective was to determine the community perceptions and understanding of factors contributing to stillbirths.
Methods: A qualitative explorative study was conducted. The population comprised traditional birth attendants and women who had experienced a stillbirth in their lifetime. Purposive sampling was used to select the four hospitals and twelve women while snowball sampling was used to select five Traditional Birth Attendants. Data were collected through in-depth interviews and analyzed through Tesch's open coding method. Trustworthiness was ensured by considering the criteria of credibility, dependability, applicability, and transferability.
Results: The themes that emerged as general perceptions and understanding of stillbirth focused on participants' knowledge of stillbirth, perceived contributory causes, perceived prevention interventions, and traditional birth attendants' roles and interventions.
Conclusion: Lack of knowledge, cultural practices, and health workers' attitudes were perceived to be contributory causes of stillbirth. The antenatal care health education content for women of childbearing age and traditional birth attendants needs to include the medical diseases that cause stillbirth.

Keywords

Main Subjects


  1. Ayebare E, Lavender T, Mweteise J, Nabisere A, Nendela A, Mukhwana R, et al. The impact of cultural beliefs and practices on parents' experiences of bereavement following stillbirth: a qualitative study in Uganda and Kenya. BMC Pregnancy Childbirth 2021;21(1);443. doi:10.1186/s12884-021-03912-4 PMid:34172018 PMCid:PMC8228937
  2. Aminu M, Bar-Zeev S, van den Broek N. Cause of and factors associated with stillbirth: a systematic review of classification systems. Acta Obstet Gynecol Scand 2017; 96(5):519-528 doi:10.1111/aogs.13126 PMid:28295150 PMCid:PMC5413831
  3. Awoleke JO, Adanikin AI. Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital. J Pregnancy 2016;2016:1703809 doi:10.1155/2016/1703809 PMid:26885395 PMCid:PMC4738935
  4. World Health Organization. Making Every Baby Count Audit and review of stillbirths and neonatal deaths. 2017; [Available from: www.who.int/docs/default-source/mca-documents/maternal-nb/making-every-baby-count.pdf?Status=Master&sfvrsn=6936f980_2, Last access date: 10 April 2023]
  5. McNamara K, Meaney S, O'Connell O, McCarthy M, Greene RA, O'Donoghue K. Healthcare professionals' response to intrapartum death: a cross-sectional study. Arch Gynecol Obstet 2017; 295 (4): 845-852. doi:10.1007/s00404-017-4309-9 PMid:28210863
  6. Froen JF, Cacciatore J, McClure EM, Kuti O, Jokhio AH, Islam M, et al. Stillbirths: why they matter. Lancet 2011;377:1353-1366.
    doi:10.1016/S0140-6736(10)62232-5 PMid:21496915
  7. Duryea EL, Happe SK, McIntire DD, Dashe JS. The natural history of twin-twin transfusion syndrome stratified by Quintero stage. J Matern Fetal Neonatal Med 2016;29(21):3411-3415. doi:10.3109/14767058.2015.1131263 PMid:26768418
  8. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: a population-based study. BMJ 2013; 346: f108. doi:10.1136/bmj.f108 PMid:23349424 PMCid:PMC3554866
  9. Tveit JV, Saastad E, Stray-Pedersen B, Børdahl PE, Frøen JF. Concerns for decreased foetal movements in uncomplicated pregnancies - increased risk of foetal growth restriction and stillbirth among women being overweight, advanced age, or smoking. J Matern Fetal Neonatal Med 2010;23(10):1129-1135 doi:10.3109/14767050903511578 PMid:20476880
  10. World Health Organization. Newborns: improving survival and well-being. 2020. [Available from: http://www.who.int/mediacentre/factsheets/fs333/en/, [Last access date: 4 Oct 2021]
  11. Kiguli J, Namusoko S, Kerber K, Peterson S, Waiswa P. Weeping in silence: community experiences of stillbirths in rural eastern Uganda. Glob Health Action 2015;8(1):24011. doi:10.3402/gha.v8.24011 PMid:25843493 PMCid:PMC4385210
  12. Goldenberg RL, Griffin JB, Kamath-Rayne BD, Harrison M, Rouse DJ, Moran K, et al. Clinical interventions to reduce stillbirths in sub-Saharan Africa: a mathematical model to estimate the potential reduction of stillbirths associated with specific obstetric conditions. BJOG 2018; 125 (2):119-129. doi:10.1111/1471-0528.14304 PMid:27704677
  13. Das MK, Arora NK, Gaikwad H, Chellani H, Debata P, Rasaily R, et al. Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents: A qualitative study. PLoS one 2021; 16(1): e0240270. doi:10.1371/journal.pone.0240270 PMid:33503017 PMCid:PMC7840017
  14. Nuzum D, Meaney S, O'Donoghue K. The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study. BJOG 2014; 121(8):1020-1028. doi:10.1111/1471-0528.12695 PMid:24589177
  15. Nuzum D, Meaney S, O'Donoghue K. The spiritual and theological challenges of stillbirth for bereaved parents. J Relig Health 2017; 56 (3): 1081-1095. doi:10.1007/s10943-017-0365-5 PMid:28154999
  16. Nuzum D, Meaney S, O'Donoghue K. The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed-methods study. BMJ Support Palliat Care 2016;6(2):194-200 doi:10.1136/bmjspcare-2013-000533 PMid:24916197
  17. O'Connell O, Meaney S, O'Donoghue K. Caring for parents at the time of stillbirth: how can we do better?. Women Birth 2016; 29 (4):345-349. doi:10.1016/j.wombi.2016.01.003 PMid:26916147
  18. Day C, Gray A, Cois A, Ndlovu N. Health and related indicators: Interrogating the UHC service coverage index. S Afr Health Rev 2019; 2019(1):215-9
  19. Tveit JV, Saastad E, Stray-Pedersen B, Børdahl PE, Flenady V, Fretts R, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement. BMC Pregnancy Childbirth 2009;9:32. doi:10.1186/1471-2393-9-32 PMid:19624847 PMCid:PMC2734741
  20. Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. 4th edition. Sage publications. 2018.
  21. Beck CT. Polit DF, Essentials of Nursing Research: Appraising Evidence for Nursing Practice. (9th Ed). Philadelphia, Lippincott Williams, & Wilkins. United States of America; 2018.
  22. Attachie I, Mwini-Nyaledzigbor P, Affram C, Adjei D. Mothers' experiences of stillbirth: A study in the Accra Metropolis (Socio-Cultural Implications). Adv Multidiscip Res J 2016;2(2):223-230.
  23. Dapaah JM. Attitudes and Behaviours of Health Workers and the Use of HIV/AIDS Health Care Services. Nurs Res Pract 2016; 2016: 5172497. doi:10.1155/2016/5172497 PMid:28116154 PMCid:PMC5225383
  24. Sharma B, Bhattarai S, Shrestha S, Joshi R, Tamrakar R, Singh P, et al. Maternal and fetal characteristics and causes of stillbirth in a tertiary care hospital of Nepal: secondary analysis of registry-based surveillance data. BMJ Open 2021;11(8):e045012. doi:10.1136/bmjopen-2020-045012 PMid:34373292 PMCid:PMC8354277
  25. Smyth RM, Taylor W, Heazell AE, Furber C, Whitworth M, Lavender T. Women's and clinicians perspectives of presentation with reduced fetal movements: a qualitative study. BMC Pregnancy Childbirth 2016; 16(1): 280. doi:10.1186/s12884-016-1074-x PMid:27671523 PMCid:PMC5037887
  26. Abdul-Mumin KH. Village midwives and their changing roles in Brunei Darussalam: a qualitative study. Women Birth 2016;29 (5): e73-81. doi:10.1016/j.wombi.2016.04.002 PMid:27105748
  27. Aborigo RA, Allotey P, Reidpath DD. The traditional healer in obstetric care: a persistent wasted opportunity in maternal health. Soc Sci Med 2015; 133:59-66. doi:10.1016/j.socscimed.2015.03.046 PMid:25841096
  28. Nergard CS, Ho TP, Diallo D, Ballo N, Paulsen BS, Nordeng H. Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West Africa. J Ethnobiol Ethnomed 2015: 11:73. doi:10.1186/s13002-015-0057-8 PMid:26453339 PMCid:PMC4600315
  29. Nyeko R, Tumwesigye NM, Halage AA. Prevalence and factors associated with use of herbal medicines during pregnancy among women attending postnatal clinics in Gulu district, Northern Uganda. BMC Pregnancy Childbirth 2016;16(1):296. doi:10.1186/s12884-016-1095-5 PMid:27716105 PMCid:PMC5053208
  30. Rasch V, Sørensen PH, Wang AR, Tibazarwa F, Jäger AK. Unsafe abortion in rural Tanzania - the use of traditional medicine from a patient and a provider perspective [published correction appears in BMC Pregnancy Childbirth. 2015;15:355]. BMC Pregnancy Childbirth 2014;14:419. doi:10.1186/s12884-014-0419-6
    PMid:25524498 PMCid:PMC4279892
  31. Steenkamp V. Traditional herbal remedies used by South African women for gynaecological complaints. J Ethnopharmacol 2003;86 (1): 97-108. doi:10.1016/S0378-8741(03)00053-9 PMid:12686447