Training programme for elderly women to improve the reduction of maternal mortality in Limpopo Province, South Africa

Abstract

Introduction: Midwives observe childbirth as a normal physiological process which is, however, associated with risks that may lead to loss of life. Pregnancy and childbirth are socially constructed events that bring joyous moments in the lives of parents because new life has been brought into the family. Unfortunately, maternal mortality is unacceptably high worldwide, especially in developing countries where South Africa is no exception. Approximately 810 women die daily from preventable causes related to pregnancy and childbirth. Improving maternal health was the fifth of eight Millennium Development Goals to reduce the maternal mortality ratio by 2015. Much has changed regarding the care that was previously provided during pregnancy and childbirth by elderly women. Elderly women were regarded as expert advisers to pregnant women during pregnancy and childbirth. It is in this light that the researcher explored whether their roles are outdated in improving the reduction of maternal mortality. Purpose: The study intended to develop a training programme for elderly women to improve the reduction of maternal mortality. Methods: The study adopted a qualitative approach using descriptive, exploratory, and contextual design. The population included elderly women, pregnant women, breastfeeding mothers, and midwives, who were purposively sampled. Non-probability purposive sampling was used to select the districts, clinics, and elderly women, while convenient sampling was used to select pregnant women, breastfeeding mothers, and midwives. The study was guided by the System Ecological Model (SEM) of human behaviour (Baral, Logie, Grosso, Wirtz & Bevrer, 2013). Data were collected using an unstructured interview with the participants, in-depth individual interviews, and a focus group discussion for elderly women. Data were coded and analysed using the thematic analysis approach described by Tesch. Finally, key themes were extracted and analysed from the collected data. Training programme was done on the basis of six elements of Dickoff et al., (1968), Kolb’s theory of learning guided the development. Chinn and Kramer (2019) guided the validation of training programme. vi Findings: The findings revealed that elderly women are no longer given an opportunity to care for their daughters-in-law during pregnancy and childbirth, and that elderly women lack current knowledge on adequate care and support for pregnant women and childbirth. Furthermore, midwives reported barriers that delay pregnant women from seeking early medical intervention in order to receive prompt, adequate and quality care to avoid common problems encountered in a maternal health facility. The findings from pregnant women and breastfeeding mothers indicated that elderly women lack knowledge of their role regarding the early utilisation of healthcare services and the need for elderly women to be trained on their roles regarding maternal healthcare practices. The study concluded by revealing the usefulness of elderly women as advisers and caregivers during pregnancy and childbirth. Elderly women showed care, compassion, and suggested pregnant women eat small amounts of food to avoid large neonates. Their influences regarding the utilisation of healthcare services using their indigenous knowledge was also found useful. The findings of the study informed the development of a training programme for elderly women to improve the reduction of maternal mortality to advance health outcomes in women and newborns within the maternal healthcare facilities in South Africa and the world at large. Recommendations: The study recommends that the training of elderly women should be implemented by skilled healthcare workers. In addition, a longitudinal study should be conducted to assess the effectiveness of the programme.