Stigma toward small babies and their mothers in Ghana: A study of the experiences of postpartum women living with HIV

Abstract

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.

RETRACTED ARTICLE: Mothers’ experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country

“…Parents face an enormous cost burden [17] coupled with having to conform to popular sector beliefs and harmful practices propelled by Ghanaian culture and religion [18]. Premature babies are frowned upon and so mothers may not seek for or receive adequate support for fear of stereotypical attitudes [18,19]. Often many preterm babies are readmitted in a critical state and particularly those born extremely preterm die at home [15].…”

Experiences of families and health professionals along the care continuum for low‐birth weight neonates: A constructivist grounded theory study

“…Studies have widely discussed the psychosocial traumas faced by mothers whose babies were admitted in neonatal wards (Al Maghaireh et al, 2016; Garti et al, 2021). The risk of neglect due to stigma and shame have been well established (Sakyi et al, 2020; Smith et al, 2017). Like our findings, in Malawi and Ethiopia, the use of success stories had positive impact on families with LBW infants and when complemented with early counselling could change negative perceptions and stigma in communities (Lydon et al, 2018; Usman et al, 2019).…”

“…Mothers of LBW infants are often constrained by finances, work and the responsibility of caring for their vulnerable babies. Others have reported on inadequate maternal support and economic challenges faced by mothers post‐delivery (Sakyi et al, 2020; Unsworth et al, 2021). Similar to the needs and responsibilities our participants highlighted, in a recent Ghanaian study, women of preterm babies reported on practical (domestic chores/baby care), material, psychosocial and spiritual support (Tibil & Ganle, 2021).…”

Transition from hospital to home care for preterm babies: A qualitative study of the experiences of caregivers in Uganda

“…There is also no support to overcome social pressures, stigma and other barriers in the community and family settings that affect survival of preterm infants [ 9 ]. Studies have discussed the issue of stigma related to small babies and preterm babies in sub-Saharan Africa, which can have a detrimental effect on the ability of the parents to care for the baby, as well as affect their own health and wellbeing [ 10 ]. For example, a study from Malawi found that in some communities, a premature baby is equated to having an abortion and was therefore perceived as “a curse” [ 11 ].…”

“…For example, a study from Malawi found that in some communities, a premature baby is equated to having an abortion and was therefore perceived as “a curse” [ 11 ]. In a study in Ghana, stigma was linked to “undesirable” physical features by people who were unfamiliar with small babies [ 10 ].…”