Results emerged from analysis of data obtained through focus group discussions involving groups of younger and older women, and groups of men as participants. Their perceptions of motherhood were discussed and conclusions on how these contributed to mental distress in the perinatal period were drawn. The responses represent the three groups of participants (younger women, older women, and male participants) in order to capture the different opinions.
One hundred and fifty nine participants took part in the focus group discussions. The age of both male and female participants ranged between 18 and 45 years. Female participants were either attending antenatal or postnatal clinics or above the reproductive age, while male participants were teachers. Various themes emerged including how the themes positively and negatively influenced women’s psychological well-being during the perinatal period. This paper focuses on those factors that women thought negatively influenced their psychological wellbeing during the perinatal period as outlined below.
A negative perspective of motherhood was highlighted resulting from various common experiences among women attending antenatal and those attending postnatal clinics in the group discussions. The most pervasive theme was unhappiness common to most of the women participants. The experiences women considered negative are outlined below and include: Uncertainty about survival of self and the baby; anxiety about HIV status and testing; Lack of support; and vulnerability/oppression.
Uncertainty about survival of self and the baby
Most women (both antenatal and postnatal) felt that motherhood, especially during the antenatal period, was a source of worry because women could not foretell whether they would go through the process of childbirth without complications, and survive it. Male participants as well as older women acknowledged this view. Below are extracts from younger woman and male participants respectively.
"YOUNGER WOMAN: You are unhappy because you don’t know how and whether you will deliver okay or whether the child will be okay. You can’t get happy until you give birth because you don’t know what will come."
"YOUNGER WOMAN: For first pregnancy it is difficult to be happy because you are anxious about the process of labour whether you will survive or whether the baby will be healthy and safe."
"MALE PARTICIPANT: When they are pregnant, they are closer to the grave –They are scared of death."
Worry regarding survival from childbirth is a common feature in Zambian culture. The estimated maternal mortality rate in Zambia is 605 per 100 000 live births as compared with 17 per 100,000 in the United States, and thus women cannot guarantee their survival from childbirth.
Anxiety about HIV/AIDS status and testing
As well as being worried about how they would manage to go through child birth, women experienced anxiety and worry because they were uncertain about their general health status. Women in most groups mentioned that it was mandatory for all pregnant women to be tested for the HIV, and that if they declined to get tested, medical staff would not attend to them during delivery. This appeared to be a source of worry for women as exemplified in the statements below from participants.
"YOUNGER WOMAN: It is very worrying to test, but we have no choice."
"YOUNGER WOMAN: Others are scared to come to the clinic because they are scared of being found HIV positive."
"OLDER WOMAN: And….if they refuse to take a test, they won’t be delivered at the time of delivery."
The above view was especially pervasive in pregnant women who were waiting for testing, but postnatal women spoke of it as having been a source of worry for them as well, probably because they were not guaranteed a negative test result next time they would be due for testing. In Zambia, while HIV testing for pregnant women is based on “voluntary counselling and testing”, women may be refused prenatal treatment if they have not been tested.
Lack of support
Some of the pregnant women were not supported by their partners. Denial of paternity by the man responsible for the pregnancy was a source of distress. Participants worried about how they would manage to care for their babies in cases where the man refused to acknowledge the pregnancy. This was especially common with women whose pregnancies were unplanned and whose relationships with their partners were not officially recognised.
Some participants highlighted refusal of responsibility by men as one of the sources of worries experienced by women in the perinatal period, while feelings of helplessness were also prevalent in married women although some of the participants believed they were only common in single women. Men, married or not, were said to desert their pregnant wives and partners respectively, for other women. From women’s views, desertion of women by men was prevalent during pregnancy as well as after child birth.
"YOUNGER WOMAN: If you are not married, it’s worrying especially if the man refuses responsibility of the pregnancy."
"YOUNGER WOMAN: Some men abandon you and start seeing other women because you are pregnant, especially if you have two children. They don’t spend time with you. They go for other women."
"OLDER WOMAN: Men are same, ee..(yes) they run away from their pregnant wives, even when the woman delivers, they will still run away, but we just have to endure."
Most women attributed desertion by their partners to the change in women’s focus when they became mothers. They transferred their attention from their partners to their new baby.
This shift in attention made their partners feel less valued and used it to rationalise their engagement in extra marital relationships. Statements below, from participants provide testimony to the dynamics around desertion of women by men especially after childbirth.
"OLDER WOMAN: Yes, our focus is on the child and the man gets less care….then he starts looking for other women."
"YOUNGER WOMAN: The coming of the baby chases the men away, but what do we do? Children are also important."
"However, men revealed opposing views. For them, the arrival of a child harnessed their relationship with their partner and reduced the chances of them divorcing their women."
"MALE PARTICIPANT: There is happiness and love for the wife after a child. Love towards each other, love is first and children second."
"MALE PARTICIPANT: The bond grows more between the wife and husband, causes of divorce are reduced."
"MALE PARTICIPANT: Children brighten the relationship with your wife."
For women who get pregnant while they are still with their parents or guardians, from men who may still be in a similar situation (living with their parents or guardians), the environment was said to be a source of stress.
They were forced by their parents to move in with the men responsible for their pregnancy. Being in a foreign home, they suffered mistreatment and had restrictions in what they were allowed to do.
"YOUNGER WOMAN: Sometimes, a man’s relatives mistreat you especially bakakufwitila (if they force you on them) – So umankala (you are) unhappy."
"YOUNGER WOMAN: If you are being kept, you will be forced to overwork and can’t take rest when you want."
Another facet of the distress for women was a lack of support when the husbands deserted their pregnant wives, as opposed to just having an extramarital relationship. However, it is not uncommon for the man to still be living within the household but not providing financial support to his family. As most women were dependant on their husbands for financial sustenance, lack of material support raised worry for women, about the welfare of their family. Besides men being a source of unhappiness through abandonment of their families, they were labelled as a source of fear for contracting disease due to their promiscuous behaviour. They were said to engage in unprotected sex with other women, from whom they contracted diseases like HIV which in turn they transmitted to their wives.
"YOUNGER WOMAN: If the man abandons you, you can’t afford to buy food. Especially if one is breastfeeding because you need to eat frequently. Kuchepa kwa ndalama (inadequacy of finances) especially when you are dependent on the man. When he comes back he comes with HIV."
"YOUNGER WOMAN: Motherhood these days is scaring because of the prevalence of diseases like HIV. It is very difficult because we are suppressed by men. Men bring HIV to us because they like sleeping around."
"OLDER WOMAN: This generation is very unfortunate, because when a man deserts his wife, he comes back infected with HIV and he gives it to his wife. We didn’t have HIV in our time, so it was not as bad."
Participants interviewed expressed their vulnerability and oppression through various statements. There was widespread agreement among participants that they lack decision-making powers and control over their own lives. The common thread that can be traced through participants’ statements is the dominance of the men. Women felt decisions to do with having children were better left for the man to undertake. This is evident in the statements below.
"YOUNGER WOMAN: It is not possible to stop bearing children because of HIV/AIDS. It might be easy for single women but for us married women, the man won’t cooperate."
"OLDER WOMAN: In married relationships, men do not compromise for the woman to stop bearing children; women are scared of making their own decisions even during life threatening situations, for example, bleeding during pregnancy leading to death."
These statements were shared by other participants as articulated by one of the younger women below.
"YOUNGER WOMAN: It is true what she has said, what they tell us about HIV/AIDS is true but we live in different homes. But like my colleague has said, as women we might go family planning but it brings problems in the home in future. The man won’t allow you."
From the statement above by one of the older women, vulnerability and oppression was also represented by women lacking power to make decisions about their health, even in serious situations like bleeding, which might result in fatality. Women also lack control and power when it comes to decision making about HIV testing, even with the current high prevalence of the HIV/AIDS. Numerous participants commented that men were uncooperative with issues to do with HIV testing, putting women at risk of contracting the virus. This is evident in participants’ statement below.
"YOUNGER WOMAN: Other men refuse to go for testing. They take medicine without their wives knowing."
"YOUNGER WOMAN: You need to be tested for HIV. But men refuse to be tested, they say if they found you negative, it means I am also negative."
"OLDER WOMAN: They will get tested secretly and when they are positive, they won’t tell anyone."
The above statements represent one of the ways in which women in the population under study may be experiencing oppression by men. Vulnerability and oppression was also evident through lack of support that women experienced when they were pregnant and after delivery. Denying women material as well as emotional support as evident above may be regarded as a way of oppressing women in the home. Additionally, many women argued that it was easier for single women to make decisions about reproduction than it was for married women. It was however acknowledged that being single had its challenges.
Single motherhood as a source of worry
Motherhood was also considered an unhappy experience if a woman was not married. What seemed to pervade these discussions was the inseparability of marriage from motherhood as the two appeared throughout the discussions as if they were synonymous and marriage as a road to happiness. A woman had to be married before she had children as a prerequisite to happiness.
"MALE PARTICIPANT: Those who are well married will be happy but those impregnated by a boyfriend will be unhappy because of the implications."
"OLDER WOMAN: A woman is happy when there is harmony in the home especially if the husband cares. A woman without a man has problems."
The assertions given above were common to all the different group interviews, although they appear to contradict earlier sub-themes about men as a source of negative emotions which have been asserted mostly by women groups, and hence reinforce the notion of the complexity of motherhood as an experience.
"YOUNGER WOMAN: Being a mother is going through hardships, enduring them. Ukukwata imisula (Being tolerant)."
"YOUNGER WOMAN: It is a difficult experience but we have to get ready for it. Mothers are required to be strong. It is a hard job taking care of the children."
"OLDER WOMAN: Motherhood is not easy, marriage (pause) is not also easy, but as women, we are taught to be strong, and we should hold on."
A sense of endurance is commonly inculcated in women in Zambia. A strong woman is one who possesses the ability to withstand problems in her marriage, including extramarital affairs by her husband. The latter is a common practice; men’s extramarital affairs are regarded as justifiable while women’s (extramarital affairs) are considered unacceptable and warrant instant divorce.