Stokes E, Dumbaya I, Owens S, Brabin L
Academic Unit of Obstetrics and Gynaecology, University of Manchester, Manchester, UK.
BJOG. 2008 Dec;115(13):1641-7; discussion 1647. doi: 10.1111/j.1471-0528.2008.01950.x.
Control of infectious diseases in developing countries often requires using drugs that are contraindicated during pregnancy. Avoiding inadvertent exposure to drugs involves women (a) recognising pregnancy early, (b) disclosing the pregnancy to health workers and (c) using medicines in an informed manner. We explored these factors to inform and improve the process by which health workers provide care and treatment to pregnant women.
Qualitative study.
The Gambia.
Rural women and men.
We conducted 41 interviews and 16 focus group discussions with women, adolescents, men and traditional birth attendants (TBAs).
Pregnancy disclosure.
Most women recognised early signs and symptoms of pregnancy and believed other people could easily do so. To avoid gossip, women hid their pregnancies and delayed antenatal care, even though husbands and TBAs insisted on attendance. Women acutely ill in early pregnancy hoped health workers would recognise pregnancy without explicit disclosure. Women said that they knew, and sought to avoid, some contraindicated drugs, but their knowledge was rudimentary. Health workers stressed the benefits, not the risks of prescribed drugs.
Despite public health and clinical benefits of preventing and treating pregnancy infections, women were ill informed and pressurised into taking drugs. These ethical issues should be more widely addressed.
在发展中国家，控制传染病往往需要使用孕期禁忌药物。避免意外接触这些药物需要女性做到：（a）尽早确认怀孕；（b）向医护人员透露怀孕情况；（c）明智地用药。我们探究了这些因素，以便为医护人员为孕妇提供护理和治疗的过程提供信息并加以改进。
定性研究。
冈比亚。
农村妇女和男性。
我们对女性、青少年、男性和传统助产士进行了41次访谈和16次焦点小组讨论。
怀孕情况的披露。
大多数女性能识别怀孕的早期迹象和症状，并且认为其他人也能轻易做到。为避免流言蜚语，女性会隐瞒自己的怀孕情况并推迟产前护理，即便丈夫和传统助产士坚持要求她们去。怀孕早期患重病的女性希望医护人员能在她们未明确告知的情况下识别出怀孕。女性表示她们知道一些禁忌药物并试图避免使用，但她们的了解很基础。医护人员强调的是处方药的益处，而非风险。
尽管预防和治疗孕期感染对公共卫生和临床有益，但女性了解的信息不足，且在压力下用药。这些伦理问题应得到更广泛的关注。
