Guinea-Bissau: what women know about the risks--an anthropological study.

The study examined the range of traditional and spiritual concepts surrounding pregnancy and childbirth. Most of these beliefs and practices prevent appropriate nutrition, antenatal, and delivery care. Knowledge of danger signs and risk factors is virtually absent. When illness becomes manifest the women tend to consult competing sectors of traditional and modern medicine, but no referral or cooperation exists between them. The perceived curative orientation of antenatal service results in their underutilization. The study findings reinforce the need to develop appropriate health education programmes to overcome prevailing prejudices towards the modern health sector and covering a wide range of health education topics, including danger signs in pregnancy and the accompanying antenatal and delivery care. The integration of traditional practitioners into the existing primary health care system should be encouraged. The modern sector would benefit from the upgrading of personnel, equipment, and drugs as well as the development of integrated maternal and child health and family planning services. Continuous education should help nurses and midwives to become more responsive to the special needs of pregnant women and to provide family planning education. Outside the health sector, school health education should include sex education in order to avoid unwanted, early pregnancies. Finally the health information system should be improved to provide accurate information on pregnancy related morbidity and maternal mortality.