The results of this research present the social perceptions and explanatory factors related to anaemia among pregnant women interviewed at the Ahougnansou urban health facility in the city of Bouaké, Côte d'Ivoire.
Social perceptions of anaemia in pregnant women
The pregnant women interviewed considered anaemia as a blood-related illness. For the participants,
"Anaemia is a disease that happens when you don't have enough blood in your body."(Participant 5).
In their view, a person with anaemia was someone who had a lack of blood in their body. This physiological expression revealed disturbances in the physical body of pregnant women with anaemia. The presence of these disturbances was primarily marked by expressive signs. One participant spoke of signs of manifestations of anaemia during pregnancy, including fever, dizziness, fatigue, lack of appetite:
"It can manifest itself in the body heating up a lot, the person sweating a lot, and the eyes turning. When she has this, you can also see that the pregnant woman never eats much but sleeps too much because she works a lot without rest." (Participant 10).
In addition, other signs of anaemia in the pregnant woman included pallor of the face, eyes, palm, sole of the foot and thinness. As one participant said:
"You can tell a pregnant woman who is anaemic when there is a change in skin tone, she becomes very pale, her eyes are not coloured, the soles of her feet and fingers are whitish. She often becomes desperate."(Participant 16).
For them in particular, the pallor would represent the stage of severity in the evolution of this condition. From these facts called symptoms, etiological theories were derived. Pregnant women interviewed attributed the supposed causes of anaemia to a lack of variety in diet, as one participant reported:
"I think that when you are pregnant and then you eat "attiéké" only, you think it's the only food in the world, or when you always eat the same food, it's normal that you don't have a lot of blood." (Participant 20).
In addition, the pregnant women interviewed also felt that the onset of anaemia could be due to unbalanced food, as one participant said,
"It is the food that causes anaemia. Foods such as yams, rice without sauce, these foods do not contain iron. In a word, the diet is unbalanced." (Participant 1).
Diet therefore remained a major cause of anaemia during pregnancy. The issue of imbalance in the diet of the pregnant woman during the prenatal period was related to compliance with the dietary prohibitions of the custom of belonging, as one participant revealed:
"At home when you're pregnant, your mother reminds you not to eat papaya and coconut because your feet and breasts will swell, beans because of bloating, okra because of itching, and bush meat because of the diseases and some of their characteristics that the child may take after delivery. It is because we sort food because of custom that we eat what is not rich in iron and causes anaemia." (Participant 18).
It was clearly stated here that food bans were highlighted as the cause of anaemia. Based on these nosological, symptomatological and etiological facts, most of the pregnant women interviewed described this disease as dangerous because it is fatal, as one participant said:
"When we talk about anaemia, I automatically think of death. Anaemia kills quickly, it's really dangerous." (Participant 7).
Anaemia was identified as a specific threat in the prenatal period. They emphasized the health risks for mother and child during pregnancy, as one participant put it:
"I think it is serious, because if mother is sick, baby in the womb will get sick too." (Participant 3).
Similarly, the anaemic pregnant woman was predisposed to risks that could not only be fatal for her but also for the foetus during delivery, as illustrated by one participant's comment:
"It can be complicated for the pregnant woman who is anaemic during delivery, I think her delivery will be fatal." (Participant 12).
The risks involved in this situation actually heightened the seriousness of this illness and raised strong emotions of fear in pregnant women, as one participant pointed out:
"I'm really scared for her, when you don't have enough blood you can die or lose the baby during pregnancy or delivery." (Participant 14).
From this knowledge of the pregnant women interviewed, social perceptions about anaemia during pregnancy emerge. This foundation of the social dimension of anaemia remains essential in determining the rationales for its prevalence in the prenatal period among the pregnant women interviewed.
The explanatory logic of anaemia in pregnancy in pregnant women
Pregnant women interviewed suggested that irregular prenatal visits were related to anaemia during pregnancy. This was due to the fact that pregnant women did not attend prenatal appointments as often as necessary. This practice influenced the early detection of anaemia during pregnancy, as one participant noted:
"Coming to the hospital is one way to find out what health problems a pregnant woman may have in order to provide treatment or advice on how to deal with them, but staying at home is not going to tell if she is anaemic and to monitor the pregnancy well." (Participant 19).
This was like saying that not attending antenatal visits does not give them access to edifying advice about anaemia. These behavior change communications were far from reaching some pregnant women who were still resistant to regular prenatal care. As one participant said in the interview,
"We pregnant women neglect antenatal visits very much. Because of this, we are not really aware of important messages against anaemia and other problems during pregnancy." (Participant 8).
As a result, they remained unaware of the messages carried by midwives during prenatal consultations on the issue of anaemia, for the well-being of the mother and her unborn baby. According to one participant:
"When you are not aware of anaemia, the blood medication we are prescribed and the food the pregnant woman needs to eat so that we and our baby are healthy, this is what makes it impossible to be aware and take precautions to avoid this disease." (Participant 17).
This neglect to provide information about anaemia in pregnancy exposes women willingly to this morbidity. Moreover, the absence of pregnant women from awareness messages on anaemia during prenatal consultations undeniably accentuated the lack of use of daily oral iron and folic acid supplementation recommended by midwives at the health facility. This irresponsibility was completely consistent with the fact that pregnant women developed a fearful conception of the side effects of iron supplements. One participant illustrated this as follows:
"I can't stand blood medication. The smell there really makes me tired. When I take them, I vomit and often I feel weak like that. It's not even worth it, because as soon as I put them in my mouth, they automatically come out. So I don't even want to take them." (Participant 13).
This fear, accentuated by the lack of information on anaemia, was also conducive to the failure to mobilize financial resources for iron and folic acid supplementation, as one participant confided:
"When I am pregnant, I eat a lot of leaves because they give a lot of blood. It's good because always, always hospital, it can't go, because there is no money. When it's like that, I do indigénat instead of taking blood medicine." (Participant 19).
Similarly, the absence of pregnant women from the anaemia behavior change communication during prenatal visits naturally accelerated compliance with dietary bans during pregnancy. These restrictions were criteria for normal dietary practices erected by custom in the prenatal period. This logic was part of the breakdown in the observance of a balanced diet that causes anaemia during pregnancy, as one participant mentioned:
"At home, to avoid the wrath of the geniuses, we forbid you to eat meat and fruit. It's because we totally respect that instead of knowing the midwife's advice that we don't have a lot of blood during pregnancy." (Participant 2).
All of these factors related to anaemia in pregnant women require consideration of social relevance in order to induce changes in the provision of antenatal care and to help reduce the vulnerabilities of pregnant women. This body of evidence deserves to be illuminated.