Table 2 Themes with Selected Illustrative Quotes

 Baby-Focused Postpartum Care

“What postpartum care entails is that you may want to take good care of the baby and you are not well to do because most of us are unemployed, so you can’t do it. We are supposed to take good care of them. On the part of breast feeding, we should keep our breasts neat.” (Kalpohin < 6mo)

“If you can afford, you take the child to school and makaranta (Islamic school).” (Kanvili, 6mo +)

“After delivery, like every month they do us to come for weighing. They check on my child’s weight as to whether it is reducing or it is increasing. If it reduces they will teach you on what and what to do to let him gain weight and then they also help the child to grow. They give like the 6 killer diseases. They give injections like every month or every 3 months just to prevent the child from getting these diseases or diseases that are coming. So that’s what I understand.” (Choggu, 6mo +)

“They tell us how to feed the baby to be strong but not we the mothers. We receive education only about how to care for the baby.” (Bagabaga 6mo +)

“They educate us on the importance of family planning. If you do family planning, you can take proper care of you children if they are few.” (Kanvili, 6mo +)

“They teach us to practice personal hygiene that will prevent the breast milk from contamination so that the child can feed on it. Wash your hands with soap and water after visiting the toilet and wipe your hands with a clean wiper or handkerchief before you breastfeed the child.” (Kalpohin < 6mo)

“When I was pregnant that they were taking my vitals but after delivery they have not done such a thing.” (Kalpohin < 6mo)

“Yes, it is only the children that they take care of. The nurses don't take care of us at the facility. When you complain about any condition to them, they will tell you that they heard you and that is all.” (Kalpohin < 6mo)

“When you complain about yourself not being well they will tell you to go to OPD.” (Choggu, 6mo +)

 Postpartum Practices

“In the culture of the Dagombas, some women don’t give birth at the hospital. So, when a woman gets a cut, they call it ŋmaɣa. If it happens to a woman’, they can use local soap commonly known as ‘awabila’ to wash it.” (Bagabaga 6mo +)

“Wash your hand with soap and water to keep it hygienic anytime you are to pick the child.” (Kalpohin < 6mo)

“As the woman just gave birth like that, it is hot food (TZ) they will give her but not cold food in order to help your wound heal fast” (Bagabaga 6mo +)

“Pouring hot water in a chamber pot and add canfo and dettol and sit on the hot water so that it will help heal the wounds. If you don’t do this, it can affect you.” (Kanvili < 6mo)

“After giving birth there are wounds in you so they will give you drugs so what you will do to help yourself is to take the medications according to how it was prescribed.” (Choggu 6mo +)

“I have never practiced any cultural practices but I heard that when a woman delivers and have not enough breast milk, they will mix millet flour with water and use it to massage the breast of the woman who delivered.” (Bagabaga < 6mo)

“They will buy fresh cow milk in Islam they will write some verse and dissolve it with the milk in a bowl for you to take it in the morning before breakfast.” (Bagabaga < 6mo)

“When the grandmothers are there, they do it because they are those practicing them. When I delivered this child, I didn’t have breast milk even today, so mixed warm water with shear butter to feed the child.” (Kalpohin 6mo +)

Inadequate Knowledge of Postpartum Danger Signs

“Yes, they always tell us when you go home and you are bleeding or when you are feeling dizzy or severe headache that you come back and report.” (Choggu 6mo +)

“When your BP rises that you can come back to the facility.” (Kalpohin < 6mo)

“You can also experience headache all the time after birth.” (Kanvili < 6mo)

“If the blood is too much, they will put cotton in the wound to stop the bleeding. So, if you forget about the cotton they put in you during the surgery, it will begin to smell when it is rotten, which means you have to go to hospital.” (Bagabaga 6mo +)

“When you go home and detected that the child is exhibiting some strange signs you need to go back to the facility.” (Bagabaga < 6mo)

“If the baby is having difficulty in breathing, you can take him to hospital.” (Choggu < 6mo)

 Barriers in Accessing Postpartum Care

“They just come to work and relax in their chairs.” (Kanvili < 6mo)

“When you come to the facility during labor at night you will call the nurses on phone or knock on their doors but you won’t get any response. Some of the nurses will be shouting at you (their utterances) toward the mothers especially during labor can prevent a pregnant woman from accessing health care services at the facility.” (Bagabaga 6mo +)

“You can go to hospital; the nurses are many but some of them doesn’t have time for us. At times a woman may be at labor, and they call the nurses and none of them will mind her.” (Bagabaga < 6mo)

“When I met her, she didn’t mind me but was rather talking on her phone. So, when she finished, and people were talking to her about her behavior toward me, I told them to leave her because ‘every person dies but nurses never die’. So, she became annoy and threw my folders away.” (Bagabaga < 6mo)

“When you are in labour and you go to the hospital where the nurses will care for you, it is better. When I was in labour, I went to HABAANA where there was attention for me.” (Kanvili < 6mo)

“The reason why people don’t want to go hospital is that when they go to hospital they won’t give them the drugs free, unless they buy with their money. So, they prefer going to the drug store to just complain and buy with their money and go home, is better than going to the hospital. Even the health insurance you will send it and it is nothing.” (Kalpohin < 6mo)

“Truly, someone may fall sick but the means to get to the hospital is the problem. If she has no money to transport herself to the hospital, it is a problem.” (Kanvili < 6mo)

“Like today for instance, many people came and they asked them to go back and come on Monday because there is no injection forgetting that nobody knows what will happen even before Monday.” (Bagabaga 6mo +)

 Experiences of Poor Mental Health

“If you the mother is giving birth for the first time, some babies can cry a lot. So, in the night, the cry of the baby will make you sad.” (Bagabaga 6mo +)

“You feel very uncomfortable when the child is not feeling well. They advise that we should not give them grip water again that it is not good for the children so when that happens you the mother will cry because you don’t know how you will handle it. Mostly that is our problem.” (Kalpohin 6mo +)

“..Meanwhile you see your colleagues’ children neatly dressed but you can’t afford for your child, you will ask yourself why God has put you in that situation, and eventually you will feel if God had taken your life, it would have been better.” (Bagabaga 6mo +)

“You see, in life we are not equal; some are rich others are poor. So, if a poor person like me gives birth my worry is how I will be able to take care of the child until he or she becomes an adult just like the parents took care of me until I become who I am today. I think about it a lot.” (Bagabaga 6mo +)

“You don’t get any help or support to take care of you and the baby, you can be sure of your sadness” (Bagabaga 6mo +)

“Sometime you will wake up and there is nothing to take care of the children, and the man has not provided, so you the mother will definitely think negatively.” (Kanvili 6mo +)

“Even if the child annoys you, you carried the pregnancy and knows how it feels not to talk of the day of delivery. There is no day that you will hate the child even when you beat the child for annoying you, you always remember the pain you go through during the pregnancy and the delivery.” (Bagabaga < 6mo)

“If you deliver through surgery, you cannot forget it.” “Sometimes you don’t expect someone to do something to you, but when it happens you remember it.” (Kanvili < 6mo)

“What I consider to be sad is when you deliver and God takes back the baby, then you will be sad by all means, otherwise I don’t see anything sad about giving birth.” (Choggu < 6mo)

Group Facilitator: Do moms feel like they are really having a tough time, so much so that they may not want to be here or keep going?

Participants: (All in unison) No!

“As for ending your life, NO. We pray to God to protect you against that one.” (Kalpohin < 6mo)

No. I can’t think of killing myself.” (Bagabaga < 6mo)

 Postpartum Educational Needs

“I will want us to talk about good health of our babies, we the mothers, the food we should be eating to be healthy, personal hygiene, and how to space our births.” (Bagabaga 6mo +)

“Someone may think about how to control her birth, give birth to a reasonable number of children and take good care of them and yourself.” (Choggu < 6mo)

“We need education about BP to help us know our BP level. The nurses should tell us what we should be eating.” (Kanvili 6mo +)

“Already, after birth when we come to the hospital, they tell us the kind of food we should eat to be strong for the baby to sack and look healthy, and how to ensure neatness so that you won’t give any sickness to the baby.” (Choggu < 6mo)

“What they think is good for mothers, especially the kind of food mothers should eat to be strong.” (Choggu < 6mo)

“When you discharged and there is no breast milk, you can prepare tea with a lot of milk and take or you prepare porridge with millet flour and take it and you will have enough breast milk.” (Kalpohin 6mo +)