The right to remain silent: a qualitative study of the medical and social ramifications of pregnancy disclosure for Gambian women

OBJECTIVES: 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. DESIGN: Qualitative study. SETTING: The Gambia. POPULATION: Rural women and men. METHODS: We conducted 41 interviews and 16 focus group discussions with women, adolescents, men and traditional birth attendants (TBAs). MAIN OUTCOME MEASURE: Pregnancy disclosure. RESULTS: 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. CONCLUSIONS: 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.