Evidence brief: Lived experiences of postpartum hypertensive women in Accra, Ghana

Abstract

Hypertension is a leading cause of adult mortality globally with postpartum hypertension posing distinct risk to women. In Ghana, particularly within the Accra Metropolis, there is a limited understanding of the lived experiences of women managing hypertension after childbirth.

We described the lived experiences of postpartum women diagnosed with hypertension receiving care in a resource-constrained setting in Accra, Ghana.

The study employed a qualitative, descriptive-phenomenological design. We purposively selected 16 postpartum women diagnosed with hypertension and receiving care. They were recruited from the postnatal clinic of the Greater Accra Regional Hospital. The data was collected via in-depth, semi-structured interviews using a pre-tested interview guide. The interviews were audio-taped and transcribed verbatim. We then conducted thematic analysis with the aid of NVivo 11.0.

The analysis yielded three major themes; expectations about living with hypertension, self-efficacy in managing hypertension and environmental factors on the management of hypertension. On the expectation about living with hypertension, we identified the following sub-themes: optimism and hope for recovery as well as fear and uncertainty about complications. Regarding self-efficacy, the following sub-themes were identified: Confidence in adhering to treatment and challenges with lifestyle modification and monitoring. On the environmental factors influencing management of hypertension among the participants, we found the following sub-themes, spousal and family support, role of healthcare providers, social perceptions and stigma.

Postpartum women diagnosed with hypertension face social stigma and have mixed feelings of hope, fear and uncertainty about developing complications. We recommend that midwives/nurses should design and implement targeted postpartum hypertension education programmes to promote confidence in the treatment, improve knowledge on the condition and enhance emotional resilience. Also, managers of antenatal and postnatal clinics must integrate spouses and faith-based organizations in the management of postpartum hypertension to reduce the associated social stigma.

Introduction

Hypertensive disorders remain among the foremost causes of maternal morbidity and mortality globally [1–7], yet the postpartum period continues to receive limited attention despite its high-risk nature [4]. Postpartum hypertension, which may represent persistent or new-onset high blood pressure following childbirth, is increasingly recognized as a critical maternal health issue [2,4]. Recent studies [1–7] estimate that approximately 28.4% of women who experience hypertensive disorders of pregnancy continue to have hypertension within two years postpartum, compared with 9.1% of those without prior hypertensive disorders [8]. In low-resource settings, as many as 62.1% of women with preeclampsia or eclampsia remain hypertensive one year after delivery [1,9]. Moreover, even among women with uncomplicated pregnancies, about 3% develop de novo hypertension within the first postpartum year [4,10].

In Africa, the burden of postpartum hypertension is notably higher due to delayed diagnosis, limited access to quality prenatal and postnatal care, and inadequate treatment strategies [11–13]. For instance, research in Nigeria revealed that 12% of postpartum women developed hypertension, a situation worsened by weak health systems and cultural influences [13]. In Uganda, prevalence was reported at 14%, largely attributed to gaps in follow-up care [13] while in South Africa, around 10% of postpartum women were affected, with striking differences in healthcare access between rural and urban areas [4,13]. In Ghana, available data points to a rising trend, with estimates suggesting 10–15% of mothers experience postpartum hypertension, particularly in urban centers such as Accra [14]. Similar figures were found in other African countries: 11% in Kenya, where inadequate monitoring was a key contributor [13], and 13% in Ethiopia, where late diagnosis often led to life-threatening complications [4,15].