Abstract

This paper provides a comprehensive review of self-care practices during pregnancy within the African context, focusing on their profound implications for maternal, neonatal, and child health (MNCH) outcomes. Despite global efforts, maternal and neonatal mortality rates in Africa remain disproportionately high, underscoring systemic vulnerabilities and the critical need for effective interventions. The review defines self-care in pregnancy, examining its various components including diet and nutrition, weight management, physical activity and rest, mental health, preventive measures, sexual health, and breastfeeding preparation. A significant emphasis is placed on the complex interplay of cultural perceptions, traditional practices, socioeconomic disparities, and systemic barriers that either facilitate or impede optimal self-care. The analysis reveals that while some traditional practices offer valuable support, others, such as certain food taboos and restrictions on physical activity, directly conflict with evidence-based medical recommendations, contributing to adverse health outcomes. Furthermore, pervasive issues like limited access to quality healthcare, essential medicines, and accurate health information exacerbate challenges, often leading to unsafe self-medication and delayed care-seeking. The paper highlights the critical role of antenatal care as a platform for self-care education and the pragmatic necessity of integrating traditional birth attendants and community health workers into formal healthcare systems to extend reach and improve quality. It concludes by advocating for multi-faceted, culturally sensitive, and integrated public health strategies that empower pregnant women, engage communities, and strengthen healthcare infrastructure to foster improved MNCH outcomes across the African continent.

1. Introduction

1.1. The Global and African Context of Maternal, Neonatal, and Child Health (MNCH)

Maternal and neonatal mortality continue to pose significant global public health challenges, with alarming statistics underscoring the urgent need for sustained intervention. Annually, approximately 287,000 women die due to pregnancy or childbirth complications worldwide, translating to a preventable death every two minutes.¹ While global maternal mortality ratios experienced a 34% decline over the past two decades, this progress has disconcertingly plateaued since 2016.¹ This stagnation suggests that initial, more straightforward interventions may have reached their efficacy limits, pointing to deeper, systemic vulnerabilities within healthcare infrastructures and societal structures that require more nuanced and comprehensive approaches.

Africa bears a disproportionate burden of this global crisis, accounting for 57% of all maternal deaths.² The lifetime risk of an African woman dying from pregnancy-related complications stands at a stark 1 in 39, a dramatic contrast to the 1 in 4,700 risk observed in industrialized nations.² Sub-Saharan Africa, in particular, records the highest neonatal mortality rate globally, with 27 deaths per 1,000 live births, and is the region where two-thirds of all global maternal deaths occur.³ The persistent high mortality rates in Africa indicate that the challenge extends beyond individual health choices, representing a profound public health and development crisis that demands urgent, multi-faceted action.

The primary direct causes of maternal mortality, such as post-partum haemorrhage, pre-eclampsia/eclampsia, obstructed labour, infections/sepsis, and complications from unsafe abortion, are largely preventable with known healthcare solutions.¹ The strong correlation between maternal and newborn deaths, where the loss of a mother substantially increases the likelihood of her newborn’s death, further underscores that maternal well-being is a direct determinant of child survival and overall MNCH outcomes.² This connection highlights that maternal and neonatal health are not separate entities but are intrinsically linked, reinforcing the necessity of integrated interventions that consider the holistic well-being of both mother and child from conception.

1.2. Defining Self-Care in Pregnancy and its Significance for MNCH in Africa

Self-care during pregnancy encompasses a broad spectrum of practices wherein pregnant individuals actively engage in maintaining and promoting their health and well-being. This proactive engagement often occurs in consultation with healthcare professionals and includes diligent monitoring of normal physiological changes, adherence to dietary guidelines, appropriate weight management, attention to mental health, adoption of recommended preventive measures, and general health promotion strategies [User Query]. The Basic Antenatal Care Plus (BANC Plus) Handbook in South Africa exemplifies this approach by emphasizing preventive care and the early detection of potential problems as central tenets of antenatal care.⁵ Self-care thus complements formal antenatal care by empowering women to manage their health proactively, fostering a sense of shared responsibility for health outcomes.

In African contexts, where access to formal healthcare facilities is frequently constrained by factors such as geographical distance, prohibitive costs, and inadequate infrastructure, self-care practices emerge as an indispensable first line of defense and a continuous layer of health management.⁶ When formal care is inaccessible or of suboptimal quality, women are often left to navigate their pregnancies with limited professional support. Equipping them with self-care knowledge and practical skills enables earlier identification of warning signs, consistent engagement in preventive measures, and more informed decisions regarding when and how to seek professional medical assistance. This approach shifts the burden from solely facility-based care to a shared responsibility, potentially reducing preventable complications and improving overall health outcomes in settings where healthcare systems are under significant strain.

Beyond immediate health benefits, promoting self-care during pregnancy is fundamentally about fostering women’s agency and enhancing their capacity for autonomous decision-making concerning their own bodies and the health of their unborn children. Self-care inherently involves personal choice and active participation. By educating women about self-care, they transition from passive recipients of care to active participants in their health journey. This empowerment can yield broader societal benefits, contributing to enhanced health literacy within communities and advancing gender equality, aligning with a rights-based approach to reproductive health.¹

1.3. Overview of the Paper’s Structure and Objectives

This paper aims to provide a comprehensive review of self-care practices during pregnancy, specifically contextualized within the unique challenges and opportunities of the African continent, under the overarching theme of Maternal, Neonatal, and Child Health. The subsequent sections will delve into the core components of self-care, meticulously analyzing the influencing factors, including prevalent cultural and socioeconomic barriers. The paper will conclude by proposing actionable recommendations for policy development, programmatic interventions, and community-based approaches designed to enhance the uptake and effectiveness of self-care practices, ultimately striving for improved MNCH outcomes across Africa.

2. Foundations of Self-Care in African Pregnancy Contexts

2.1. Cultural Perceptions and Traditional Practices Influencing Pregnancy Self-Care

Pregnancy and childbirth in Africa are not merely biological events but are deeply interwoven with diverse cultural contexts, where traditional beliefs and practices profoundly shape perceptions and management strategies.⁹ These practices can exert both beneficial and potentially detrimental influences on maternal and child health.

Dietary Practices: Many African societies adhere to specific food taboos during pregnancy, often leading to the avoidance of foods rich in essential micronutrients and protein, such as meat products, fish, eggs, and certain fruits.¹¹ The rationale behind these restrictions varies but commonly includes fears of harming the unborn child, causing difficult labor (e.g., a baby growing too large), or the belief that certain foods may stimulate continuous menstruation, leading to infertility.¹¹ For instance, some Zulu women avoid specific orange/yellow fruits rich in Vitamin A and C.¹² This direct conflict between traditional dietary restrictions and modern nutritional science can lead to decreased intake of vital nutrients, rendering pregnant women nutritionally vulnerable and exacerbating existing deficiencies.¹¹ Conversely, some African societies promote the consumption of particular wild foods or herbal decoctions, believing them to enhance maternal and child health, facilitate delivery, stimulate breastmilk production, or “strengthen” the fetus.¹¹ This highlights that effective interventions must understand the underlying motivations for these practices, such as fear of harm or spiritual beliefs, and then work to either integrate beneficial elements or offer culturally appropriate, evidence-based alternatives.

Physical Activity: Culturally, pregnancy is often perceived as a period requiring confinement and rest, prompting many women to reduce their physical activity levels as their pregnancy advances.¹⁴ This widespread belief, which suggests that physical activity might increase body temperature or that pregnancy is solely a time for relaxation, can directly contradict medical recommendations for moderate exercise. Specific traditional restrictions, such as forbidding pregnant women from sweeping at night or climbing trees due to beliefs about the baby’s soul, further limit activity.¹⁷ This creates a significant dilemma where cultural norms discourage beneficial physical activity, even as many women must maintain high physical workloads due to economic necessity.¹⁸

Sexual Activity: Traditional beliefs in numerous African societies, including Nigeria, frequently discourage sexual activity during pregnancy. These prohibitions stem from fears of harming the unborn child, causing complications during delivery, or concerns regarding ritual impurity.¹⁹ In some communities, strict abstinence is enforced until the baby is weaned, potentially for up to three years.²⁰ Myths and taboos surrounding sexual issues are pervasive, often serving to regulate sexual behavior within communities.²¹ Such mixed perceptions can lead to either complete avoidance of sexual activity or engagement in unsafe practices due to a lack of accurate guidance.¹⁹ This chasm between medical fact and deeply ingrained cultural beliefs necessitates culturally sensitive counseling from healthcare providers.

Traditional Herbal Remedies: The use of traditional herbal remedies is widespread across Sub-Saharan Africa, often favored due to their accessibility and perceived affordability.²² These remedies may be consumed for various purposes, including strengthening pregnancy or facilitating labor.¹¹ However, this practice raises significant concerns due to a lack of regulatory frameworks, absence of safety and efficacy assessments, poor quality control, and the potential for contamination, adulteration, and adverse herb-drug interactions.²² Some herbal preparations used for abortion or fertility regulation have been linked to severe side effects, including liver damage, breathing difficulties, and even death.²⁴

The aforementioned examples illustrate that cultural practices in Africa are not uniformly detrimental; some offer valuable social support and traditional knowledge. However, a significant portion of these practices, particularly food taboos and restrictions on physical and sexual activity, directly conflict with evidence-based medical recommendations, leading to adverse health outcomes like nutrient deficiencies or delayed care-seeking. This means that simply dismissing traditional beliefs as “wrong” is counterproductive. Effective interventions must understand the rationale behind these practices and then work to either integrate beneficial elements or offer culturally appropriate, evidence-based alternatives. Furthermore, cultural beliefs, such as attributing pregnancy complications to witchcraft or misfortune, can significantly delay or prevent women from seeking timely and appropriate medical care.⁶ If a woman perceives her health issue as spiritual rather than medical, she will seek traditional healers over formal healthcare. This creates a critical barrier to accessing life-saving interventions, suggesting that public health programs must engage community and religious leaders and integrate health education with traditional belief systems to bridge this gap and encourage early presentation to clinics.

2.2. Socioeconomic and Systemic Barriers to Optimal Self-Care Access

Optimal self-care during pregnancy in Africa is frequently hampered by a complex interplay of socioeconomic and systemic barriers that limit access to quality healthcare and essential resources.

Access to Healthcare: Major impediments to maternal healthcare access in Africa include formidable transportation difficulties, long distances to health facilities, and prevailing economic constraints.³ In regions like Togo, natural obstacles such as flooded rivers and dense forests physically obstruct timely access to care.⁷ Consequently, only about half of pregnant women in developing countries receive adequate antenatal, delivery, and newborn care.² In Sub-Saharan Africa, less than half of pregnant women receive the recommended four or more antenatal care (ANC) visits from a provider, representing one of the lowest rates globally.⁷

Quality of Care: Beyond mere access, the quality of care provided acts as a significant deterrent. Pregnant women frequently encounter long waiting times, a scarcity of well-trained healthcare professionals, inadequate infrastructure, insufficient medical equipment, and, critically, disrespectful attitudes from providers.³ Reports of verbal abuse and non-consented care further discourage facility-based deliveries.⁶ This consistent reporting of negative patient experiences highlights that even when physical access to facilities exists, the

experience of care can actively deter women from seeking or continuing it. This points to a critical “demand-side” barrier that extends beyond physical accessibility, suggesting that improving the patient experience, fostering respectful maternity care, and addressing healthcare worker burnout or understaffing are as crucial as building new facilities or reducing direct costs. Without trust and a positive experience, women are likely to disengage from formal health systems, undermining all other efforts to promote self-care.

Financial Barriers: Limited household resources and income constitute a substantial barrier, even in settings where maternity services are nominally free, due to the persistent burden of indirect costs such as transportation.⁸ Financial constraints are a primary reason for non-adherence to prenatal supplements and contribute significantly to low attendance at ANC visits.²⁶

Information and Knowledge Gaps: A prevailing lack of awareness regarding the benefits of maternal healthcare, including the importance of antenatal care and specific interventions like iron supplementation, serves as a significant barrier.⁶ Furthermore, conflicting information and a general absence of clear advice on practices such as physical activity further impede effective self-care.¹⁶

Essential Medicine Availability: The availability of priority essential medicines for women and children in many African countries is unacceptably low, with median availability ranging from a mere 22% to 40% for women’s medicines across surveyed nations.²⁸ This critical shortage often compels women to resort to self-medication, frequently with traditional remedies, as safer, regulated options are unavailable.²³

The aforementioned barriers are not isolated but form an interconnected web. For instance, poverty exacerbates transportation issues, which in turn limits ANC attendance, leading to lower supplement adherence and potentially increased reliance on unregulated traditional remedies. This complex interplay implies that siloed interventions addressing only one barrier will have limited impact if other, co-existing barriers are not simultaneously addressed. A holistic, integrated approach is therefore essential for sustainable improvement, necessitating multi-sectoral collaboration and policy coherence. The significantly higher non-adherence to iron supplementation in rural areas, compared to urban areas, particularly in low-income countries ²⁹, further illustrates a deeper systemic weakness in reaching remote populations. This disparity reflects broader inequities in healthcare delivery, including infrastructure, healthcare provider distribution, and supply chain management. Addressing this requires targeted strategies that consider the unique challenges of rural settings, such as mobile health solutions, community health worker programs, and decentralized service delivery.

3. Core Components of Self-Care During Pregnancy

3.1. Diet and Nutrition

3.1.1. Recommended Caloric and Nutrient Intake

Optimal maternal nutrition is fundamental for fetal development, growth, and the long-term health of offspring.³⁰ For pregnant women who begin pregnancy with a normal body mass index (BMI), the recommended additional caloric intake varies by trimester: no additional calories are typically needed in the first trimester, approximately 340 kcal extra daily in the second, and about 450 kcal extra daily in the third [User Query]. Beyond caloric quantity, a well-balanced diet is crucial. This should include fresh fruits, grains, and vegetables, with high-fiber foods being a beneficial choice. Fish, particularly varieties low in mercury, is important for fetal growth and development [User Query]. The World Health Organization (WHO) specifically recommends consuming a variety of foods, such as green and orange vegetables, milk, meat, poultry, fish, beans, nuts, and whole grains.³¹ The WHO Regional Office for Africa (WHO AFRO) further emphasizes the importance of a strategic plan to reduce malnutrition, promoting safe and healthy diets, and strengthening national capacity for nutrition management.³² This focus on quality and diversity of diet is particularly important in regions where access to varied foods may be limited or where processed foods are becoming more prevalent. Simply advising more calories without specifying nutrient-dense foods can be misleading, especially in areas grappling with the “double burden of malnutrition” where individuals may be overweight but still micronutrient deficient.

3.1.2. Common Micronutrient Deficiencies in Sub-Saharan Africa

Micronutrient deficiencies represent a substantial public health challenge among pregnant women in Sub-Saharan Africa. Data indicate that six out of ten pregnant women in the region exhibit at least one form of micronutrient deficiency.³³ The most commonly observed deficiencies include iron (prevalent in 38.4% of pregnant women), folate (21.7%), vitamin B12 (9.9%), and vitamin A (9.8%).³³ Studies conducted in Nigeria also reveal a high prevalence of deficiencies in iron, folate, vitamin D, and vitamin A.³⁴ These nutritional shortfalls contribute significantly to severe health outcomes, such as Iron Deficiency Anemia (IDA), which affects 61.7% of anaemic pregnant women.³³ Furthermore, these deficiencies are directly linked to a range of obstetric complications, including hypertension, general anemia, neural tube defects (NTDs), night-blindness, low birth weight (LBW), and increased maternal and perinatal mortality.¹³ This widespread presence of specific micronutrient deficiencies signifies a pervasive “hidden hunger” that extends beyond mere caloric insufficiency. These deficiencies have profound, often irreversible, consequences on fetal development, such as NTDs resulting from folate deficiency, and can impact the long-term health trajectories of both mother and child, including an increased susceptibility to chronic diseases in adulthood.³⁵ Addressing these deficiencies is therefore not solely about ensuring a healthy pregnancy but also about safeguarding the lifelong health and cognitive development of the child, underscoring the urgency of comprehensive nutritional interventions.

3.1.3. Impact of Cultural Food Taboos and Traditional Dietary Practices

Cultural beliefs and deeply ingrained food taboos significantly influence dietary choices during pregnancy across Africa.¹¹ A study conducted in the Eastern Cape, South Africa, found that 37% of women reported food practices shaped by local cultural taboos or beliefs.¹¹ Commonly avoided foods include nutrient-dense items such as meat products, fish, potatoes, fruits, beans, and eggs.¹¹ The reasons for these avoidances are varied and often rooted in fears of harming the unborn child, causing difficult labor (e.g., a baby growing too large), or the belief that certain foods might stimulate continuous menstruation, leading to infertility.¹¹ For instance, some Zulu women explicitly avoid specific orange/yellow fruits rich in Vitamin A and C.¹² These cultural food taboos are not abstract beliefs but have a direct, measurable negative impact on the nutritional status of pregnant women by restricting access to vital micronutrients, thereby exacerbating existing deficiencies.¹¹ This creates a direct conflict between traditional practices and modern nutritional science. Effective nutrition education cannot be a one-way transfer of information; it must be a dialogue that acknowledges and respects existing cultural beliefs. Interventions need to be culturally appropriate, perhaps by identifying nutrient-rich alternatives that are culturally acceptable or by engaging community leaders to re-evaluate harmful taboos based on scientific evidence.

3.1.4. Food Safety Practices and Challenges

Pregnant women face a heightened risk for foodborne illnesses due to a naturally weaker immune system during gestation, which can lead to severe complications for both the mother and the fetus.³⁶ It is crucial for pregnant women to avoid undercooked meat or fish, certain seafood with high mercury levels, and foods posing a high risk of contamination by pathogens such as

Listeria (e.g., raw or rare fish/meat, unpasteurized dairy products, deli meats unless heated to steaming hot, and raw sprouts).³⁶

In Africa, microbial foodborne outbreaks represent a severe public health challenge, with the continent bearing the highest global burden due to systemic vulnerabilities.³⁷ Key contributing factors include poor hygiene, inadequate food storage, and limited compliance with established food safety practices.³⁷ Common microbial pathogens implicated in outbreaks include

Salmonella, Staphylococcus aureus, and Listeria monocytogenes.³⁷ A study conducted in Ghana revealed a significant disparity: while 87.06% of pregnant women possessed satisfactory knowledge regarding food safety, only 51.18% demonstrated satisfactory practice.³⁸ This substantial gap between knowledge and practice is particularly alarming for pregnant women due to their increased vulnerability to foodborne illnesses. This suggests that awareness alone is insufficient, and practical, context-specific interventions are needed. Interventions must move beyond informational campaigns to address the underlying reasons for poor practice, such as a lack of resources (e.g., refrigeration, clean water), time constraints, or deeply ingrained habits. Community-based training that demonstrates safe food handling, storage, and preparation methods using locally available resources could prove more effective. The high burden of foodborne diseases in Africa is further compounded by systemic vulnerabilities like limited food safety infrastructure, poor sanitation, and inadequate access to clean water.³⁷ This means that individual self-care efforts, while important, are insufficient without broader public health infrastructure improvements. Policy-level interventions to enhance sanitation, water quality, and food regulatory enforcement are therefore crucial to creating an enabling environment for safe food practices.

3.1.5. Prenatal Supplementation: Importance, Access, and Adherence

Daily prenatal multivitamin supplementation, particularly with iron and folate, is strongly recommended for pregnant women, even when their diet is considered adequate, as pregnancy significantly increases iron requirements [User Query]. Folate deficiency, in particular, substantially elevates the risk of neural tube defects (NTDs) in the fetus [User Query]. Despite this critical importance, non-adherence to iron supplementation is notably higher in rural areas of Sub-Saharan Africa (68.42%) compared to urban areas (51.32%), with this disparity being more pronounced in low-income countries.²⁹

Numerous barriers impede adherence to prenatal supplementation. These include poor healthcare infrastructure, a shortage of trained healthcare providers, limited access to antenatal care (ANC) services, challenges in stock management leading to inconsistent supply, and the financial costs associated with prenatal services.²⁶ Data indicate that nearly half of pregnant women attend only 2-3 of the recommended 8 ANC visits during pregnancy, often initiating care after 20 weeks, which further reduces the likelihood of consistent supplement use.²⁶ This low adherence to essential prenatal supplements, despite their critical importance for preventing severe maternal and neonatal complications, is primarily a systemic failure rather than a matter of individual choice. Issues such as stockouts, financial barriers, and poor ANC attendance point to fundamental supply chain and access problems. This highlights that even highly effective, low-cost interventions fail if the delivery system is broken. Policy efforts must therefore prioritize strengthening supply chains, ensuring the free provision of essential supplements, and improving ANC access and quality to maximize adherence.

Conversely, certain interventions have demonstrated success in increasing adherence. These include education-based strategies, consistent consumption monitoring by volunteer health workers or family members, the use of SMS reminders, and the free provision of supplements.⁴⁰ The effectiveness of these interventions, particularly SMS reminders and community-based monitoring, demonstrates the potential of leveraging technology and existing social networks to overcome adherence barriers, especially in rural areas where conventional access is limited.²⁶ This offers a practical pathway for improving self-care by integrating mobile health solutions and empowering community health workers or family members to provide consistent support and reminders, thereby bridging the gap between clinical recommendations and daily practice.

3.2. Weight Management

3.2.1. Gestational Weight Gain Recommendations and Patterns in African Women

Gestational weight gain (GWG) recommendations are tailored based on a woman’s pre-pregnancy Body Mass Index (BMI). For a woman with a normal BMI (18.5-24.9 kg/m²), the recommended total weight gain during pregnancy is typically between 11.5 and 16 kilograms.⁴¹ Underweight women are advised to gain more (12.5–18 kg), while overweight (7–11.5 kg) and obese (5–9 kg) women should aim for a lower weight gain range.⁴¹

In Sub-Saharan Africa, a systematic review of 26 studies revealed that insufficient GWG was the predominant pattern in most countries, particularly the poorest ones.⁴² This prevalence of insufficient weight gain often reflects underlying issues of malnutrition and food insecurity. Conversely, excessive GWG is emerging as a significant public health concern, particularly prevalent in richer African countries such as South Africa, Nigeria, Ghana, and Kenya.⁴² The co-existence of both insufficient and excessive GWG patterns across different African countries directly reflects the “double burden of malnutrition” prevalent in the region.³² This means that interventions must be highly differentiated and context-specific. A universal approach to GWG counseling will prove ineffective; in poorer, food-insecure regions, the focus must be on ensuring adequate nutrition to prevent insufficient gain, while in more affluent or urbanized areas, the emphasis shifts to preventing excessive gain, which is linked to an increase in non-communicable diseases. This highlights the need for tailored public health strategies based on local epidemiological data.

3.2.2. Maternal and Neonatal Outcomes Associated with Insufficient and Excessive Weight Gain

Suboptimal gestational weight gain, whether insufficient or excessive, carries significant risks for both maternal and neonatal health, with consequences extending far beyond the immediate pregnancy and birth. Insufficient GWG is consistently associated with adverse outcomes such as intrauterine growth retardation (IUGR), low birth weight (LBW), prematurity, and an increased risk of neonatal morbidity and mortality.⁴² Importantly, LBW is linked to increased mortality rates and a higher propensity for chronic diseases in later life for the affected child.³⁵

Conversely, excessive GWG is associated with a range of maternal complications, including gestational hypertension, pre-eclampsia, gestational diabetes mellitus (GDM), and an increased likelihood of caesarean section.⁴² For the neonate, excessive GWG raises the risk of macrosomia (a large baby).⁴² In the long term, excessive GWG contributes to postpartum weight retention in the mother and increases the risk of childhood and future adult obesity, as well as various cardiometabolic complications.³⁵ The profound and lasting consequences of suboptimal GWG, impacting the child’s long-term health and susceptibility to chronic diseases in adulthood, elevate the importance of GWG management from a short-term pregnancy concern to a critical determinant of public health across the lifespan. This argues for early intervention, even preconception, and highlights the intergenerational impact of maternal health on child development and future societal health burdens.

3.2.3. Strategies for Promoting Optimal Gestational Weight Gain

Effective strategies for promoting optimal gestational weight gain involve comprehensive lifestyle modifications, encompassing both balanced dietary counseling and tailored exercise recommendations.⁴³ Dietary interventions should focus on optimizing the consumption of whole grains, vegetables, and fruits, implementing portion control, and reducing the intake of ultra-processed foods and simple sugars.⁴⁴ Crucially, dietary plans should be personalized to account for individual eating habits, taste preferences, and cultural or religious considerations.⁴⁵

Physical activity programs should encourage moderate-intensity activities, such as brisk walking or cycling, for at least 30 minutes, three times per week.⁴⁵ Behavioral counseling and innovative e-health interventions, including telehealth systems and remote programs, have shown promise in motivating women and improving adherence to GWG guidelines.⁴³ For example, the “Parents As Teachers Plus” (PAT+) program in the United States has successfully delivered lifestyle interventions through home visits to socioeconomically disadvantaged African American women.⁴⁷ The success of multi-component lifestyle interventions that combine dietary, physical activity, and behavioral counseling, delivered through accessible channels like home visits or e-health, suggests a powerful model for Africa. The PAT+ example is particularly relevant for the African context, where home-visiting models by community health workers (CHWs) or traditional birth attendants (TBAs) could be adapted to deliver these interventions, thereby overcoming barriers of access and cultural relevance. This highlights the need for training healthcare providers in these integrated approaches to ensure tailored and practical support.

3.3. Physical Activity and Rest

3.3.1. Benefits and Recommended Physical Activities

Engaging in physical activity during pregnancy carries minimal risks and offers numerous demonstrated benefits for both the mother and the developing fetus. These benefits include the maintenance or improvement of physical fitness, better control of gestational weight gain, reduction in low back pain, and a potential decrease in the risk of developing gestational diabetes or preeclampsia.¹⁶ Most pregnant women can safely continue their usual activities and exercises throughout pregnancy. Mildly strenuous sports, such as swimming and brisk walking, are considered excellent choices. More vigorous activities like running or horseback riding are also possible, provided they are performed cautiously to avoid injury, particularly to the abdomen. Contact sports, however, should be avoided.¹⁸ The World Health Organization (WHO) emphasizes that any amount of physical activity is beneficial, and all forms of physical activity contribute positively to health.⁴⁹ Despite these clear benefits and a generally positive attitude towards exercise among pregnant women in Africa ¹⁶, actual participation levels remain low, often limited to household activities.¹⁸ This represents a significant missed opportunity for a relatively low-cost, high-impact self-care intervention. The gap between knowledge and practice indicates that behavioral change is complex and influenced by more than just awareness. Interventions need to address specific barriers and make physical activity feasible and desirable within women’s daily lives, rather than prescribing Western-centric exercise regimes.

3.3.2. Cultural Perceptions and Barriers to Physical Activity

Research on prenatal physical activity in South Africa, though limited, has identified several significant barriers. These include a lack of specific advice, inadequate or conflicting information on prenatal physical activity, pervasive tiredness, existing work commitments, physical discomfort associated with pregnancy, lack of time, low energy levels, and general non-accessibility to appropriate physical activity resources.¹⁶ Culturally and religiously, pregnancy is often perceived as a time of confinement and rest, leading many women to significantly decrease their activity levels as their pregnancy progresses.¹⁴ Many women hold the belief that pregnancy is primarily a period for relaxation and rest.¹⁶ This cultural perception of pregnancy as a time of confinement directly conflicts with the reality of high physical workloads that many African women, particularly in rural areas, must maintain throughout their pregnancy due to economic necessity.¹⁸ This creates a complex dilemma for self-care. Interventions need to differentiate between structured exercise and daily physical labor. Education should focus on

safe ways to manage daily physical demands and incorporate beneficial, low-impact activities like brisk walking within their existing routines, rather than adding a new burden. A key barrier also lies in the lack of proper advice and support from healthcare providers regarding safe physical activity during pregnancy.¹⁶ This points to a training gap for healthcare professionals, as equipping them with the knowledge and skills to provide culturally appropriate, individualized physical activity counseling is crucial for overcoming misinformation and encouraging beneficial practices.

3.3.3. Importance of Adequate Rest and Sleep

Beyond physical activity, adequate rest and sleep are critical components of self-care during pregnancy. Prioritizing sufficient sleep, ideally up to nine hours per night, is crucial and has been shown to be beneficial for the baby’s brain development.⁵² Furthermore, managing stress and anxiety is paramount, as these emotional states can exacerbate common pregnancy symptoms, such as morning sickness.⁵² In contexts where pregnant women often perform strenuous physical labor ¹⁸, advocating for adequate rest and sleep becomes a critical, yet challenging, aspect of self-care. This is not merely about “relaxing” but about addressing the systemic factors that force women into excessive physical exertion. This highlights the need for social and family support mechanisms that enable pregnant women to reduce their physical burden, especially in later trimesters. Public health messages should emphasize the importance of rest for maternal and fetal well-being, potentially encouraging family members to share household and agricultural responsibilities.

3.4. Mental Health and Emotional Well-being

3.4.1. Addressing Emotional Fluctuations, Stress, and Anxiety

Pregnancy is often described as a period characterized by significant emotional fluctuations, which can be both exciting and, at times, frightening.⁵² Effective self-care in this domain involves cultivating emotional resilience, consciously avoiding negative narratives from external sources, including unsolicited advice, “Dr. Google,” and curated social media portrayals, and actively seeking strategies to remain grounded.⁵² It is well-established that heightened levels of stress and anxiety can exacerbate common pregnancy issues, such as morning sickness.⁵² Beyond the typical emotional changes of pregnancy, women in Africa frequently contend with compounded stressors stemming from poverty, food insecurity, limited access to healthcare, and various cultural pressures.⁶ These pervasive socioeconomic and systemic factors can significantly intensify stress and anxiety, detrimentally impacting both mental and physical health. This means that mental health support cannot be solely individualistic, focusing only on coping mechanisms like “avoiding Dr. Google.” It must be integrated into broader public health strategies that address the root causes of stress, such as economic empowerment and improved access to quality care. Screening for mental health issues during antenatal care (ANC) and providing culturally appropriate counseling are therefore crucial components of comprehensive maternal care.

3.4.2. Role of Family and Community Support Systems

Family and community networks play a pivotal role in supporting pregnant women. Connecting with family members, particularly other women who have experienced pregnancy, can provide invaluable emotional support and strengthen interpersonal relationships during this transformative period.⁵² The African proverb, “it takes a village to raise a child,” aptly underscores the profound importance of collective community support in maternal and child well-being.⁵² However, the role of family and community is dual-faceted. While they serve as vital sources of support, a lack of family support is also identified as a barrier to maternal health.⁶ Furthermore, family dynamics, including the influence of husbands or mothers-in-law, can inadvertently impede a woman’s attendance at ANC appointments or her adherence to medical advice.⁵⁵ This complex dynamic requires nuanced engagement. Interventions should not bypass family and community but actively engage them. Programs should involve male partners and influential community members, such as elders and traditional birth attendants, in health education initiatives, addressing prevailing myths and promoting supportive behaviors. This ensures that self-care is not merely an individual endeavor but a practice supported and reinforced by the entire community.

3.5. Preventive Measures and Health Promotion

3.5.1. Antenatal Care (ANC): Access, Quality, and Integration Models (e.g., TBAs, CHWs)

Regular prenatal care visits with a qualified healthcare professional are paramount for the early recognition and prevention of potential problems during pregnancy [User Query]. The World Health Organization (WHO) recommends an increase in the number of contacts a pregnant woman has with health providers from four to eight throughout her pregnancy. This increased frequency is associated with a reduced likelihood of stillbirths and improved opportunities for the timely detection and management of potential complications.⁵⁶ Similarly, South Africa’s Basic Antenatal Care Plus (BANC Plus) guidelines have also increased the recommended number of visits.⁵

Despite these recommendations, only 40% of pregnant women in low-income countries received the recommended ANC visits in 2015.⁴ Access to and utilization of ANC services are frequently hindered by significant barriers, including long distances to health facilities, prohibitive costs, extended waiting times, and experiences of disrespectful care from providers.⁶ Antenatal care is not merely a series of appointments but a crucial platform for comprehensive self-care education, screening, and preventive interventions. The low uptake and quality issues mean that this vital platform is underutilized, directly impacting MNCH outcomes. Improving ANC access and quality, through respectful care, reduced wait times, and adequate staffing, is a foundational self-care intervention, as it enables all other self-care practices by providing information, resources, and trust.

Role of Traditional Birth Attendants (TBAs) and Community Health Workers (CHWs): Traditional Birth Attendants (TBAs) play a deeply entrenched role in many African communities, assisting in 60-90% of births in some parts of Sub-Saharan Africa, particularly in rural areas where they often represent the only available source of immediate assistance.⁵⁸ TBAs typically provide guidance, counseling, and advise on herbs.⁵⁹ Integration models, where TBAs receive training to identify obstetric complications and refer women to formal health facilities, have shown considerable promise in increasing skilled birth attendance and improving maternal and neonatal outcomes.⁵⁸ Notable examples include Malawi’s program training TBAs on the prevention of mother-to-child transmission of HIV ⁵⁸ and the implementation of financial incentives for TBAs to encourage women to deliver in hospitals in Sierra Leone.⁵⁸ Given the pervasive and culturally aligned role of TBAs in African communities, their integration into formal healthcare systems represents a pragmatic and culturally sensitive strategy to extend the reach and quality of antenatal care, rather than attempting to eliminate their role. This approach recognizes that traditional systems are often more accessible and culturally resonant. By training TBAs to serve as referral agents and basic health promoters, formal systems can leverage existing community trust, bridge cultural gaps, and ultimately improve health-seeking behaviors, thereby increasing skilled birth attendance and reducing preventable deaths.

3.5.2. Medication Use, Substance Avoidance, and Traditional Herbal Remedies

Medication Use: As a general principle, avoiding medications during pregnancy is advisable, particularly during the critical first trimester. Pregnant women should always consult their healthcare professional before taking any medication, including nonprescription drugs or medicinal herbs [User Query].

Substance Avoidance: Pregnant women are strongly advised to abstain from alcohol, tobacco (and exposure to secondhand smoke), cannabis, and illicit drugs. Small amounts of caffeine, such as one cup of coffee per day, appear to pose minimal risk to the fetus [User Query]. However, substance use during pregnancy remains a significant concern in Sub-Saharan Africa, with overall prevalence ranging from 2.2% to 36.5%.⁵³ In some East African countries, this figure can be as high as 60%.⁵³ Specific prevalence rates for alcohol consumption during pregnancy vary widely across the continent, from 3.8% in South Africa to 59.3% in parts of Nigeria.⁵⁴ Factors associated with maternal substance use include unplanned pregnancy, a history of pre-pregnancy substance use, substance use by the partner, and a lack of awareness regarding the side effects of these substances.⁵³ Cultural beliefs can also contribute to perceived benefits of prenatal alcohol exposure.⁵⁴ The high prevalence of substance use during pregnancy is not merely a matter of individual choice but is deeply intertwined with the lack of access to affordable, quality formal healthcare and essential medicines. When safe options are unavailable, women may resort to what is accessible and perceived as affordable. This highlights a critical public health failure, suggesting that improving access to essential medicines and quality ANC services is a direct intervention against unsafe self-medication and substance use. Furthermore, substance use during pregnancy is influenced by deeply rooted cultural norms and the behavior of partners. This means that interventions must be multi-pronged, involving community leaders and male partners, and addressing the social determinants that perpetuate these practices.

Traditional Herbal Remedies: The use of traditional herbal remedies is widespread in Sub-Saharan Africa ²², with self-medication rates reaching up to 85% in some resource-limited settings.²³ This practice, however, raises serious concerns due to a pervasive lack of regulatory frameworks, an absence of rigorous safety and efficacy assessments, poor quality control, and the potential for contamination, adulteration, and adverse herb-drug interactions.²² Some herbs used for abortion or fertility regulation have been documented to cause severe side effects, including liver damage, breathing difficulties, and even death.²⁴ The unacceptably low availability of priority essential medicines for women in Africa, with median availability ranging from a mere 22% to 40% across countries, further contributes to the reliance on self-medication with traditional remedies.²³

3.5.3. Environmental Toxic Exposures: Risks and Mitigation Strategies

Pregnant women should take proactive measures to minimize exposure to various environmental toxins. This includes avoiding direct handling of cat litter (due to the risk of toxoplasmosis), prolonged exposure to hot temperatures (such as in hot tubs or saunas), contact with individuals infected with rubella (German measles) or chickenpox, and exposure to toxic chemicals or paint fumes [User Query]. Exposure to toxic environmental agents, including lead, pesticides, solvents, and phthalates, during pregnancy is associated with a range of adverse reproductive and developmental outcomes, such as infertility, miscarriage, preterm birth, low birth weight, neurodevelopmental delay, and childhood cancer.⁶⁴

Lead Exposure: Elevated lead levels in pregnant women are associated with serious complications including preeclampsia, recurrent pregnancy loss, and low birth weight.⁶⁵ Significant sources of lead exposure in Africa include artisanal gold mining ⁶⁵ and, notably, the consumption of substances like “farin-kasa” (white baked clay), which is sometimes consumed to alleviate pregnancy-related nausea.⁶⁷

Pesticide Exposure: Occupational and environmental exposure to various pesticides, particularly in agricultural settings, can increase the risks of birth defects, infertility, and pregnancy complications.⁶⁴ Women working in horticulture, for example, may be disproportionately exposed due to prevailing gender roles and financial pressures that necessitate their continued involvement in tasks involving pesticides, even during pregnancy.⁶⁸

Mitigation Strategies: Effective interventions to reduce environmental toxic exposures include comprehensive public awareness campaigns, targeted policy advocacy, robust health surveillance systems, detailed source analysis to identify primary exposure points, and behavior change interventions.⁶⁹ Specific strategies for heat exposure include promoting “Water-Rest-Shade” practices and reducing heavy physical workloads.⁷⁰ For agricultural workers, gender-sensitive health training is crucial to enhance safety practices.⁶⁸ Pregnant women in Africa, particularly those in specific occupations or with certain cultural practices, face a disproportionate burden of environmental toxic exposures. This is an issue of environmental justice, where vulnerable populations bear the brunt of unregulated industries and traditional practices. This highlights the need for broader policy and regulatory interventions, implying that addressing environmental toxins requires multi-sectoral collaboration, including public health, environmental agencies, and economic development, to protect pregnant women and future generations. The consumption of “farin-kasa” for nausea relief exemplifies how cultural practices, often rooted in traditional coping mechanisms, can inadvertently lead to severe toxic exposures, especially when modern medical alternatives are inaccessible. This reinforces the need for culturally sensitive health education that provides safe alternatives to harmful traditional practices, coupled with efforts to improve access to safe, affordable medical care.

3.5.4. Immunizations and Infection Prevention

Comprehensive preventive care during pregnancy includes screening for a range of disorders such as high blood pressure, preeclampsia, diabetes, sexually transmitted infections (STIs), urinary tract infections (UTIs), and genetic or chromosomal abnormalities [User Query].

Vaccinations: Pregnancy generally does not preclude the receipt of vaccines, and inactivated vaccines are considered safe. Live vaccines (e.g., measles, rubella, yellow fever) are typically avoided due to theoretical risks to the fetus but may be considered if the risk of disease is exceptionally high.⁷³

• Tetanus: South Africa demonstrates high utilization of the tetanus toxoid-containing vaccine (TTCV), with over 99% of women receiving at least one dose. This is a positive indicator for preventing maternal and neonatal tetanus.⁷⁴
• Influenza: The uptake of influenza vaccination in South Africa remains low (16.6%), though it is higher among women who attend more ANC visits.⁷⁴
• Pertussis: The diphtheria-tetanus-pertussis (DTP3) vaccine is crucial for protecting infants.⁷⁵ However, barriers to pertussis vaccine uptake during pregnancy include a lack of awareness, safety concerns, and insufficient encouragement from healthcare professionals.⁷⁷
• Malaria: The WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for pregnant women in malaria-endemic areas.⁵⁵ The RTS,S/AS01 malaria vaccine is also recommended for children living in such areas.⁷⁸ Barriers to IPTp-SP uptake include poor knowledge of its benefits, the perception that pregnancy is not an illness requiring medical intervention, a lack of spousal consent, and negative attitudes from healthcare professionals.⁵⁵

Despite the availability of crucial vaccines and clear WHO recommendations, uptake remains suboptimal for many, especially in Sub-Saharan Africa. The barriers are often at the point of delivery: a lack of awareness, safety concerns, inconsistent healthcare provider recommendations, and systemic issues like stockouts and distance.⁷⁴ This highlights that vaccine development is only half the battle; effective delivery and uptake are equally critical. Interventions need to focus on strengthening primary healthcare systems, improving communication between providers and patients, addressing vaccine hesitancy through evidence-based counseling, and ensuring consistent supply chains. Furthermore, factors such as spousal consent, the perception of pregnancy as not an illness, and negative attitudes of healthcare professionals significantly influence vaccine uptake.⁵⁵ This reinforces the need for community engagement and male involvement in health education, and it underscores the importance of respectful, patient-centered care to build trust and encourage adherence to preventive measures.

3.6. Sexual Health During Pregnancy

3.6.1. Safety of Sexual Activity and Cultural Considerations

Sexual activity is generally considered safe throughout an uncomplicated pregnancy. However, it should be avoided in cases of vaginal bleeding, pelvic or vaginal pain, leakage of amniotic fluid, or uterine contractions [User Query]. Medical research indicates that engaging in sexual activity can have positive effects on a pregnant woman’s emotional well-being and relationship satisfaction.¹⁹

Despite medical consensus, a significant disconnect exists between these facts and deeply ingrained cultural beliefs in many African societies. Traditional beliefs often discourage sexual activities during pregnancy due to fears of harming the unborn child or causing complications during delivery.¹⁹ Myths and taboos surrounding sexual issues are widespread, frequently propagated to control sexual behavior.²¹ Some cultures even consider pregnant women to be in a state of “ritual impurity,” leading to enforced abstinence, sometimes for extended periods, such as until the baby is weaned, potentially up to three years.²⁰ These mixed perceptions can lead to either complete avoidance of sexual activity or, conversely, engagement in risky behaviors due to a lack of proper, evidence-based guidance.¹⁹ This chasm between medical fact and cultural belief creates a sensitive area for self-care. It highlights the need for healthcare providers to approach discussions about sexual health with extreme cultural sensitivity. Direct, non-judgmental counseling that acknowledges existing beliefs while providing accurate, evidence-based information is crucial. This can help demystify pregnancy and address fears, promoting healthy sexual well-being within the relationship.

3.6.2. Healthcare Provider Counseling and Education

Addressing the complex perceptions surrounding sexual activities during pregnancy, which are influenced by cultural, social, and medical factors, through targeted education and counseling is vital for promoting the well-being of pregnant women.¹⁹ In South Africa, the Department of Health offers comprehensive Sexual and Reproductive Health and Rights (SRHR) training for healthcare providers. This training includes dedicated modules on pre-natal care, sexual function, and the prevention and management of HIV (PMTCT).⁸¹ Similar training programs are being implemented for community health workers in West Africa to equip them with the necessary knowledge and skills to promote SRHR among young married women and first-time parents.⁸² Counseling on HIV prevention, including the use of pre-exposure prophylaxis (PrEP) for partners, is also an important component of this education.⁸³ Given the pervasive cultural taboos surrounding sexual health during pregnancy, the effectiveness of self-care in this domain hinges on the capacity of healthcare providers to deliver culturally competent and sensitive SRHR counseling. This emphasizes that merely having SRHR training is insufficient; the training must specifically equip providers to navigate complex cultural beliefs, address misinformation respectfully, and facilitate open dialogue. This is critical for improving communication, building trust, and ensuring that women receive accurate guidance on safe sexual practices and HIV prevention during pregnancy.

3.7. Preparing for Breastfeeding

3.7.1. Importance and Current Initiation Rates

Preparing for breastfeeding during pregnancy is a crucial aspect of self-care. Women who plan to breastfeed are encouraged to prepare by reading about the practice, attending classes, or engaging in discussions with women who have successfully breastfed [User Query]. Breastfeeding offers numerous well-documented benefits for both the child and the mother. For infants, it provides ideal nutrition and significantly lowers the risk for infections, respiratory diseases, diarrhea, and child stunting.⁸⁴ Despite these profound advantages, the prevalence of exclusive breastfeeding (EBF) for children under six months in Sub-Saharan Africa remains low, at 34% between 2000 and 2018, falling short of WHO targets.⁸⁵ Early initiation of breastfeeding in the region is estimated at 47%.⁸⁵ This disparity between the known benefits and the actual practice of EBF in Sub-Saharan Africa highlights a “breastfeeding paradox.”

3.7.2. Cultural Practices and Beliefs Influencing Breastfeeding

Breastfeeding practices in Africa are profoundly influenced by deeply embedded cultural norms and beliefs, which often pose significant barriers to exclusive breastfeeding. It is common knowledge that women are culturally encouraged to mix-feed their infants, leading to the early introduction of water and other food supplements, with over 38% of infants receiving water in their first month of life in some regions.⁸⁶ These practices are often driven by traditional beliefs, such as the notion that breast milk alone is an incomplete food that does not adequately promote infant weight gain, or that all family members should benefit from food grown on the family farm.⁸⁶ Furthermore, cultural beliefs may include the perception that colostrum (the first milk) is “dirty” or harmful to newborns and thus needs to be “purified”.⁸⁷ Prelacteal feeding (giving substances other than breastmilk before breastfeeding is established) is common, believed to cleanse the infant’s gastrointestinal tract, quench thirst, flush the bladder, or allow the mother to rest after childbirth.⁸⁷ The taboo prohibiting sexual contact during breastfeeding also influences feeding practices.⁸⁶ The high cost of infant formula, coupled with widespread poverty, makes formula feeding prohibitively expensive for many families, yet cultural pressures persist.⁸⁶ Social norms, lower maternal literacy, and limited social power of women, particularly in rural areas, further hinder exclusive breastfeeding practices.⁸⁸ These cultural norms represent significant barriers to EBF, underscoring the critical importance of contextualized interventions. Simply promoting EBF without addressing these deeply held beliefs and practices will be ineffective. Interventions must engage community leaders, address misconceptions respectfully, and offer practical, culturally acceptable solutions that support mothers in adopting and sustaining EBF.

3.7.3. Support Systems and Programs for Breastfeeding Mothers

To address the challenges in breastfeeding initiation and exclusivity, various support systems and programs are being implemented across Africa. The World Health Organization (WHO) explicitly recommends exclusive breastfeeding for the first six months of life, especially in resource-poor countries, given its numerous nutritional and health benefits.⁸⁶ Organizations like HelpMum are leveraging innovation and technology to improve maternal and infant health in Africa. Their initiatives include AI-driven solutions like MamaBot Chatbot, which provides expecting mothers with reliable and timely information on prenatal care, nutrition advice, and fitness tips, empowering them to navigate pregnancy confidently.⁸⁹ HelpMum also engages in women’s empowerment programs, digitally equipping community health workers (CHWs) with mobile tablets and e-learning platforms to avert maternal mortality in remote rural areas.⁸⁹ They also establish Digital Health Cafes, which are renovated maternity homes offering quality healthcare and serving as training centers for community birth attendants.⁸⁹ Similarly, Wellbeing Africa focuses on strengthening capacity development in breastfeeding support for CHWs and ensuring mothers have timely access to adequate support through clinics and phone-based systems. They also facilitate the establishment of breastfeeding support groups.⁸⁴ These examples demonstrate the potential of leveraging technology and community-based approaches to reach mothers, provide education, and offer practical support. Empowering women and CHWs through digital tools and training can significantly enhance breastfeeding outcomes by providing accessible, consistent, and culturally relevant information and support.

4. Conclusions and Recommendations

The comprehensive review of self-care during pregnancy in Africa reveals a complex landscape shaped by a confluence of medical recommendations, deeply ingrained cultural practices, and formidable socioeconomic and systemic barriers. While the importance of self-care is universally acknowledged for optimal maternal, neonatal, and child health outcomes, its implementation in the African context is uniquely challenging. The disproportionately high maternal and neonatal mortality rates in Africa underscore that the issue is not merely individual but a profound public health crisis rooted in systemic vulnerabilities.

The analysis highlights that cultural practices, while offering valuable social cohesion, often present a double-edged sword. Specific food taboos and restrictions on physical and sexual activity, though often well-intentioned, directly conflict with evidence-based medical advice, contributing to nutrient deficiencies and delayed care-seeking. This indicates that interventions must move beyond simplistic condemnation of traditional practices toward a nuanced, culturally sensitive dialogue that respects local beliefs while introducing evidence-based alternatives.

Socioeconomic and systemic barriers, including limited access to quality healthcare, prohibitive costs, inadequate infrastructure, and a scarcity of essential medicines, further exacerbate the challenges to self-care. The pervasive knowledge-practice gap in areas like food safety and prenatal supplementation demonstrates that awareness alone is insufficient; practical, context-specific support is essential. The consistent reporting of disrespectful care and long waiting times in formal health facilities acts as a significant deterrent, emphasizing that the quality of the patient experience is as critical as physical accessibility.

The review also points to the critical role of antenatal care as a pivotal platform for self-care education and intervention. Given the deeply entrenched role of traditional birth attendants (TBAs) and community health workers (CHWs) in many African communities, their pragmatic integration into formal healthcare systems is not merely an option but a necessity. By training TBAs and CHWs to serve as referral agents and health promoters, existing community trust can be leveraged to bridge cultural gaps, improve health-seeking behaviors, and extend the reach of quality care.

Recommendations for Policy and Programmatic Interventions:

1. Strengthen Integrated Antenatal Care (ANC) Services:

• Policy: Advocate for and fund the implementation of WHO-recommended increased ANC contacts (8 or more) across all primary healthcare facilities, ensuring these visits are comprehensive platforms for self-care education, screening, and intervention.⁵⁶
• Programmatic: Invest in improving the quality of ANC services by reducing waiting times, ensuring adequate staffing, and implementing respectful maternity care training for all healthcare providers to build trust and encourage consistent attendance.⁶
• Citation: World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Retrieved from https://www.who.int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-pregnancy-experience.⁵⁶

2. Culturally Competent Health Education and Community Engagement:

• Policy: Develop national health education strategies that are culturally appropriate and challenge harmful traditional beliefs (e.g., food taboos, physical activity restrictions, sexual health myths) by providing evidence-based alternatives in a respectful manner.¹¹
• Programmatic: Implement community-based health promotion programs that actively involve male partners, elders, and traditional leaders in health education, fostering collective responsibility for maternal and child well-being.⁵² Utilize existing community structures and communication channels effectively.
• Citation:.¹¹

3. Enhance Access to Essential Nutrition and Supplements:

• Policy: Prioritize strengthening supply chains for essential prenatal multivitamins (iron, folate) and ensure their free and consistent provision, particularly in rural and underserved areas.²⁶ Implement policies to control the consumption and marketing of unhealthy, processed foods.³²
• Programmatic: Deploy mobile health solutions (e.g., SMS reminders) and empower community health workers to monitor supplement adherence and provide ongoing nutritional counseling, focusing on diverse, locally available nutrient-rich foods.²⁶
• Citation:.²⁶

4. Integrate Traditional Birth Attendants (TBAs) and Community Health Workers (CHWs) into Formal Healthcare:

• Policy: Develop clear policy frameworks that officially recognize and integrate TBAs and CHWs into the formal healthcare system through standardized training, supervision, and defined referral pathways.⁵⁸
• Programmatic: Provide TBAs and CHWs with the necessary tools, training (e.g., on identifying complications, safe practices, PMTCT of HIV), and incentives to effectively guide women to skilled birth attendance and formal ANC services, while respecting their cultural role.⁵⁸
• Citation:.⁵⁸

5. Address Environmental Toxic Exposures:

• Policy: Implement and enforce regulations to control lead and pesticide exposure, particularly in industries like artisanal mining and agriculture, which disproportionately affect pregnant women.⁶⁵
• Programmatic: Conduct targeted public awareness campaigns about environmental toxins and provide gender-sensitive health training for women in high-risk occupations. Offer safe alternatives to traditional practices that involve toxic substances.⁶⁷
• Citation:.⁶⁵

By adopting these multi-faceted and integrated strategies, African nations can significantly enhance self-care practices during pregnancy, leading to a substantial reduction in maternal, neonatal, and child mortality and morbidity, thereby fostering a healthier future for generations to come.

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