Social Determinants of Health in Very Poor Ruralities. Striving and Thriving in Dire Conditions: Is It Possible? A Qualitative Study with Women in a Poor Rural District of Ghana
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Women living in very poor rural regions of developing countries are among those in the world facing the largest, avoidable risk for early illness, disability and death. Yet, some women in very poor areas are healthier than other women living in the same communities. Identification of factors that protect the health of women of childbearing age is a priority in the UN Millennium Development Goals. This is challenging as previous research shows that the standard protective factors higher income, higher education and higher occupational status are poorly associated with health in very poor rural places. Thus there is a need for research to emphasise protective factors that do have relevance in very poor ruralities. This project is part of a larger project which analyses qualitative and quantitative data from India, the Philippines, Peru, Haiti, Ghana, Tanzania and Saskatchewan (Canada). The aim of the larger project is to identify protective factors for the health of women at childbearing age living in poor ruralities of these countries. This thesis presents findings from qualitative data collected in the Bole District of Northern Ghana. This study implemented a case study design collecting data through focus group interviews, key informant interviews, personal observations during the field visit as well as information provided by a local nongovernmental organisation, GRID-NEA, established in and working with the women where the study took place. An open, semi-structured guide was implemented during the interviews and was modified as needed throughout the duration of the field visit in April 2009. Analysis of this research adapted the linear, hierarchical approach for qualitative data. The results indicated existing connections between social determinants and women's health. The ability to bear children, traditional skills, education, religious beliefs and social status were strong indicators that affect the status and wellbeing of women of childbearing age. Social support from husbands was highly valued in addition to assistance from older children. Previous local customs marginalised women yet with the adaption of different religions and change in beliefs of roles for women, women's health and status have increased. Although most women were not completely healthy women were able to sustain livelihoods to support themselves and their families. Unfortunately, the challenge lies in creating these opportunities because the women live in such dire circumstances. They have little access to existing resources in order to start on their own. Assistance from local organisations and agencies is necessary to create activities for them. It was difficult for a woman to succeed on her own, meaning social support had significant contributions to women's health and status. Several elements within the field of health promotion emerged from the findings of this study. These include empowerment, salutogenesis as well as influences of globalisation. These intertwined and sometimes complex concepts can be recognised as effective means to promote health, even in the harshest of living conditions.