AWO!
An Expert Guide to Motherhood from
the Ghanaian Perspective
Edited by Linda Vanotoo MBChB PhD
Buruwaa Adomako Agyekum PhD MPhil Msc[xiii]

Foreword
Pregnancy is a paradox: whereas it is a channel to welcome a new life into the world for which there is huge celebration, it can also be a means to pain and anguish through the death of mother and/or child. Nations and governments, families and couples, and individuals and health workers continue to work towards reducing the rate of death of mother and child before, during and after pregnancy; and also improving the birth conditions and experience for mother and child. This book could not have come at any better time than this.
As an edited volume by a medical practitioner and a psychologist on a very critical subject in Ghana’s health landscape, it has organized in a holistic manner, important contributions from over 20 experts with varied backgrounds.
The book is divided into 5 sections. The authors begin from Before Pregnancy. The idea is that pregnancy must be carefully planned, and as much as possible, mobilise the resources needed to go through the entire period. From financial planning to diet and mental health, the authors have carefully provided very important nuggets
for beginning this journey. The clear objective is to help women intending to get pregnant to avoid the taken-for-granted lifestyle issues which have the potential to affect a healthy pregnancy. Section Two covers the pregnancy stage and what the pregnant woman must do. From complications to diet, mental health, oral health and others, the information provided will erase any ignorance that might cost a life. Babies do not automatically grow as expected after birth; conscious and intentional actions are required from their mothers to help them grow healthily.
This is the focus for Section Three. The authors provide useful information on vaccination and feeding, among others, to improve both baby and mother’s health. Sections Four and Five address selected topics for the family. From maternity care, parenting children, violence in pregnancy and children, cultural issues, and a provision of a resource guide to mothers, the authors commit themselves to help women and their families to experience pregnancy as a process with phenomenal outcomes.

The book is culturally sensitive and provides the Ghanaian mother (and even mothers from other countries) with knowledge on cultural nuances during pregnancy, and how to address them. As the Editors have indicated, “Every page is written with the needs of the Ghanaian woman in mind and is packaged to meet the unique needs of Ghanaian families”.
The book makes the woman agentic, with the power to choose when to get pregnant, what to do to improve her pregnancy experience throughout the journey, and a healthy way of caring for the baby and herself after the pregnancy. I find this book liberating as it does not treat the pregnant woman as a victim, or an object of
an experience that could jeopardize her life. Rather, it treats the subject from an empowering perspective to appropriately and culturally respond to all issues that affect pregnant women, their children, and families. Indeed, it is compliant with the SDGs Goal 3, “Ensure healthy lives and promote well-being for all at all ages”. I strongly recommend this book to all women and mothers, husbands and fathers, family caregivers of pregnant women, religious leaders, women leaders in religious organizations, teachers, sex educators, NGOs, health trainees and workers, mental health workers, and anyone who cares about women, mothers, and children.
This is a must-read and must-have compendium that should be in your library. Prof. Joseph Osafo Adu Head of the Department of Psychology University of Ghana

Introduction
In Ghana and across various Ghanaian languages, the name woman has several interrelated meanings including "mother" and "childbirth". Awo conferred on a It is a term of endearment. AWO signifies strength, resilience, wisdom, ability, poise, elegance, determination and power of the woman.
AWO! A Comprehensive Guide to Motherhood from the Ghanaian Perspective has emerged from the aggregation of the lack of cultural congruity and sensitivity in published literature for Ghanaian women. It is a response to the call for culturally affirming maternal care and prioritization of the well-being of both baby and
mother during pregnancy and beyond. The period covering pregnancy and childbirth has received a lot of attention globally both for its positive associations with new beginnings, life and continuity, and also, the negative experiences and outcomes such as maternal and child mortality and morbidity. The increasing awareness of context and culture in health systems, care and interventions, make it imperative that this important period in the lives of women, parents and their families be approached from a paradigm that they are able to identify with, accept and fosters positive outcomes for them.
AWO! brings together over 20 authors who are experienced and respected experts
within their various professional roles. These professionals include; Family
resource management experts, Dietitians, Nutritionists, Psychologists, Child
and Family Studies experts, Obstetrician-Gynecologists, Midwives, Pediatricians,
Lawyers, Sociologists, Dentists, Public Health Specialists, Psychiatrists, special
education specialists and many more.

Through AWO! the authors intend to articulate and explain in simple terms,
various issues that affect women, families and babies before pregnancy, during
pregnancy and labour, and the period after childbirth. Although they discuss ways
of coping with these issues that are particularly oriented towards the Ghanaian
woman and her family, they can be adapted and applied in other settings
around the globe. AWO! is divided into 3 sections covering the period before
pregnancy, the period during pregnancy and the period after pregnancy. It also[xvi]
has an additional section that is composed of a collection of topical issues that
are particularly relevant to maternal and child care in Ghana and the journey of
families, but can be applicable in countries with similar needs. This book goes
further to incorporate a resource guide at the end of the book, a key addition, that
will signpost families to critical services that they may require.
AWO! A comprehensive Guide to motherhood from the Ghanaian perspective is one-ofa-kind; a holistic introduction and walk-through book for every woman interested
in the pregnancy journey from before-beginning to the end and beyond. Every
page is written with the needs of the Ghanaian woman in mind and is packaged to
meet the unique needs of Ghanaian families. Be empowered and inspired as you
read AWO! We wish you a fantastic pregnancy and childbirth experience!
Linda Vanotoo, MBChB PhD
Buruwaa Adomako Agyekum, PhD MPhil Msc[1]
SECTION ONE
BEFORE PREGNANCY
Chapter One
PRE-PREGNANCY FINANCIAL PLANNING AND MANAGEMENT
Dr. Fortune Djirackor
Author’s Profile
Dr. Fortune Djirackor is a lecturer in Family Resource Management at the
University of Ghana. She has a PhD in Adult Education and an MPhil in
Home Science (Women and Development and Family Welfare). Her Research
Interests are in the fields of:
– Poverty Reduction
– Work-Family Conflict
– Family Resources Management
She enjoys training students for work and family life.
Becoming a parent can be exciting, since pregnancy and childbirth are wonderful experiences in every couple’s life. However, they come with many changes to
your life and entail a lot of work. You need to be prepared before you become
pregnant. If you just found out you are pregnant, congratulations. This chapter
can be a good resource for you too. We discuss below essential items you will need
in this journey for which you need to be financially prepared.
Questions to ask
- Why do I want to have a baby?
- Can we afford to take care of a baby? If I’m single, do I have the necessary
resources to care for a child?[2]
- Does my health insurance plan cover maternity and newborn care?
- If I decide to return to work, am I sure I can access good care for my child?
Health Insurance
Once it is confirmed that you are pregnant, you need to sign up for a health
insurance if you do not already have one. If you have one, find out what antenatal
and childbirth care is covered. This helps you make informed decisions that will
save you money. Be sure to read the fine print in your health insurance policy and
understand it. Your health insurance coverage varies widely depending on the
type of insurance you have. So, review the policy and take note of the following:
1. The network of providers within your plan. Receiving care from a care
provider within the network of care providers within your plan is always
cheaper. If you are on the National Health Insurance Scheme, find out
about the package for antenatal and childbirth care and care providers
and take advantage of that. There are private health insurance companies
available in Ghana who offer good services. You may be interested in one
of them. Find a list of them at the end of this chapter.
2. Find out if all the laboratory services are paid by your insurer; whether you
can choose any care provider (Obstetrician gynaecologist, nurses-midwives,
family physicians, maternal and foetal medicine specialist); and find out if
the insurance package covers delivery at any birthing location.
Getting enough fine details can save you a lot of money.
If you choose to finance the entire cost of your antenatal and childbirth
care, it is completely fine. You have to find out the cost of care providers
and all the laboratory services in advance and allocate money for that.
3. Look into your workplace policies on leave and conditions of service for
pregnant women.
Next, study your workplace policy on maternity leave and see how that affects
your finance. In Ghana, maternity leave is for twelve weeks. This period
may be extended by two weeks in the case of multiple birth. Maternity leave
is fully paid by the employer and the pregnant woman is also entitled to any
benefits due her. This policy is strictly applied in most formal work sectors
but in the informal sector, it is not strictly enforced. On returning to work
after childbirth, women are entitled to one-hour break for breastfeeding.[3]
The law provides that women on maternity leave shall not be dismissed on
absence on maternity leave. It is your right to fully enjoy six weeks on paid
maternity leave. Take advantage of it and plan your leave well so you can
have some time with your baby before you resume work.
Look into the cost of antenatal service
If you have not signed up for any health insurance policy, then investigate the cost
of antenatal care available to you. Find out about all the lab tests that need to be
done throughout the pregnancy.
Some of the tests you will normally do are
1. Routine prenatal tests during the 5th to 11th week
2. Optional tests may be done from the 11th to 17th week
3. Ultrasound exams between the 18th to 20th week
4. Group B Strep test between 35 and 37 weeks
It is important that you know and prepare adequately for these tests. Please note
that the time these tests are carried out differ from one medical centre to the
other.
Routine tests may include blood test to determine your blood group, Rhesus
factor test to see whether Rh positive/negative, HIV, Hepatitis B, tests for chicken
pox, measles, mumps, or toxoplasmosis, etc. You may be screened for bladder or
kidney infections. Your urine sample may also be screened for sugar or protein in
the urine, which will indicate diabetes or kidney disease.
Decide on your birth options
The first trimester is a good time to decide on your childbirth options. Your doctor
or healthcare provider can advise you on the childbirth options that are available.
You may decide to have a spontaneous vaginal delivery which is the most common
form of delivery, a spontaneous vaginal delivery with epidural anaesthesia, or a
caesarean section. Although some women like to have their babies in their homes,
it is advisable that you have your baby in a hospital or health facility where you can
be assisted to deliver your baby safely. No matter the type of delivery you choose
to have, make sure you are aware of the financial cost and prepare towards that
if it is not covered by your insurance. The National Health Insurance Scheme
(NHIS) in Ghana covers antenatal delivery and postnatal healthcare services. The[4]
NHIS covers six antenatal visits, delivery including delivery complications, two
post-natal care visits within six weeks of delivery, and care for infants up to three
months of age. After this period, you need to register the child on the NHIS to
continue to enjoy the service.
Look good for the second trimester
- The second trimester is the right time to go shopping for maternity wears. As
your tummy begins to expand, you will realize that your clothes do not fit you
any longer. It is time to invest in maternity clothes. You can sew or buy good
quality maternity clothes that you can save for future pregnancies. In shopping
for maternity clothes, choose fabrics that make you feel comfortable and good.
You may wear your husband’s large T-shirts or dress shirts if that makes you
comfortable and that will help save some money. You will need to invest in at
least two good maternity bras. Invest in good maternity pants that are stretchy
with an adjustable waist, or low-slug trousers that can sit neatly under your
growing bump.
- For the office, purchase a few loosely-shaped basic clothes and accessorize them
with jewellery and scarfs.
The second trimester is another time to cut out unnecessary expenses so that you
can save in case you need extra money to spend on your baby.
As your energy level is higher in the second trimester, make a budget for your baby
and shop for most of the items you and your baby may need. Make a note of the
estimated cost of caring for your baby and calculate the cost of baby toiletries, toys,
baby equipment such as cradle, carrier, stroller, etc. and even baby books. You
also need to estimate cost for baby food e.g., formula/milk after your baby is six
months of age. Again, you need to cost baby cloths. After you have done all these,
begin to buy the items you need one at a time to spread the costs.
Beware that the most expensive items are not necessarily the best. Acquire enough
information from friends, family, stores, and the internet before you make your
purchase decisions.
Preparing for your baby clothes
Although you are likely to receive a lot of baby clothes from well-wishers and
friends, you still need to buy a few clothes for your baby. If you want to invest in[5]
expensive clothes, buy them in slightly larger sizes so that your baby can get more
wears out of them. Babies outgrow their clothes quickly. You may need many
clothes in each cloth category so that you do not end up washing several times a
day or waiting for an item to dry. You may need the following clothing for your
baby:
1 – 2 nightgowns
5 – 8 one-piece pyjamas
5 – 8 undershirts
5 – 8 pairs of socks or booties. These may be necessary if your baby is not wearing
a footed pyjamas or when your baby needs to go out.
1 – 2 hats – choose hats with a wide brim for sunny days and one to keep him or
her warm on cold days.
4 – 5 bibs – you will need theses to take care of those messes during breastfeeding.
They also protect baby clothes against drools or spit-ups.
You may need to invest in both cloth diapers and disposable diapers. Cloth diapers
may be cheaper in the long run but need to be washed for reuse which is time
consuming and creates more wastewater but environmentally more friendly than
the disposable diapers.
Bath time Essentials
- Invest in a good baby bath. The bath should be sturdy and not bend or spill
contents when moved.
- You need two bathing towels.
- Baby bath and shampoo. Choose ones with organic or should be a
hypoallergenic product which is gentle on your baby’s skin.
- A sponge – natural is best.
- Small bucket to hold water during bath.
- A non-slip mat to secure you and baby against fall or slips.
These cleaning items are also essential
- Burp clothes to mop up spit up, milk, drool, etc.
- Cotton ball – for moping your little one’s nose and eye[6]
- Wipes – you need these to clean up your baby. Invest in a lot of them.
Choose organic ones or hypoallergenic ones.
Transporting your baby
If you own a car, then you need to transport your baby in a car seat. Spend some
time to look around for quality car seat and invest in it. Choose a car seat with an
easy to fasten belt, and has removable and washable parts.
Stroller
A stroller is a popular means of transporting your baby around the house and when
you are out and about. A stroller is a good investment to make especially when
your neighbourhood roads are tarred. It also adds to the comfort of transporting
your baby in town when you go shopping.
Slings
Slings are optional. Ghanaian women love to carry their babies close to them with
a cloth at the back but for extra comfort, you may want to invest in slings.
Feeding equipment
As your energy level increases in the second trimester, make time to purchase your
feeding equipment. Look around for:
- 3 – 4 good quality nursing bras. These should be easy to open with one
hand.
- A breast shield for sore nipples.
- Nipple cream to relieve sore cracked nipples. Be sure to choose one that be
ingested safely by your baby and does not have peanut oil which is linked
with allergies in children. If you plan to express your breast milk, then invest
in a
- quality breast pump
- 2 – 4 feeding bottles
- brush/dishwasher to clean the pump and bottle
If you need to feed your baby with formula, then you may need to invest in
additional bottles, cups, measuring scoops, spoons and knife for levelling the
formula.[7]
Your Baby Nursery
Whatever you need to place in your baby’s nursery and how you want to decorate
is entirely up to you, but these are a few essential equipment that should be in
your child’s nursery.
- A full-sized crib with a new mattress
- Bedding
- Soft rug made of natural fibres for play time
- Diaper pail or any suitable container with a tight fitting
- Dresser for storage
- Comfortable chair for feeding
It may be cost effective to organize space in your room for your baby’s nursery. In
the Ghanaian culture, we love to keep our babies close to us.
Baby’s medicine cabinet
It is advisable to invest in a little medicine cabinet for your little one. Alternatively,
you can get a suitable plastic basket or container to keep the baby’s medications.
Ideally, the medicine cabinet must contain:
- A diaper cream, preferably, one containing zinc oxide to deal with nappy
rashes
- Petroleum jelly useful for dry skin/diaper rash or eczema
- Teething gel
- Antibacterial cream for cuts or scrapes
- Baby acetaminophen (pain relief). There are many at the pharmacies these
days and you need to get one.
It will be helpful to have a checklist of all the things you need to purchase. This
will guide you so that you do not forget anything you need.
Last Trimester
From the 36th week to the onset of labour, your doctor/care provider will ask
you to visit the antenatal clinic on a more regular basis than you were doing in
the earlier months. You may be feeling a little tired now but make sure you have
enough money to finance these visits and any other tests that may be required if
your health insurance does not cover them.[8]
Be sure you have decided on your birth option and have financially planned
towards that. By this time, your hospital bag should be packed and handy. Your
baby’s nursery should be sorted out and all your essential clothing and equipment
must have been purchased.
Once your baby is born, add your baby to your health insurance. As I mentioned
earlier, the NHIS caters for two post-natal visits within the first six weeks of having
your baby, and after this period you need to foot the bills for medical care. So, it
is important that you sign up your child for the NHIS.
Draw a baby budget
Once your baby is born, draw a baby budget. A budget keeps you aware of all your
income and financial obligations so that you can put your money to good use.
1. Create a retirement savings plan. This should be a high priority financial
plan. Make sure you are saving enough for your retirement. If you are on
SSNIT, make sure you are paying enough to depend on later on in life.
Again, you may want to start thinking of a business or any other incomegenerating activity to make additional income.

- Pay off any debts you owe, such as car loan. It is important to clear those debts to allow you to focus on the right things.
- Again, build an emergency fund. This should be money set aside, an equivalent of several months’ salary that can help you in those times of need.
- Start saving towards your child’s education. Be disciplined with this. It will be very useful when your child starts school. You may use monetary gifts received during the child’s naming ceremony or outdooring as seed for this plan, and endeavour to contribute to the fund every month.

2. Practice living on less.
As you will be adding to the family, it will inevitably add to your expenditure.
Meanwhile, your income may not change. It is advisable to practice living on less before your baby is born and save and invest the rest of your income in your emergency fund or a special saving plan for childcare.
3. Anticipate changing expenses
The expenses you make particularly on your baby will change as he or she grows older. The baby’s needs in the first year will include many of the things I have already listed in addition to childcare. As your baby grows, he[9] or she will need clothing, shelter, childcare, and education. Think carefully
about these needs and make plans towards meeting them. This is an ideal
time for you to plan your family based on your resources.
From age 1 – 3 years, your child will be in pre-school. She will need food,
clothing, and quality childcare.
From age 4 – 14 years, your child will be in basic school and she will need
food, clothing, and educational materials (including school fees). Decide
on which school you want to send your child and prepare towards all that
he or she will need.
From 15 – 18 years, your child will be in Senior High School. Again,
expenditure will depend on the kind of education you want to provide for
your child. Decide on this and make preparations towards it.
From 19 years and above, your child should be in a tertiary institution
or learning a profession. Do well to prepare financially towards this stage
too. Think ahead and start making savings and investments towards these
stages.

Coming soon