Differentials in Health-Related Quality of Life of Employed and Unemployed Women With Normal Vaginal Delivery

Purpose:  This study investigated the differences in health-related quality-of-life of employed and unemployed women in Enugu, Nigeria, with normal vaginal delivery at 6, 12 and 18 weeks postpartum in the light of their mother-worker dyad. Childbirth is an important event affecting the health of women. The arrival of new baby to a family in an African society where women do most of the unpaid household tasks and subsistence food production (Team & Doss, 2011) automatically increases the woman’s workload. This, in turn, can affect her health-related quality-of-life, that is, self-report of her perceived feeling of comfort, ability to realize her life potentials and satisfaction with life as expressed in her physical, emotional and social functions of life. Extreme situations may result to all-cause morbidity and mortality. Available literatures on health-related quality-of-life such as Plugge, Douglas and Fitzpatrick (2011) and Bhagat, Baviskar, Mudey and Goyal (2014) view health-related quality-of-life as a framework for examining disease and its impact on a patient. There has been a paradigm shift from emphasis on curative to preventive healthcare. However, there is paucity of studies that compared quality-of-life of newly delivered women who have paid job and the unemployed. Results from studies like this will provide valid quality-of-life indicators for measuring maternity outcomes and promoting health of women of child bearing age in this era when women’s roles have expanded exposing them to more physical, mental and socio-economic health risks (Bar & Jarus, 2015). Sprangers and Schwartz’s Response Shift Theory underpinned the study.

Methods:  Longitudinal, prospective descriptive design was used for the study. A sample of 234 newly delivered mothers were drawn from an estimated population of 363 women that used six selected hospitals in Enugu, Nigeria, through proportionate stratified and convenience sampling techniques. Subjects were identified through hospital records and self-revelation. Data were collected at 6, 12 and 18 weeks post-delivery by using a researcher-modified form of the standardized Iranian version SF-36v2^TM health-related quality-of-life instrument – a generic short form of health-related quality-of-life survey instrument developed by Ware and Sherbourne in 1992 with 36-item self-rated health status profile that measures eight health-related concepts: physical functioning, role limitation due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitation due to emotional problems, and perceived mental health – and five personal-profile items as interview guide. Data collection was through personal contacts at the hospital initially, and visits to home/workplace or cell-phone interview at subsequent times. Women were requested to respond to each interview item as applied to them at each of the three post-partum contact periods. Data collection continued until sample size was reached and lasted for six calendar months and seventeen days. Data were analysed descriptively using frequencies, percentages, mean and standard deviations. T-test was used for group comparison of dimensions of health-related quality-of-life of the women while two-way Repeated Measure ANOVA with time/group effects was used to establish statistical significant difference in mean scores on the eight SF-36v2^TM subscales over time.

Results: There was significant difference in the women’s health-related quality-of-life over time (F = 4,58; Df_n = 2; p = 0.0268). Both groups had better health-related quality-of-life at 6 and 12 weeks. Employed women reported bodily pains (x̅ = 51.0) and problems with role physical (x̅ = 51.2) and social functioning (x̅ = 52.9) more frequently. However, employed women that did not resume work after 18 weeks had better health-related quality-of-life than those who resumed work. Health-related quality-of-life scores of the women increased as their age, educational level and personal income increased (p < 0.05). However, working-class women with increased education had higher health-related quality-of-life than the unemployed.

Conclusion:  Findings strongly suggest that quality-of-life improves as a woman’s level of education and personal income increase. On the other hand, increased responsibility combined with increasing age negatively affect their reported health-related quality-of-life. Based on the findings, researchers recommend that paid six months maternity leave should be adopted by governments of all countries paricularly the developing countries. The role of social supports for domestic chores is highly implicated. To this effect, special allowance should be paid to all employed women with under-one year old baby to enable them hire a paid care-giver. Also, paternity leave should be granted to fathers, on request, to have time at home to assist their spouse as may be necessary. Gender sensitive employment opportunities should be created to empowered more women economically