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“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban

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  • Rishworth, Andrea
  • Dixon, Jenna
  • Luginaah, Isaac
  • Mkandawire, Paul
  • Tampah Prince, Caesar

Abstract

This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations.

Suggested Citation

  • Rishworth, Andrea & Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul & Tampah Prince, Caesar, 2016. "“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban," Social Science & Medicine, Elsevier, vol. 148(C), pages 8-17.
    • Handle: RePEc:eee:socmed:v:148:y:2016:i:c:p:8-17
    DOI: 10.1016/j.socscimed.2015.11.018
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    References listed on IDEAS

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    1. Claudia Vieira & Anayda Portela & Tina Miller & Ernestina Coast & Tiziana Leone & Cicely Marston, 2012. "Increasing the Use of Skilled Health Personnel Where Traditional Birth Attendants Were Providers of Childbirth Care: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-9, October.
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    4. WHO & UNICEF & UNFPA & World Bank & United Nations Population Division, 2014. "Trends in Maternal Mortality : 1990 to 2013," World Bank Publications - Books, The World Bank Group, number 18203.
    5. Paul, Bimal Kanti & Rumsey, Deborah J., 2002. "Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study," Social Science & Medicine, Elsevier, vol. 54(12), pages 1755-1765, June.
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    Cited by:

    1. Atinga, Roger A. & Agyepong, Irene Akua & Esena, Reuben K., 2018. "Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation," Social Science & Medicine, Elsevier, vol. 201(C), pages 27-34.
    2. MacVicar, Sarah & Berrang-Ford, Lea & Harper, Sherilee & Steele, Vivienne & Lwasa, Shuaib & Bambaiha, Didacus Namanya & Twesigomwe, Sabastien & Asaasira, Grace & Ross, Nancy, 2017. "How seasonality and weather affect perinatal health: Comparing the experiences of indigenous and non-indigenous mothers in Kanungu District, Uganda," Social Science & Medicine, Elsevier, vol. 187(C), pages 39-48.
    3. Luginaah, Isaac N. & Kangmennaang, Joseph & Fallah, Mosoka & Dahn, Bernice & Kateh, Francis & Nyenswah, Tolbert, 2016. "Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context," Social Science & Medicine, Elsevier, vol. 160(C), pages 75-86.

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