Socio-Cultural Dimensions of Maternal Healthcare in Ghana
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UNIVERSITI MALAYSIA SARAWAK
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About 99% of the 830 women who die every day from maternal causes worldwide are from developing countries. Regardless of the 45% improvement in maternal deaths in 2013, the WHO recorded an increase in indirect causes of maternal deaths from 9.1% in 1990 to 10.2% in 2013. Africa contributes only 14% of global population but accounts for more than half of global maternal deaths. The WHO/World Bank current estimate of Ghana's maternal mortality ratio at 320/100,000 live births is unacceptably high in the face of interventions such as National Health Insurance Scheme, safe motherhood protocol and national ambulance system amongst others. Between 2011 and 2012 the Northern Region of Ghana recorded the highest maternal deaths of 302 with 72.8% home deliveries, out of which about 36% were assisted by untrained traditional birth attendants. This qualitative study uses culturally appropriate methods to explore the experiences of women in childbirth and decision-making towards utilisation of maternal healthcare services. In 30 individual and 15 focus group interviews, the study purposively sampled key actors in maternal healthcare such as women aged 15-49 years ever-pregnant or given birth within two years preceding data collection, their spouses, traditional practitioners and health professionals in the Yendi Municipality and Chereponi District of the Northern Region. Guided by the structure-agency theory and the delays model, this study thematically analysed utilisation of maternal healthcare services in the three inter-connected stages of maternity. Amongst other things, the study discovered systemic-structural delays in care-seeking within households inherent in gender norms and religious beliefs such as dietary taboos and behavioural codes that governed women's care-seeking behaviour. The socio-cultural system within households were structured hierarchically and characterised by oppression and marginalisation of women, especially in decision-making towards care-seeking. This male supremacy and gender discriminatory practices facilitated male-dominance in decision-making for care seeking, which denied women timely clinical intervention. Dualism of care characterised by the use of traditional iii and pharmaceutical medicines was observed amongst participants as an outcome of dual-faithism. Moreover, attention on maternal healthcare was focused more on delivery, neglecting the inter-connectedness of antenatal, delivery and postnatal care. Facility-based challenges were inadequacy of facilities, equipment and health professionals, lack of professionalism and collection of illegal fees amongst others. In the light of these findings, the thesis has developed a model for viewing maternal healthcare services utilisation. There is the need to adopt gender responsive and mainstreaming policies and programmes as well as a culturally competent and structurally transformative agency strategy to empower women at the household and community levels in all spheres of life through active engagement of men.