Introduction
This policy brief presents the findings of research by Ganle et al. (2015) on how intrafamilial decision-making affects women’s access to and use of maternal healthcare services in Ghana. The study reveals significant barriers to women’s autonomy in healthcare decision-making, which hinders progress in improving maternal health outcomes. With Ghana’s efforts to reduce maternal mortality and achieve universal health coverage, addressing these socio-cultural barriers is crucial. This brief provides an overview of the current landscape, point out the primary challenges, and offers strategic recommendations to enhance maternal health outcomes in Ghana.
Main Highlights
- Limited Women’s Autonomy: Women often lack decision-making power regarding when to access skilled antenatal, delivery, and postnatal care services.
- Influential Family Members: Husbands and mothers-in-law frequently act as principal decision-makers in maternal health matters.
- Socio-Cultural Barriers: Patriarchal norms, low levels of female education, and economic marginalization contribute to women’s limited healthcare autonomy.
- Urban-Rural Disparities: Rural women face greater challenges in healthcare decision-making compared to their urban counterparts.
- Key Actions Needed:
- Promote women’s education and economic empowerment
- Engage men and other family members in maternal health issues
- Strengthen community-based health education
Background
Ghana has implemented policies to improve maternal healthcare access, including free maternity care services in public and mission healthcare facilities since 2003. However, in some parts of Ghana, over 45% of births still occur at home without skilled care. The maternal mortality ratio stands at 380 per 100,000 live births as of 2013. This study, conducted in six communities across the Bosomtwe and Central Gonja districts, explores how intra-familial decision-making affects women’s ability to access and use maternal healthcare services.
Main Issues
- Limited Participation in Decision-Making: In 49.2% of cases where women were unable to access maternal health services, husbands were the final decision-makers. Mothers-in-law made the final decision in 16.2% of cases, while women themselves were final decision-makers in only 2.7% of cases.
- Freedom of Movement Restrictions: Many women require permission from husbands or male family members to travel to healthcare facilities, particularly in rural areas.
- Religious and Cultural Factors: In some communities, especially those where Islam is predominant, religious beliefs and practices exacerbate women’s inability to participate in healthcare decision-making.
- Economic Dependence: Women’s economic marginalization contributes to their limited autonomy in healthcare decisions.
- Communal Decision-Making Structure: The emphasis on interdependence and communal decision-making in Ghanaian society can sometimes conflict with individual women’s healthcare needs.
Policy Implications
The research emphasises that efforts to improve maternal health outcomes in Ghana must go beyond improving healthcare infrastructure and address the socio-cultural factors that limit women’s autonomy. Policies must consider the complex network of decision-makers within families and communities, and the varying influences on women in different contexts (e.g., rural vs. urban, different religious backgrounds).
Recommendations
- Promote Women’s Education and Economic Empowerment: Invest in girls’ education and women’s economic opportunities to enhance their decision-making power within households.
- Engage Men and Family Members: Develop programs that involve husbands, mothers-in-law, and other influential family members in maternal health education and decision-making.
- Strengthen Community-Based Health Education: Implement community-wide campaigns that communicate the importance of skilled maternal healthcare and address socio-cultural barriers.
- Tailor Interventions to Local Contexts: Develop strategies that consider the specific challenges faced by women in different settings (e.g., rural areas, Islamic communities).
- Enhance Women’s Mobility: Address restrictions on women’s movement, particularly in rural areas, through community engagement and education.
- Promote Gender Equity: Implement broader policies and programs that challenge patriarchal norms and promote women’s rights and autonomy.
- Strengthen Health Systems: Improve the capacity of local health facilities to provide quality maternal care services, making them more accessible and appealing to women and their families.
Conclusion
Improving maternal health outcomes in Ghana requires addressing the complex socio-cultural factors that influence women’s access to healthcare. While Ghana has made strides in providing free maternal health services, the autonomy of women to make decisions about their own healthcare remains a significant barrier. By implementing policies that empower women, engage family and community members, and address cultural norms, Ghana can make substantial progress in reducing maternal mortality and achieving its health goals. This multi-faceted approach, combined with continued improvements in healthcare infrastructure and quality, will be crucial in ensuring that all women in Ghana have access to the maternal care they need.
This brief is based on the following reference:
Ganle, J.K., Obeng, B., Segbefia, A.Y. et al. How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study. BMC Pregnancy Childbirth 15, 173 (2015). https://doi.org/10.1186/s12884-015-0590-4
Other references
- Ghana Statistical Service. Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker, 2011. Accra, Ghana: Ghana Statistical Service; 2011.
- World Health Organization. Trends in Maternal Mortality: 1990 to 2013: Estimates Developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: World Health Organization; 2014.