Exploring the reasons why women prefer to give birth at home in rural northern Ghana: A qualitative study

Background: Skilled birth care during childbirth is reported in the literature as one critical strategy for reducing maternal morbidity and mortality. Despite the importance of birth care provided by skilled birth attendants, women in rural areas of northern Ghana still give birth utilising the birth services provided by Traditional Birth Attendants. The aim of this study,therefore, was to explore and describe the reasons why a small group of rural women chose homebirth in rural northern Ghana. Methods: A qualitative approach was adopted to explore the reasons why women prefer to deliver at home in rural areas of northern Ghana. Individual interviews were used to obtain a full description of factors and experiences of women associated with home births in rural areas in Ghana. The research population consisted of 10 women who utilised birth care services provided by Traditional Birth Attendants in a rural community of northern Ghana. Data collected from the interviews were transcribed verbatim and analysed to identify themes. Results: This study, which was conducted among a small group of women, yielded interesting results on why these women still give birth at home in rural northern Ghana. It was found out that perceived poor quality of care and conduct of skilled birth attendants; the perception that women received better care from Traditional Birth Attendants; financial constraints and lack of access to healthcare facilities in the rural areas by these women accounted for majority of the reasons why women in rural northern Ghana still give birth at home. Conclusion: The study highlighted some barriers experienced by participants to the utilisation of birth care services provided by skilled birth attendants in rural northern Ghana. Management of healthcare facilities should facilitate the implementation of supportive supervision in the maternity units to improve the quality of care and attitude delivered by skilled birth attendants in maternity care in rural communities. The aim of this study, therefore, is to explore and describe the factors and experiences of a small group of rural women choosing homebirth in rural northern Ghana. A qualitative explorative and descriptive research approaches were used to gain an understanding of the reasons accounting for home birth in rural areas of northern Ghana. This design enabled the researchers to explore and understand rural women’s reasons for utilising unskilled birth services provided by Traditional Birth Attendants in rural northern Ghana [18]. The research was carried out in a small District in the Upper East Region of Ghana. The District is one of most rural and deprived districts in Ghana which has all the characteristics of a typical rural area in Ghana [18]. The District has 94 % (94%) of its population residing in rural areas. Also, the District was chosen because it recorded low utilisation of skilled birth care provided by skilled birth attendants at the time of data collection. The District has one district hospital in the district capital with four reproductive health clinics, and seven completed Community Health-based Planning Services (CHPS) compounds, sixty-two outreach points, ten feeding centres and one rehabilitation centre. Records from the District Health Directorate, showed there was only one medical doctor and sixty-five nurses in the entire district [19]. Midwives mostly provide primary maternity care for women during pregnancy and childbirth. It is imperative to mention that women in the district are exposed to a variety of alternative childbirth sources. Among these include TBAs, traditional healers and herbalists, spiritual healers and diviners. The purpose of this study was to understand why women give birth at home by utilising birth services provided by Traditional Birth Attendants in rural northern Ghana. The research population in this study comprised of women who gave birth using birth care provided by Traditional Birth Attendants in the rural areas in the Bongo District of Ghana. To qualify to participate in this study, a participant should be a: This study did not consider participants who fell within the under listed criteria: A purposive sampling technique was used to select ten (10) participants for individual semi-structured interviews. The sample size of 10 women was based on data saturation [20]. In qualitative inquiry, the sample size is determined based on informational needs. The guiding principle, therefore, is data saturation, that is sampling to the point at which no new information is obtained, and redundancy is achieved [20]. Ten interviews were conducted, and saturation of the data occurred at the 10th participant. The researcher selected participants based on who could give the most and the best information about the objectives of the study. Bongo District is sub-divided into six sub-districts or zones according to the Bongo District Health Directorate. Two Zones were used for the study. The two sub-districts were purposefully selected for the study because of the rural nature of these communities. The researchers contacted nurses and Community Key Informants (CKIs) who provided them with a list of potential participants (women) who delivered at home within six months and also utilised birth care provided by Traditional Birth Attendants in each of the selected zones. Also, only women who were willing to participate in the study and also met the inclusion criteria were recruited for the study. The purpose of the study was then explained to them in order to help them to appreciate what was required of them. Data were collected through semi-structured interviews using a flexible interview guide to explore to the reasons why women prefer to deliver at home in rural areas of northern Ghana. Thus, participants had the opportunity to tell their story with minimal interruption. The interviews took place in safe, quiet, comfortable, private and mutually agreed-upon locations. The individual interviews were initially planned to take place at the health facilities in the district, but after interviews with two of the participants, it was realised that the participants were distracted by clients accessing maternal health care services in the facilities of the participants. Some of the participants suggested their home as the most preferred venues for the individuals because those venues were free from interruptions. All the participants who agreed to take part in the research were asked to sign an informed consent after reading and receiving information about what was involved in the study. The consent form was read in the Grune, a language spoken in the study area to participants who could not read or write. Such participants were made to thumbprint the consent forms. Interviews were conducted in a Grune language, preferred by participants. The interviews lasted between 45 and 60 min and were recorded. The same questions were posed to all participants (See Supplementary file 1). The audio-taped interviews were transcribed within 24 h of the interview. A language expert translated the interviews into the English language to enable the researchers of the study to understand the content of the interviews. Data analysis occurred concurrently with data collection. Our goals were to condense raw data and provide a detailed and thick description of the phenomenon of interest. Data collected through the semi-structured interviews were transcribed verbatim and analysed according. to the six-step guide proposed by Braun & Clark e[20]. The first step was reading the transcripts to become familiar with the data. The transcripts were read many times while taking down notes and were reviewed independently by two researchers with rich experience in qualitative research for accuracy and to ensure objectivity. The next step was that the data were coded using the NVivo version 12 software and initial codes were generated from the coded data. The coding was done according to the themes of the research questions of this study. After generating many codes, we searched for themes and sub-themes which relevant to the research questions. Codes were put together into themes. Initially, we identified six themes. The identified themes were later merged into four main themes after the reviewed of themes by two of the researchers.