“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 and Medicine, Volume 148, Year 2016

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Study Justification:
– The study examines the impact of Ghana’s policy that restricts the role of traditional birth attendants (TBAs) in delivering babies and focuses on their referral role.
– It explores the intersection of global safe motherhood policy discourses with the local socio-cultural and political environments in Ghana’s Upper West Region (UWR).
– The study aims to understand the perceptions and experiences of mothers, TBAs, and skilled birth attendants (SBAs) regarding the policy and its implications for maternal health.
Study Highlights:
– Mothers in rural isolated communities perceive TBAs as better placed to conduct deliveries due to limited access to SBAs.
– The government’s adherence to global guidelines may have unintended consequences on maternal and child health in remote rural locations.
– The new policy has resulted in confusion among TBAs, who have not been officially notified about the changes.
– Tensions between TBAs and SBAs have increased, undermining the delivery of maternal health services in the region.
Study Recommendations:
– Reconsider the policy that restricts TBAs to referral roles and explore alternative ways to integrate them into the healthcare system.
– Improve access to skilled birth attendants in rural isolated communities to ensure safe deliveries.
– Provide clear and timely communication to TBAs about policy changes and their new roles.
– Address the tensions and improve collaboration between TBAs and SBAs to enhance maternal health services in the region.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Traditional Birth Attendants: Play a crucial role in delivering babies and need to be involved in policy discussions.
– Skilled Birth Attendants: Provide essential maternal health services and should collaborate with TBAs.
– Community Leaders: Engage in community mobilization and support the implementation of policy changes.
– Non-Governmental Organizations: Provide resources and support to improve maternal health services.
Cost Items for Planning Recommendations:
– Training and capacity building for TBAs to enhance their skills and knowledge.
– Infrastructure development to improve access to skilled birth attendants in rural areas.
– Communication and awareness campaigns to inform TBAs and the community about policy changes.
– Collaboration and coordination efforts between TBAs and SBAs.
– Monitoring and evaluation of the policy implementation to ensure its effectiveness.
Please note that the cost items provided are examples and not actual costs. The actual budget would depend on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study uses focus group discussions and in-depth interviews to gather data, which provides qualitative insights into the perceptions and experiences of mothers, traditional birth attendants, and skilled birth attendants. The findings highlight the government’s inability to understand local realities and the unintended consequences of the new policy on maternal and child health in remote rural locations. However, the abstract does not provide information on the sample size or the methodology used for data analysis. To improve the strength of the evidence, the study could include a larger sample size and provide more details on the data analysis process.

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.

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The study “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” explores the impact of Ghana’s policy that restricts the role of traditional birth attendants (TBAs) to referrals and prohibits them from conducting deliveries. The study highlights the challenges faced by mothers, TBAs, and skilled birth attendants (SBAs) in accessing maternal health services in the Upper West Region (UWR) of Ghana.

Based on the findings of the study, the following policy recommendations can be considered to improve access to maternal health in the UWR:

1. Improve access to skilled birth attendants: Efforts should be made to increase the availability and accessibility of SBAs in rural and isolated communities. This can be achieved by deploying more SBAs to these areas or providing transportation options for pregnant women to reach healthcare facilities.

2. Strengthen collaboration between TBAs and SBAs: Instead of completely banning TBAs, the policy should focus on establishing a collaborative approach between TBAs and SBAs. This can involve training and capacity-building programs for TBAs to ensure they can provide appropriate care and referrals when necessary.

3. Increase awareness and communication: The government should ensure that TBAs are properly informed about the policy changes and their new role. This can be achieved through targeted communication strategies, such as workshops, meetings, and information campaigns, to ensure that TBAs understand their responsibilities and limitations.

4. Address socio-cultural factors: The policy should take into account the socio-cultural context of the UWR and work towards addressing the factors that contribute to the preference for TBAs. This may involve community engagement and education programs to raise awareness about the importance of skilled birth attendance and the potential risks associated with home deliveries.

5. Strengthen healthcare infrastructure: Investments should be made to improve healthcare infrastructure in the UWR, including the establishment of well-equipped healthcare facilities and the provision of essential medical supplies and equipment. This will help ensure that SBAs have the necessary resources to provide quality maternal health services.

By implementing these recommendations, it is hoped that access to maternal health services in the UWR of Ghana can be improved, leading to better health outcomes for mothers and their children.
AI Innovations Description
The study “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” explores the impact of Ghana’s policy that restricts the role of traditional birth attendants (TBAs) to referrals and prohibits them from conducting deliveries. The study highlights the challenges faced by mothers, TBAs, and skilled birth attendants (SBAs) in accessing maternal health services in the Upper West Region (UWR) of Ghana.

Based on the findings of the study, the following policy recommendations can be considered to improve access to maternal health in the UWR:

1. Improve access to skilled birth attendants: Efforts should be made to increase the availability and accessibility of SBAs in rural and isolated communities. This can be achieved by deploying more SBAs to these areas or providing transportation options for pregnant women to reach healthcare facilities.

2. Strengthen collaboration between TBAs and SBAs: Instead of completely banning TBAs, the policy should focus on establishing a collaborative approach between TBAs and SBAs. This can involve training and capacity-building programs for TBAs to ensure they can provide appropriate care and referrals when necessary.

3. Increase awareness and communication: The government should ensure that TBAs are properly informed about the policy changes and their new role. This can be achieved through targeted communication strategies, such as workshops, meetings, and information campaigns, to ensure that TBAs understand their responsibilities and limitations.

4. Address socio-cultural factors: The policy should take into account the socio-cultural context of the UWR and work towards addressing the factors that contribute to the preference for TBAs. This may involve community engagement and education programs to raise awareness about the importance of skilled birth attendance and the potential risks associated with home deliveries.

5. Strengthen healthcare infrastructure: Investments should be made to improve healthcare infrastructure in the UWR, including the establishment of well-equipped healthcare facilities and the provision of essential medical supplies and equipment. This will help ensure that SBAs have the necessary resources to provide quality maternal health services.

By implementing these recommendations, it is hoped that access to maternal health services in the UWR of Ghana can be improved, leading to better health outcomes for mothers and their children.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach could be employed. Here is a brief description of the methodology:

1. Quantitative data collection: Conduct a survey or structured interviews with a representative sample of pregnant women in the Upper West Region (UWR) to gather data on their access to skilled birth attendants (SBAs) and their experiences with maternal health services. This data can be used to measure the current level of access and identify any barriers or challenges faced by pregnant women.

2. Qualitative data collection: Conduct focus group discussions (FGDs) and in-depth interviews (IDIs) with traditional birth attendants (TBAs), skilled birth attendants (SBAs), and mothers to gather in-depth insights into their perceptions and experiences related to the policy and the recommendations. This qualitative data can provide a deeper understanding of the context and help identify specific areas for improvement.

3. Analysis: Analyze the quantitative data using statistical methods to identify patterns and trends in access to maternal health services. Analyze the qualitative data using thematic analysis to identify key themes and issues related to the policy and the recommendations.

4. Simulation: Develop a simulation model based on the findings from the analysis. This model can simulate the impact of implementing the recommendations on improving access to maternal health services in the UWR. The model can consider factors such as the availability and accessibility of SBAs, the collaboration between TBAs and SBAs, awareness and communication efforts, socio-cultural factors, and healthcare infrastructure.

5. Scenario testing: Test different scenarios within the simulation model to assess the potential impact of each recommendation on improving access to maternal health services. This can involve adjusting variables such as the number of SBAs deployed, the level of collaboration between TBAs and SBAs, the effectiveness of awareness and communication strategies, and the level of investment in healthcare infrastructure.

6. Evaluation: Evaluate the outcomes of the simulation model to determine the potential effectiveness of each recommendation in improving access to maternal health services. This evaluation can provide insights into the feasibility and potential impact of implementing the recommendations.

By using this methodology, policymakers and stakeholders can gain a better understanding of the potential impact of the recommendations and make informed decisions on how to improve access to maternal health services in the UWR.

Statistics:
Citations: 24
Authors: 5
Identifiers:
DOI: 10.1016/j.socscimed.2015.11.018
ISSN: 02779536
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care, Workforce
Study Countries:
Ghana
Study Approach:
Qualitative
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