Youth Alive Ghana, P.O Box TL 1708, Tamale, Ghana.
School of Community Health, Faculty of Science, Charles Sturt University, Orange, NSW, Australia.
BMC Pregnancy Childbirth. 2019 Jul 23;19(1):260. doi: 10.1186/s12884-019-2414-4.
Despite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women's healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women's ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana.
This exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women's autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions.
Women's lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care.
Decisions about seeking maternal care were usually made by the expectant woman's husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.
尽管加纳有许多孕产妇保健政策计划，如免费产前护理 (ANC) 和国家健康保险计划下的费用豁免政策等，但该国在解决妊娠和分娩期间低技能护理利用方面仍未取得实质性进展。从之前的研究中可以看出，在许多中低收入国家，产妇死亡率与妇女在家庭层面的医疗保健决策能力有关。因此，孕妇选择医疗保健提供者、根据自己的喜好采取行动以及在经济上有足够的能力在决定生殖和妊娠护理方面发挥主导作用，对服务利用结果有重大影响。因此，我们从母亲、青年、意见领袖和医疗保健提供者的角度探讨了纳多利-卡莱奥和达菲亚马-布西-伊萨区在上沃尔特地区农村社区中与产科并发症和分娩相关的寻求护理的障碍。
这项探索性定性研究基于妇女、卫生提供者和社区利益相关者的叙述，了解期望妇女决定和利用孕产妇保健的自主权。为了实现最大程度的多样性反应，我们采用了有目的的抽样程序，选择了 16 名卫生专业人员、3 名传统助产妇和 240 名社区成员（意见领袖、青年和未怀孕妇女），他们参加了个人深度访谈和焦点小组讨论。
妇女在没有事先许可的情况下寻求护理的自主权不足、传统助产妇的护理质量感知、对意外怀孕的污名化以及与分娩劳动晚披露相关的文化信仰，都导致研究社区中的母亲未能及时利用熟练护理。这些障碍加剧了由于社区与医院护理隔离而产生的问题。
关于寻求孕产妇护理的决定通常由孕妇的丈夫和家人做出，而在孕妇妊娠和分娩的后期阶段，没有为孕妇提供足够的支持。我们得出的结论是，这主要是一个文化问题。该研究建议改变社区一级的健康教育运动方法，通过增加男性和家庭对卫生服务提供和利用的参与，以实现最大影响。
