Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
Nursing and Midwifery Training College, Tamale, Ghana.
Womens Health (Lond). 2021 Jan-Dec;17:17455065211002483. doi: 10.1177/17455065211002483.
Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities.
Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses.
The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also an essential consideration for the use of their services.
The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.
熟练的分娩可以降低母婴死亡率。加纳已经采取措施减少获得熟练分娩服务的地理和经济障碍。尽管如此，大约 30%的分娩仍然在家中进行，或者由传统助产妇进行。因此，我们进行了这项研究，以探讨尽管有卫生设施，但仍利用传统助产妇服务的原因。
使用现象学研究设计，我们选择了加纳北部地区的四名传统助产妇所在设施中分娩的 31 名妇女。采用目的抽样法，仅招募居住在有卫生设施的地方的妇女进行深入访谈。访谈进行了录音并转录为 Microsoft word 文档。将转录内容导入 NVivo 12 进行主题分析。
研究发现，护理质量是传统助产妇分娩服务的主要驱动因素。助产士态度恶劣、虐待和对剖腹产的恐惧是熟练分娩的障碍。社区规范规定，女性身份与阴道分娩有关，而通过剖腹产分娩的女性不会受到同等的尊重。传统助产妇被认为更有经验，更能理解女性在分娩过程中的社会心理需求，而年轻的助产士则不然。此外，妇女无法在生物医学设施中获得分娩所需的所有物品，这也是传统助产妇分娩服务的推动因素。分娩时更喜欢蹲姿，以及传统助产妇为母亲提供的社会支持，也是使用他们服务的重要考虑因素。
该研究得出结论，卫生管理人员应超越减少财务和地理障碍，以改善妇女的护理质量和分娩体验。这对于增加卫生设施的可用性和免费分娩服务的努力是必要的补充。
