title: Social costs of skilled attendance at birth in rural Ghana.
abstract: OBJECTIVE
  To examine the social costs to women of skilled attendance at birth in rural Ghana.
  
  
  METHODS
  Ethnographic data were obtained through participant observation, interviews, case histories, and focus groups and were analyzed alongside data from a birth cohort of 2878 singletons born in the Kintampo study district between July 2003 and June 2004.
  
  
  RESULTS
  Most women delivered at home. Home delivery raises a woman's status in her community, while seeking skilled attendance lowers it. Women feel that seeking assistance in childbirth wastes other people's time and they value secrecy in labor. Negative treatment by health providers and expensive supplies needed for delivery also act as barriers.
  
  
  CONCLUSIONS
  The social costs of obtaining skilled attendance at birth must be offset by community level strategies such as mobilization of older women and husbands, and ensuring health providers extend professional, humane care to laboring women.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. alessandra.bazzano@touro.edu
authors.forename: Alessandra Nina
authors.initials: AN
authors.lastname: Bazzano
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah-Agyemang
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Philip
authors.initials: P
authors.lastname: Adongo
mesh_terms: D000884:Anthropology, Cultural; D036861:Delivery, Obstetric / Q000523:psychology; D005260:Female; D005869:Ghana; D006700:Home Childbirth / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D011247:Pregnancy; D018907:Privacy; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012928:Social Desirability