title: Listening to women's voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana.
abstract: BACKGROUND
  Women who survive severe obstetric complications can provide insight into risk factors and potential strategies for prevention of maternal morbidity as well as maternal mortality. We interviewed 32 women, in an urban facility in Ghana, who had experienced severe morbidity defined using a standardized WHO near-miss definition and identification criteria. Women provided personal accounts of their experiences of severe maternal morbidity and perceptions of the care they received.
  
  
  RESULTS
  The study took place in a referral facility in urban Accra, and semi-structured interviews were conducted with women who had either a maternal near miss (n = 17) or a potentially life-threatening complication (n = 15). The most common themes surrounding the traumatic delivery were the fear of dying and concern over the potential (or actual) loss of the baby. For many women, the loss of a baby negatively influenced how they viewed and coped with this experience. Women's perceptions of the quality of the care highlighted several key factors such as the importance of information, good communication and attitudes, and availability of human (i.e., more doctors) and physical resources (i.e., more beds, water) at the facility.
  
  
  CONCLUSIONS
  Our results suggest that experiences of women with severe maternal morbidity may inform different aspects of quality improvement in the facilities, which in turn have a positive impact on future health seeking behavior, service utilization and reduction in maternal morbidity and mortality.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. otuncalp@jhsph.edu
authors.forename: Ozge
authors.initials: O
authors.lastname: Tunçalp
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
authors.forename: Kwame
authors.initials: K
authors.lastname: Adu-Bonsaffoh
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
mesh_terms: D000328:Adult; D005260:Female; D005869:Ghana; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D011787:Quality of Health Care / Q000592:standards*; D060728:Reproductive Health; D012959:Socioeconomic Factors