title: "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.
abstract: 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.
authors.affiliation: University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada. Electronic address: arishwor@uwaterloo.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rishworth
authors.affiliation: University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
authors.forename: Jenna
authors.initials: J
authors.lastname: Dixon
authors.affiliation: Western University, 1151 Richmond St., London, ON N6A 3K7, Canada.
authors.forename: Isaac
authors.initials: I
authors.lastname: Luginaah
authors.affiliation: Carleton University, 1125 Colonel By Dr., Ottawa, ON K1S 5B6, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Mkandawire
authors.affiliation: Wa, Upper West Region, Ghana.
authors.forename: Caesar
authors.initials: C
authors.lastname: Tampah Prince
mesh_terms: D001294:Attitude to Health; D036861:Delivery, Obstetric; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health; D008427:Maternal Health Services / Q000458:organization & administration; D008880:Midwifery / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D036301:Qualitative Research; D019035:Rural Health Services
keywords: Access to care; Ghana; Maternal health; Rural; Traditional birth attendants; Upper West Region