"It's Like a Disease": Women's perceptions of caesarean sections in Ghana's Upper West Region.
OBJECTIVE
While caesarean sections in developing contexts act as a marker for access to skilled care, little is known about the health outcomes of caesarean sections. With calls for a more in depth understanding of women's perceptions of this procedure in resource poor settings, this paper explores women's perceptions and experiences of caesarean birth in the context of Ghana's Maternal Exemption Policy of the National Health Insurance Scheme in the Upper West Region.


METHODS
A qualitative study using 10 focus group discussions and 30 in depth interviews of mothers and pregnant women were conducted. The results were thematically analysed.


RESULTS
Drawing on theories of feminist geography and embodiment, the results suggest most women perceive caesarean section birth as highly problematic, acting as a long term disease, which hinders their ability to engage in economic activities and care for their children. In the context of the Maternal Exemption Policy, caesarean section birth restricts a woman's ability to secure further health insurance for themselves and newborn child, leaving long term access to health care uncertain. Findings also suggest long term repercussions of caesarean sections may go beyond the physical health of the mother and child to include other socio-cultural and contextual challenges.


CONCLUSIONS
Accordingly, caesarean sections position women in a multifaceted situation of vulnerability. This underscores the need for context appropriate maternal health programmes in developing countries.
Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W., Waterloo, ON, Canada N2L 3G1. Electronic address: arishwor@uwaterloo.ca.
Andrea
A
Rishworth
Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W., Waterloo, ON, Canada N2L 3G1.
Elijah
E
Bisung
Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada N6A 5C2.
Isaac
I
Luginaah
D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D000068097:Maternal Health; D009035:Mothers / Q000523:psychology*; D009313:National Health Programs; D036801:Parturition; D010465:Perception; D011247:Pregnancy; D036301:Qualitative Research; D016387:Women's Health
Caesarean section birth; Ghana; Health policy rural; Maternal health; Women's health