BackgroundWhile a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana.Methods and FindingsA qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability.ConclusionsMaternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.

BackgroundThere is some evidence to suggest that within the household, family and community settings, women in sub-Saharan Africa often have limited autonomy and control over their reproductive health decisions. However, there are few studies that examine how intra-familial decision-making power may affect women’s ability to access and use maternal health services. The purpose of this paper is to examine how intra-familial decision-making affects women’s ability to access and use maternal health services.MethodsWe conducted 12 focus group discussions and 81 individual interviews with a total of 185 expectant and lactating mothers in six communities in Ghana. In addition, 20 key informant interviews were completed with healthcare providers. Attride-Stirling’s thematic network analysis framework was used to analyse the data.ResultsFindings suggest that decision-making regarding access to and use of skilled maternal healthcare services is strongly influenced by the values and opinions of husbands, mothers-in-law, traditional birth attendants and other family and community members, more than those of individual childbearing women. In 49.2 %, 16.2 %, and 12.4 % of cases in which women said they were unable to access maternal health services during their last pregnancy, husbands, mothers-in-law, and husband plus mothers-in-law, respectively, made the decision. Women themselves were the final decision-makers in only 2.7 % of the cases. The findings highlight how the goal of improving access to maternal healthcare services can be undermined by women’s lack of decision-making autonomy through complex processes of gender inequality, economic marginalisation, communal decision-making and social power.ConclusionInterventions to improve women’s use of maternity services should move beyond individual women to target different stakeholders at multiple levels, including husbands and mothers-in-law.

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Background Hunger frequently and persistently occur in older populations in low-income countries especially in sub-Sahara Africa. The aim of this study was to examine the associations between food insecurity with hunger and psychological distress among older people in Ghana. Methods A total of 1200 individuals aged �50 years were recruited during 2016/2017 Ageing, Health, Psychological Well-being and Health-seeking Behavior Study. Associations between psychological distress (assessed with the Kessler Psychological Distress Scale) and hunger (assessed with a 30-day subjective scale) were evaluated using linear regression modeling. Results The overall prevalence of food insecurity was 36% with approximately 27% and 9% respectively for moderate and severe levels of hunger whilst the mean score of psychological distress was 9.5 (±4.10). Persons experiencing moderate hunger (β = 0.71, SE = 0.160, p < 0.001) and severe hunger (β = 1.81, SE = 0.280, p < 0.001) significantly reported increased psychological distress outcome compared to those without hunger. These associations varied between women (β = 1.59, SE = 0.359 p < 0.001) and men (β = 2.33, SE = 0.474, p < 0.001) as well as 50-64 age group (β = 1.48, SE = 0.368, p < 0.005) and 65+ age group (β = 2.51, SE = 0.467, p < 0.001). Conclusions The results suggest that experiencing hunger is associated with psychological distress and the effect may be aggravated with advancing age and in men. These findings may inform social policy initiatives and health programmatic interventions for older people exposed to food insecurity.

In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in women's experiences of abortion and access to safe abortion care. Disparities in rates of abortion experience and access to safe abortion care were assessed using absolute (the difference in rates between groups), relative (the ratio of rates between selected and reference groups), and mean measures. Results suggest that 24% of women had at least one abortion in the five years preceding the survey. However, large gradients of socio-spatial disparities in abortion experience exist. The majority of abortions were also potentially unsafe: 53% of abortions occurred outside of any healthcare facility. Women themselves and medical doctors, respectively, performed 57% and 4% of all abortions. The majority of women also felt they could not get safe abortion even if they wanted one. Together, these results highlight the need for concerted multi-sectorial strategies, including legislative reform and provision of family planning services, to help transition from unsafe to safe abortions. RésuméAu Ghana, la mortalité causée par l'avortement constitue 11% de la mortalité maternelle. Des études empiriques sur les disparités possibles dans l'expérience de l'avortement et l'accès aux services d'avortement sans risque font cependant défaut. Basé sur une étude rétrospective de 1370 femmes âgées de 15-49 ans dans deux districts au Ghana, cet article étudie les disparités dans les expériences de l'avortement et l'accès des femmes à l'avortement médicalisé. Les disparités des taux d'expérience de l'avortement et de l'accès aux services d'avortement médicalisé ont été évalués à l'aide des mesures absolues (la différence de taux entre les groupes), relatives (le rapport des taux entre les groupes de référence sélectionnés et) et moyennes. Les résultats suggèrent que 24% des femmes ont eu au moins un avortement au cours des cinq années précédant l'enquête. Cependant, d'importants gradients de disparités socio-spatiales dans l'expérience de l'avortement existent. La majorité des avortements étaient également potentiellement dangereux: 53% des avortements ont eu lieu en dehors d'un établissement de santé. Les femmes elles-mêmes et les médecins, ont réalisées 57% et 4% de tous les avortements respectivement.. La majorité des femmes a également estimé qu'elles ne pouvaient pas obtenir un avortement sans risque, même si elles en voulaient un. Ensemble, ces résultats mettent en évidence la nécessité de stratégies multisectorielles concertées, y compris la réforme législative et la fourniture de services de planification familiale, pour aider à la transition de l'avortement dangereux vers l'avortement sans danger. (Afr J Reprod Health 2016; 20[2]: 43-52).Mots-clés: disparités, avortement à risque, utilisation de la contra...