How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study

Abstract

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.

Understanding factors influencing home delivery in the context of user‐fee abolition in Northern Ghana: Evidence from 2014 DHS

“…The discussion here would suggest a need for both health facility and community‐based preconception and conception care interventions to educate women and community members on the importance of early ANC initiation, and the need for continued skilled care beyond the antenatal period. In this regard, efforts must be made to address health system barriers such as long distances to service centres as well as engage community members (men and mothers‐in‐law in particular) to address socio‐cultural barriers such as the need to perform traditional pregnancy‐related rituals before permission is granted for pregnant women to access ANC services as shown in previous research in northern Ghana …”

Factors behind Institutional Delivery Preference in the Republic of Benin: An Analysis of 2011-2012 Benin Demographic and Health Survey (BDHS) data

“…In addition, findings indicate that women who report that decisions concerning health issues are made jointly with someone else (including partner) have higher chances of giving birth in a health facility. Past studies also reported on the importance of joint decision making in accessing and using maternal health facility (Ganle et al, 2015). There are unequal gender relationships, namely those relating to within household decision making where women are the most disadvantaged.…”

“…Recent studies in Kenya, revealed that some traditional birth attendants can potentially cause harm to pregnant women by advising them to restrict food intake during pregnancy (Byrne et al, 2016). Their opinions have been known to strongly influence women's decision making regarding access to and use of modern maternal healthcare services in Ghana (Ganle et al, 2015). Studies also reported a wide gap between women's preference of the place of delivery and the actual venue for birth (Lerberg et al, 2014).…”

“…Studies also revealed that decision making regarding access to and use of skilled maternal healthcare services is strongly influenced by the values and opinions of husbands, mothersin-law, traditional birth attendants and other family and community members, more than those of individual childbearing women (Ganle et al, 2015). Cultural factors can serve as significant deterrents to facility delivery throughout sub-Saharan Africa (Moyer et al, 2013).…”

“…Several factors were identified: woman's current age (Amano et al, 2012), woman's level of education (Ono et al, 2013;Mazalale et al, 2015;Shehu et al, 2016), religious background and ethnicity (Shehu et al, 2016), birth order number (Ono et al, 2013), ANC frequency (Amano et al, 2012;Pervin et al, 2012), woman's marital status (Ono et al, 2013;Mazalale et al, 2015), place of residence (Amano et al, 2012;Mazalale et al, 2015;Shehu et al, 2016), health facility accessibility (Shehu et al, 2016), intra-familial decision making (Ganle et al, 2015), household wealth index (Mazalale et al, 2015).…”