Reasons for the utilization of the services of traditional birth attendants during childbirth: A qualitative study in Northern Ghana

Abstract

Background: Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities. Method: Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses. Results: The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also an essential consideration for the use of their services. Conclusion: The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.

Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

“…The date of publication ranged from 1988–2022, and they were undertaken in all regions of the world. For maternity focused papers with theory, 48/58 were based in low or middle income countries [ 20 , 22 , 26 , 30 , 31 , 38 , 39 , 44 , 46 , 53 , 54 , 59 , 60 , 63 , 75 , 100 – 102 , 120 , 122 , 124 , 140 , 148 , 150 , 151 , 154 , 156 , 157 , 159 – 161 , 167 , 171 – 173 , 217 , 219 – 222 , 224 , 225 , 226 , 229 , 230 , 235 , 236 ], with larger numbers of studies from Ethiopia [ 31 , 38 , 59 , 60 , 154 , 221 ], India [ 44 , 75 , 120 , 124 , 154 …”

“…The topics included mistreatment in maternity settings (n = 58) [ 19 , 21 , 24 , 26 , 30 , 31 , 38 , 39 , 43 , 44 , 46 , 53 , 54 , 59 , 60 , 63 , 75 , 85 , 88 , 90 , 97 – 102 , 120 , 122 – 124 , 140 , 148 , 150 , 151 , 154 – 157 , 159 – 161 , 167 , 169 , 171 – 173 , 215 , 218 , 219 , 220 , 222 , 224 – 226 , 229 , 230 , 235 , 236 ]; physical restraint in mental health settings (n = 30) [ 23 , 32 , 40 , 41 , 48 – 51 , ...…”

“…Another [ 160 ] was framed by the notion of authoritative knowledge , in which the knowledge and beliefs of the most powerful group frame what is acceptable in terms of actions. One paper explicitly cited the socio-ecological theory [ 236 ].…”

Strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low- and middle-income countries: a narrative review

“…Social, cultural, financial, and geographic barriers are known to influence maternal care-seeking [ 46 ]. Indeed, sociocultural factors of long-held traditions and community practices that limit or affect maternal decision-making and care seeking behavior have been identified as barriers to utilization of skilled health delivery services in both sub-Saharan Africa [ 16 , 47–49 ] and South Asia [ 50 , 51 ]. Additionally, health systems themselves may present additional barriers, such as poor care quality and resource limitations [ 52 , 53 ].…”

Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

“…Even for pregnant women who are registered with the NHIS, it is known that not all costs relating to delivery care have been eliminated by the NHIS [33,34]. Another study among rural women in Ghana [35] discovered that the cost of delivery was the most important consideration why mothers choose home delivery among a wide range of factors. Another important factor related to the health system is the availability of skilled personnel at the health facilities to provide skilled delivery care.…”