Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District

Abstract

Background The Sustainable Development Goal Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives. The place, where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care. Methods A qualitative, exploratory, cross-sectional design was deployed. Data were collected from a purposive sample of 23 women, who attended antenatal care during pregnancy but delivered their babies at home, 10 health workers and 17 other community-level stakeholders. The data were collected through semi-structured interviews, which were audio-recorded, transcribed and thematically analysed. Results In line with the Andersen and Newman Model, the study discovered that traditional and religious belief systems about marital fidelity and the role of the gods in childbirth, myths about consequences of facility-based delivery, illiteracy, and weak women’s autonomy in healthcare decision-making, predisposed women to home delivery. Home delivery was also enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities. The fear of caesarean section, also created the need for women who attended antenatal care to deliver at home. Conclusion The study has established that socio-cultural and institutional level factors influenced women’s decisions to deliver at home. We recommend a general improvement in the service delivery capacity of health facilities, and the implementation of collaborative educational and women empowerment programmes by stakeholders, to strengthen women’s autonomy and reshape existing traditional and religious beliefs facilitating home delivery.

Exploring Future Research Agenda for Rural Mother’s Empowerment: A Study at the Intersection of Bibliometric and Systematic Literature Review

“…From the analysis of the literature, determinant factors for women's empowerment are found to be varied in terms of their social determinants of health (Sunguya et al, 2020), financial/economic status (Baranov et al, 2020;Nandi et al, 2016;Tuz-Zahura et al, 2022), employment (Debela et al, 2021), self-reliance, dignity (Hopkinson & Aman, 2017), autonomy (Alatinga et al, 2021), decision-making (Egbuonye et al, 2021), education (Alamneh et al, 2022;Alatinga et al, 2021;Imai et al, 2014) and domestic violence (Imai et al, 2014;Jewkes et al, 2019). In addition, some of the factors related to the socio-cultural belief system of the society are also taken as the determinant factors for women's empowerment, such as traditional and religious belief systems (Alatinga et al, 2021) and notions about the transactional sex (Wamoyi et al, 2011). Furthermore, indices such as Women's Empowerment Index (WEI), Abridged Women's Empowerment in Nutrition Index (A-WENI), Women's Empowerment in the Agricultural Index (WEAI), Abbreviated Women's Empowerment in the Agricultural Index (A-WEAI) and Project-level Women's Empowerment in the Agricultural Index (Pro-WEAI) are also used to measure the empowerment of women (Bonis-Profumo et al, 2022;Cunningham et al, 2015;Kirkwood et al, 2021;Poudel et al, 2022;Saha & Narayanan, 2022).…”

“…From the analysis of the literature, determinant factors for women’s empowerment are found to be varied in terms of their social determinants of health (Sunguya et al, 2020), financial/economic status (Baranov et al, 2020; Nandi et al, 2016; Tuz-Zahura et al, 2022), employment (Debela et al, 2021), self-reliance, dignity (Hopkinson & Aman, 2017), autonomy (Alatinga et al, 2021), decision-making (Egbuonye et al, 2021), education (Alamneh et al, 2022; Alatinga et al, 2021; Imai et al, 2014) and domestic violence (Imai et al, 2014; Jewkes et al, 2019). In addition, some of the factors related to the socio-cultural belief system of the society are also taken as the determinant factors for women’s empowerment, such as traditional and religious belief systems (Alatinga et al, 2021) and notions about the transactional sex (Wamoyi et al, 2011).…”

“…Empowerment of women is also associated with the social determinants of health (Sunguya et al, 2020), prevailing socio-cultural norms in the society, such as traditional and religious belief systems (Alatinga et al, 2021), and the notions related to transactional sex (Wamoyi et al, 2011). In addition, detrimental factors such as domestic violence have been linked with empowerment/disempowerment (Imai et al, 2014; Jewkes et al, 2019), which includes intimate partner violence (IPV) and violence from mother-in-law or sibling-in-law/siblings (Jewkes et al, 2019).…”

“…In addition, detrimental factors such as domestic violence have been linked with empowerment/disempowerment (Imai et al, 2014; Jewkes et al, 2019), which includes intimate partner violence (IPV) and violence from mother-in-law or sibling-in-law/siblings (Jewkes et al, 2019). Although education has been taken as one of the determinant factors for the empowerment of women (Alamneh et al, 2022; Alatinga et al, 2021; Imai et al, 2014), a mother’s educational status is conceptualized in terms of her illiteracy (Alatinga et al, 2021) and is relative to the father’s education (Imai et al, 2014).…”

Primary maternal healthcare service utilization among pregnant women in the oil producing Nchia-Eleme community in Nigeria

“…1,6,7 Nigeria as a sub-Saharan African country subscribes to primary maternal health care, and the utilization of the service in the low-resource and environmentally disadvantaged communities is still understudied. 8,9 Ngbala-Okpabi SO Antenatal care (ANC) offered by skilled providers following recommended guidelines in PHCs can prevent most pregnancy complications that result in morbidity or mortality. 10 It involves the provision of health promotion, birth preparedness, and complication readiness services.…”