Patricia Anafi, Cecilia Oppong-Preprah, Richard Afedi-Nagai

8th ICUH, October 23,2009. Nairobi.

Improving maternal health care utilization in the most deprived sub-metropolitan area of the Greater

Accra region of Ghana.

* *

A brief overview of Maternal Health in Ghana

The current MMR is around 451/100,000 live births (2007 GMHS Report)

By comparison the U.S has MMR of 13/100,000 live births

The 2003 GDHS reports shows a arise in deliveries with medical practitioners from 85% to 90% from 1993 to 2003 for the richest quintile while for the poorest quintile it dropped from 25% to 19%

A brief overview of maternal health in Ghana

Statistics shows that deliveries with medical practitioners dropped from 45% in 2003 to 35.1% in 2007.

The 2008 sector review report of GMH also indicated that when TBAs deliveries are included, the total deliveries with some kind of skilled attendant care is highest in rural areas than urban area.

The question is what forms of care are received by poor urban pregnant mothers since they are not showing up at clinics.

Study Area

The study was carried in Ashiedu-Kekeke sub-metropolis of the Greater Accra Region.

It has a population of 100,000 with population growth rate of 4.4% due to high urban migration.

It has one of the largest slum in Accra.

It is predominately inhabited by the indigenous Ga people and migrant workers .

Study Area

It is one of the districts with poor maternal health outcomes in the greater Accra Region.

Reports that the public clinic and maternity home were utilized in spite of the obvious need for them.

Overall Objective

To examine ways to improve upon maternal health care utilization and delivery outcomes of pregnant mothers in the study area.

Specific objectives

Identify all options of maternal health care available to pregnant mothers.

Examine the factors that influence/affect pregnant mothers’ preference or/and use of any care option during pregnancy and delivery.

Examine ways to improve the use of institutionalized care among poor pregnant mothers .

Methods

Exploratory study 8 FGD s (mothers one child or

more)

5 In-depth interviews (Midwives, TBAs and social workers

A questionnaire Survey (300 respondents- mothers with one child or more)

Results

Options of existing and available maternal care

Institutionalized/Biomedical care Traditional/herbal/TBA care

Spiritual Care

*The National Teaching hospital located close to the study area

Results

Where pregnant mothers seek maternal care

Maternal care delivery points Antenatal Care(N=300)

Delivery Care(N=300)

Two public health facilities

67.8% 46%

* Korle-Bu teaching hospital

8.6% 13%

Private clinics & maternity homes

3.4% -

TBAs/Spiritualists care

5.1% 15%

Other clinics outside study area 15.1% 26%

Results

Types of care pregnant mothers use

• In the study, especially in the focus groups, participant acknowledged the importance of TBAs and spiritual care.

• Some never used formal skilled attendant care.

• Some combine formal -biomedical care with TBA care.

• Some also use biomedical care during pregnancy and go to the TBAs/spiritualist to deliver babies.

Results

Excerpts from the FGDs

There are TBAs who visit the spiritual churches around to assist in delivery. Some of these TBAs live there. That is where they work. The men pastors head the churches and the women conduct deliveries. These are not like the organized churches we know. They are spiritualists who attend to pregnant women

[Adult mother at Bukom square].

I have also been to the spiritual church before…. Is like she is a TBA but when you go there she will bath you and give you some herbal medicine to take. I went there to see that woman when I was pregnant. She gave me holy water to drink. She applied holy oil on my tummy every day I visited her

[A teen mother at Agbogbloshie market].

Results

Factors affecting preference or use of any care option

Option of Care Factors Factors

Formal skilled attendant care

•57.3 % (N=300) said quality of care

•Approx. 40% (N= 300) said safety of care.

•66% (N=300) said cost of skilled care makes mothers prefer to seek TBA care. (e.i. Both direct & indirect cost)

•Approx. 90% (N=300) believed that negative attitude of some midwives is a de-motivation to institutionalized care.-The use abusive language-They disgrace teen pregnant mother.

•Related to this are issues of communication gap and social class.

Results

Factors affecting preference and/or use

Type of care Factors Factors

TBA/Spiritual care •Affection• Protection -‘Spiritual power’ to revoke curses and ensure safe delivery-17% (N=300) testify to this.

-84% of all those who said they have sought TBA used TBAs because they believe they can protect them from dying.

•Cost of care can be paid later- They can also give gifts or exchange gifts for service

• 5% (N=300) said mothers seek TBA care due to delays

•4% (N=300) said mothers seek TBA care because live close to them.

Results

Possible ways to improve the use of skilled attendant or institutionalized care

Community proposes education programs on the needs for quality maternal care for young mothers.

Be made aware that some sort of cost exemption exist for poor pregnant mothers .

They propose that midwives, nurses, community leaders should help to identify and encourage poor pregnant mothers to seek care at the public clinics.

Results

Possible ways to improve skilled attendant care or institutionalized care use

Poor pregnant mothers should be issued ID cards to use to attend

clinics in the study area.

Social workers interviewed mentioned that delivery exemption policy should be strengthened.

Formal midwives should respects clients and make clinics environment friendly.

Conclusions

Three main options of care exist and available to poor pregnant mothers biomedical, traditional and spiritual.

Majority prefer to seek institutionalized care in the two public clinics

Others prefer to seek TBA/Spiritual care while some prefer to combine different types of care.

Pregnant mothers seek biomedical care due to good quality and safety of the care and services.

Conclusions

They prefer to seek TBA/Spiritual care for protection against death and partly because of their inability to pay for cost of care.

Negative attitude of midwives is de-motivation to skilled attendant care use.

Recommendations

Health education and counseling programs for mothers, especially young mothers.

Orient midwives on effective provider- client communication and they should support any intended programs to improve maternal health.

Strengthen existing antenatal and delivery cost exemption policy or benefits for poor pregnant mothers.

  The Sub-metropolitan Assembly should support efforts to improve the

use of skilled attendants care in the study area.

Acknowledgements

Danida Health Sector Support Office, Accra. Ghana. Greater Accra Regional Health Directorate, GHS, Accra. Asheidu-Keteke SMHMT, Accra. Ghana.

End of presentation

Thank you!