BackgroundThe lifetime risk of dying from pregnancy or birth related complications are about 245 times higher for women from the Sub Sahara region of Africa as compared to women from Norway. One of the UN’s millennium development goals, MDG5, is to reduce maternal mortality by 75% by 2015 and to grant universal access to reproductive health. The keys points for achieving this is to increase the number of women who give birth aided by a Skilled Healthcare Worker (SHW), increase the number of contacts with Maternal Health Services (MHS), and to increase the use of Family Planning (FP).
PurposeWe wanted to survey women’s use of MHS in North Tongu district, Volta region in Ghana. We also wanted to examine possible underlying reasons weighing for or against the women’s use of MHS, with the intent of using this information to develop strategies and programs to improve the quality of MHS in the area, and the ultimate goal being to reduce Maternal Mortality Rates (MMR) in the area.
Method92 women, who had given birth within the last 12 months, were interviewed in a partly structured and partly semi-structured survey. We plotted and analyzed our data in SPSS. Our results were compared with literature found searching in PubMed, Cochrane Library and the WHO and UN’s WebPages.
ResultsAlmost all the women, 97,8 %, went for at least one antenatal check during their last pregnancy. Almost ¾ went for 4 checks or more. The large majority of the women went for their first antenatal during their first trimester. Only 27 % gave birth at a hospital in their last pregnancy. Almost 1/3 of the women who had given birth at home stated lack of transport as a reason for why they had given birth at home. In the group of women who had not given birth at a hospital, 26/67 expressed a desire to do so. Distance in time and km from nearest hospital show a significant increase (p < 0,05) in number of home births and decrease in hospital births with an increase in distance. Women in polygamous marriages, women not living with their partner and women who have income at their own disposal, show a significant increase (p < 0,05) in hospital births compared to women in other types of relationships, who are living with their partner and don’t have any income at their own disposal. 81 out of 92 women had attended Postnatal Services (PNS). About ½ of the women stated checking the health of their baby as one of the reasons for going to PNS. Only 7,4 % stated their own health as a reason for going to PNS. Of all the women, only 14 % reported using any form of FP. Among the women not using FP, about 30 % claimed fear of side effects as a reason for not using it. About ¼ of the women stated financial problems as one of the reasons for not using FP. Only 3/92, reported having been treated badly by healthcare professionals. And conversely a large majority of the women stated a positive view of MHS.
ConclusionAlmost all the 92 Ghanaian women in our survey went for antenatal checks in their last pregnancy, but ¼ of then went less than the 4 times recommended by the WHO. We do not know why some of the women attend to few antenatal checks. The number of women giving birth at a hospital was disappointingly low, and transport problems seems to be one of the main reasons. An increased degree of autonomy among the women is positively correlated with increased numbers of hospital births. In regards to FP it looks as if better information about access, side effects and benefits is needed to increase the small percentage of women using FP. Economy also seems to be a factor preventing women from using FP. PNS was not well enough investigated in our study, but is something deserving a more thorough examination, as about half the women who die in connection with pregnancy and childbirth, do so more than 24h after birth. Future studies are also needed to examine possible social and cultural aspects that form the women’s attitudes towards MHS. Hopefully this information can be used to develop strategies and programs that can reduce MMR in the area.