Abstract
BackgroundMaternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana.MethodsThe study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data.ResultsOf the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5–42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery.ConclusionDespite the government’s efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other ‘hidden costs’. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.
Highlights
The death of a woman from a pregnancy-related cause is a very sad event because the necessary interventions needed to prevent maternal deaths are well known [1]
We aimed at estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we explored the reasons for home delivery among women in rural Ghana
Though this figure is relatively lower compared to the number of maternal deaths that occurred over a decade ago, it still remains an issue of concern if the Target 3.1 of the Sustainable Developments Goals (SDGs) has to be met by 2030 [1]
Summary
The death of a woman from a pregnancy-related cause is a very sad event because the necessary interventions needed to prevent maternal deaths are well known [1]. The maternal mortality ratio in Ghana currently stands at 308 deaths per 100,000 live births. Though this figure is relatively lower compared to the number of maternal deaths that occurred over a decade ago, it still remains an issue of concern if the Target 3.1 of the Sustainable Developments Goals (SDGs) has to be met by 2030 [1]. Access to maternal health services, including skilled birth attendant (SBA), has been proven to be important in reducing maternal deaths. Physical access and finance have long been identified as major barriers to the use of health services by women in LMICs [4]. Maternal mortality remains a major challenge to health systems in low and middle-incoming countries. We aimed at estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we explored the reasons for home delivery among women in rural Ghana
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