PROMOTING SKILLED INSTITUTIONAL DELIVERIES: FACTORS TO CONSIDER IN A FREE MATERNAL HEALTH SERVICES POLICY ENVIRONMENT
Keywords:
Antenatal care, institutional delivery, free maternal health policy, negative health system factors, Talensi Nabdam district of Ghana
Abstract
Objective: This study investigated the prevalence and factors associated with the utilization of health facilities for childbirth in a rural setting of the Talensi Nabdam district of Ghana.
Material and Methods: A cross-sectional study was carried using a structured questionnaire and focus group discussions. Mothers who had delivered live babies within one year prior to the survey were selected from thirty communities in the Talensi Nabdam district of Ghana where fee exemption policy for maternal health services has been implemented since 2003.
Results: The prevalence of skilled institutional delivery was 63.3 %. Logistic regression analyses showed that antenatal care attendance and parity of a mother were the predominant factors associated with the choice of delivering in a health institution. Compared to women who attended antenatal care less than 4 times, women who attended at least 4 times were 6.2 times more likely of delivering in a health institution (Adjusted odds ratio = 6.22, 95 % CI: 3.3511.52). Compared with mothers who had 4 or more children, mothers who had one child were 6.5 times (Adjusted odds = 6.47, 95% CI [3.08, 13.60]) more likely to deliver at a health facility. Negative health system factors such as intimidation, unfriendly healthcare providers, and cultural resistance to modern methods of delivery in healthcare facilities were nagging barriers that discouraged women from seeking skilled institutional delivery.
Conclusion: Even with fee exemption policy for maternal health services, many barriers still exist which if not addressed will make universal coverage of institutional delivery remains elusive in Ghana.
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References
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32. Doku D, Neupane S, Doku PN. Factors associated with reproductive health care utilization among Ghanian women. BMC international Journal of health and human rights 2012; 12 (29).
33. Sharan M. Determinants of Safe Motherhood and Newborn Care Behaviors in Rural India: Johns Hopkins University 2004.
34. Wanjira C, Mwangi M, Mathenge E, Mbugua G, Ng’ang’ a Z. Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya. BMC Public Health 2011; 11(360).
35. Ochako R, Fotso JC, Ikamari L, Khasakhala A. Utilization of Maternal Health Services among Young Women in Kenya: Insights from Kenya Demographic Health Survey, 2003. BMC Pregnancy and Childbirth 2011; 11(1).
36. Chou D, Inoue M, Mathers C, et al. Trends in Maternal Mortality Estimates 1990-2008
Geneva, Switzerland: WHO, UNICEF, UNFPA, World Bank, 2010.
37. Kazili J, Doctor HV, Abokyi L, Hodgson A, Phillips JF. Is there any relationship between antenatal care and place of delivery? Findings from rural northern Ghana. 18 2011: 62–73.
38. Nair M, Ariana P, Webster P. What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India Rural and Remote Health, 2012. (accessed 20 December 2014).
39. Bloom S, Lippeveld T, Wypij D. Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. Health Policy and Planning 1999; 14(1): 38.
40. Anwar I, Sami M, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programs in Bangladesh. Bulletin of the World Health Organization 2008; 86(4): 252-9.
41. Obago IT. The Role of Antenatal Care in Predicting Health Facility Delivery among Women in Kenya: Further Analysis of Data from the 2008-09 KDHS Calverton, Maryland, USA ICF International 2013.
42. Navaneetham K, Dharmalingam A. Utilization of maternal health care services in Southern India. Social Science & Medicine 2002; 55(10): 1849-69.
43. Dairo MD, Owoyokun KE. Factors affecting the utilization of antenatal care services in Ibadan, Nigeria Benin Journal of Postgraduate Medicine 2010; 12(1): 3–13.
44. Beeckman K, Louckx F, Putman K. Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health 2010; 10: 527.
45. Reynolds HW, Wong EL, Tucker H. Adolescents’ Use of Maternal and Child Health Services in Developing Countries. International Family Planning Perspectives 2006; 32(1): 6–16
46. Rowley DL, Fry YW. Reproductive Health Disparities among African American Women. In: Livingston IL, ed. Handbook of Black American Health: Policies and Issues Behind Disparities in Health Westpoint, CT: Prager; 2004: 451-73.
47. Daniels P, Noe GF, Mayberry RM. Barriers to Prenatal Care among Black Women of Low Socioeconomic Status. Am J Health Behav 2006; 30(2): 188-98.
48. Celik Y, Hotchkiss D. The Socioeconomic determinants of maternal health care utilization in Turkey Soc Sci Med 2002; 50(12): 1797-806.
49. Chakraborty N, Islam MA, Chowdhury RI, Bori W. Determinants of the use of maternal health service in rural Bangladesh. Health Promot Int 2005; 18(4): 327-37.
50. Kyomuhendo GB. Low use of rural Maternity service in Uganda: Impact of women’s status, traditional beliefs, and limited resources. Reprod Health Matters 2003; 11(21): 16-26.
51. Maureen M, Peter M. Determinants of skilled birth attendant utilization in Afghanistan. Am J Public Health 2008; 98(10): 1849-56.
52. Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis LLC: Harvard School of Public Health, University Research Co, 2010.
53. d’Oliveira AFPL, Diniz SG, Scraiber LB. Violence against women in healthcare institutions: an emerging problem. Lancet 2002; 359(9318): 1681–5.
54. Mathole T, Shamu S. Maternal healthcare in Zimbabwe In: Selin H, Stone PK, eds. Childbirth Across Cultures: Ideas and Practices of Pregnancy, Childbirth, and the Postpartum. London & New York: Springer; 2009.
55. Ganle JK, Parker M, Fitzpatrick R, Otupiri E. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition BMC Pregnancy and Childbirth 2014; 14: 425 (Online).
2. WHO, UNICEF. Accountability for Maternal, Newborn, and Child Survival: available at http://www.who.int/woman_child Geneva: WHO, 2013.
3. United Nations General Assembly. United Nations Millennium Declaration. A/RES/55/2 New York: United Nations, 2000.
4. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. The Lancet 2006; 367(9516): 1066-74.
5. World Health Organization. Progress: in reproductive health research. Progress 2005; 71: 71: 5-7.
6. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. The Lancet 2006; 368(9542): 1189-200.
7. Witter S, Arhinful KD, Kusi A, Zakariah-Akoto S. The experiences of Ghana in implementing a user fee exemption policy to provide free delivery care. Reprod Health Matters 2007; 15 (30): 61–71.
8. Graham W, Bell JS, Bullough W. Can skilled attendance reduce maternal mortality in developing countries Stud HSO&P 2001; 17: 97-129.
9. WHO. Making pregnancy safer - The critical role of the skilled attendant A joint statement by WHO, ICM, and FIGO. Geneva: World Health Organization, 2004.
10. Adegoke AA, Campbell M, Ogundeji MO, Lawoyin T, Thomson AM. Place of birth or place of death: An evaluation of 1139 maternal deaths in Nigeria Midwifery 2013; (29 (11)): e115–e21
11. Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 2006; 21: 459–68.
12. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 2001; 38: 115-32.
13. Rutstein SO, Johnson K. DHS Comparative Reports 6: The DHS Wealth Index. Calverton, Maryland, USA: ORC Macro, MEASURE DHS, 2004.
14. Howe LD, Hargreaves JR, Huttly SRA. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerging Themes in Epidemiology 2008; 5:3
15. UN ACC/SCN. Second report on the world nutrition situation Geneva: Administrative Committee on Coordination–Subcommittee on Nutrition, 1992.
16. United Nations. Millennium Development Goals. UN Millennium Summit; 2000; New York; 2000.
17. Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF Macro. Ghana Demographic and Health Survey (GDHS) 2008. Accra, Ghana: GSS, GHS, and ICF Macro., 2009.
18. Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for a place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth 2004; 4:8.
19. Doku D, Neupane S, Doku PN. Factors associated with reproductive health care utilization among Ghanaian women BMC International Health and Human Rights 2012; 12:29.
20. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: a systematic review of the literature. J Adv Nurs 2008; 61(3): 244–60.
21. Neupane S, Doku D. Determinants of time of the start of prenatal care and number of prenatal care visits during pregnancy among Nepalese women. J Community Health 2011; doi:10.1007/s10900-011-9521-0.
22. Ochako R, Fotso JC, Ikamari L, Khasakhala A. Utilization of maternal health services among young women in Kenya: insights from the Kenya demographic and health survey, 2003. BMC Pregnancy Childbirth 2011; 11:1.
23. Schieber G, Cashin C, Saleh K, Lavado R. Health Financing in Ghana. Washington, DC: World Bank, 2012.
24. Tanzania National Bureau of Statistics (NBS), ICF Macro. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: NBS, ICF Macro, 2011.
25. Exavery A, Kanté AM, Njozi M, et al. Access to institutional delivery care and reasons for home delivery in three districts of Tanzania. Int J Equity Health 2014; 13: 48.
26. Koblinsky M, Matthews Z, Hussein J, et al. The Lancet Maternal Survival Series steering group: Going to scale with professional skilled care. The Lancet 2006; 368(9544): 1377-86.
27. Borghi J, Ensor T, Somanathan A, Lissner C, Mills A. Lancet Maternal Survival Series steering group: Mobilising financial resources for maternal health. The Lancet 2006; 368(9545): 1457-65.
28. Raghupathy S. Education and the use of maternal health care in Thailand. Social Science & Medicine 1996; 43(4): 459-71.
29. Hadi A, Gani MS, Dhaka B. Socio-economic, and regional disparity in the utilization of reproductive health services in Bangladesh. Dhaka, Bangladesh: BRAC, 2005.
30. Anwar I, Sami M, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programs in Bangladesh. Bulletin of the World Health Organization 2008; 86(4): 252-9.
31. Barber S. Does the quality of prenatal care matter in promoting skilled institutional delivery? A study in rural Mexico. Maternal and Child Health Journal 2006; 10(5): 419-25.
32. Doku D, Neupane S, Doku PN. Factors associated with reproductive health care utilization among Ghanian women. BMC international Journal of health and human rights 2012; 12 (29).
33. Sharan M. Determinants of Safe Motherhood and Newborn Care Behaviors in Rural India: Johns Hopkins University 2004.
34. Wanjira C, Mwangi M, Mathenge E, Mbugua G, Ng’ang’ a Z. Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya. BMC Public Health 2011; 11(360).
35. Ochako R, Fotso JC, Ikamari L, Khasakhala A. Utilization of Maternal Health Services among Young Women in Kenya: Insights from Kenya Demographic Health Survey, 2003. BMC Pregnancy and Childbirth 2011; 11(1).
36. Chou D, Inoue M, Mathers C, et al. Trends in Maternal Mortality Estimates 1990-2008
Geneva, Switzerland: WHO, UNICEF, UNFPA, World Bank, 2010.
37. Kazili J, Doctor HV, Abokyi L, Hodgson A, Phillips JF. Is there any relationship between antenatal care and place of delivery? Findings from rural northern Ghana. 18 2011: 62–73.
38. Nair M, Ariana P, Webster P. What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India Rural and Remote Health, 2012. (accessed 20 December 2014).
39. Bloom S, Lippeveld T, Wypij D. Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. Health Policy and Planning 1999; 14(1): 38.
40. Anwar I, Sami M, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programs in Bangladesh. Bulletin of the World Health Organization 2008; 86(4): 252-9.
41. Obago IT. The Role of Antenatal Care in Predicting Health Facility Delivery among Women in Kenya: Further Analysis of Data from the 2008-09 KDHS Calverton, Maryland, USA ICF International 2013.
42. Navaneetham K, Dharmalingam A. Utilization of maternal health care services in Southern India. Social Science & Medicine 2002; 55(10): 1849-69.
43. Dairo MD, Owoyokun KE. Factors affecting the utilization of antenatal care services in Ibadan, Nigeria Benin Journal of Postgraduate Medicine 2010; 12(1): 3–13.
44. Beeckman K, Louckx F, Putman K. Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health 2010; 10: 527.
45. Reynolds HW, Wong EL, Tucker H. Adolescents’ Use of Maternal and Child Health Services in Developing Countries. International Family Planning Perspectives 2006; 32(1): 6–16
46. Rowley DL, Fry YW. Reproductive Health Disparities among African American Women. In: Livingston IL, ed. Handbook of Black American Health: Policies and Issues Behind Disparities in Health Westpoint, CT: Prager; 2004: 451-73.
47. Daniels P, Noe GF, Mayberry RM. Barriers to Prenatal Care among Black Women of Low Socioeconomic Status. Am J Health Behav 2006; 30(2): 188-98.
48. Celik Y, Hotchkiss D. The Socioeconomic determinants of maternal health care utilization in Turkey Soc Sci Med 2002; 50(12): 1797-806.
49. Chakraborty N, Islam MA, Chowdhury RI, Bori W. Determinants of the use of maternal health service in rural Bangladesh. Health Promot Int 2005; 18(4): 327-37.
50. Kyomuhendo GB. Low use of rural Maternity service in Uganda: Impact of women’s status, traditional beliefs, and limited resources. Reprod Health Matters 2003; 11(21): 16-26.
51. Maureen M, Peter M. Determinants of skilled birth attendant utilization in Afghanistan. Am J Public Health 2008; 98(10): 1849-56.
52. Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis LLC: Harvard School of Public Health, University Research Co, 2010.
53. d’Oliveira AFPL, Diniz SG, Scraiber LB. Violence against women in healthcare institutions: an emerging problem. Lancet 2002; 359(9318): 1681–5.
54. Mathole T, Shamu S. Maternal healthcare in Zimbabwe In: Selin H, Stone PK, eds. Childbirth Across Cultures: Ideas and Practices of Pregnancy, Childbirth, and the Postpartum. London & New York: Springer; 2009.
55. Ganle JK, Parker M, Fitzpatrick R, Otupiri E. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition BMC Pregnancy and Childbirth 2014; 14: 425 (Online).
How to Cite
1.
Saaka M, Aviisah MA. PROMOTING SKILLED INSTITUTIONAL DELIVERIES: FACTORS TO CONSIDER IN A FREE MATERNAL HEALTH SERVICES POLICY ENVIRONMENT. Med. res. chronicles [Internet]. 2015May10 [cited 2024Nov.22];2(3):286-02. Available from: https://medrech.com/index.php/medrech/article/view/84
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