Midwives’ attitudes to women in labour in Ghana

Less than half of all women in Ghana give birth in hospital attended by a trained midwife. Some women choose not to give birth in a hospital because of fear of being treated badly by staff. Training health workers to better understand and respond to the needs of pregnant mothers is essential if women are to seek safe and effective maternal care.

More than half a million women die and one million children lose their mothers each year due to pregnancy and childbirth in developing countries. For every woman who dies, another 20 develop a life-long health problem. Many of these deaths could be prevented. Two-thirds are caused by complications which can be dealt with. However, health programmes which aim to tackle these problems have not always been successful.

While many women do not have access to good quality health services, there are factors which influence a woman's decision to seek care. The University of Aberdeen, UK, together with the Ghana Health Service, looked at how midwives’ behaviour affects pregnant women’s choice of health care. The study was part of a project on health care for women in pregnancy and delivery in developing countries called SAFE (Skilled Attendance for Everyone).

Interviews and focus group discussions were conducted in the suburbs of Ghana’s capital city, Accra. The women interviewed were between the ages of 18 and 38 and had between one and four children. Most of the mothers had basic education, were married and worked in trades such as hairdressing, dressmaking or petty trading.

Although some of the experiences the women shared in the interviews were positive, others described serious neglect and abuse. Health workers were angry when women did not to know about labour and delivery. They shouted, were rude, refused to offer assistance, and in some cases threatened women in labour.

The study found that the attitudes of health workers towards patients were a major influence on women's decisions about where to give birth. The study found that:

• Women also took into account a previous birth experience, the cost of care, the distance they had to travel, personal recommendations, and being near to family and friends when they gave birth.
• Women expected kind, courteous and professional treatment from health workers.
• When women were treated badly they looked elsewhere the next time they were pregnant and would not recommend those health services to other women.

In order to reduce mortality during pregnancy and childbirth, women need to be looked after by trained professionals who can spot complications at an early stage. But for pregnant women to choose these services the health workers must learn to treat women with respect. One explanation for the health workers’ negative behaviour may be the strong sense of social hierarchy found in many parts of sub-Saharan Africa. The study recommends that health workers:

• views on their work and what motivates them should be investigated
• receive training to improve their interpersonal skills, for example, in counselling women, learning to communicate well and being sensitive to different cultures
• are properly supervised by trained managers
• need to work in an environment which has a reliable supply of drugs, equipment and transport.

Source(s):
‘Please understand when I cry out in pain: women’s accounts of maternity services during labour and delivery in Ghana’, BMC Public Health 5(140), by Lucia D’Ambruoso, Mercy Abbey and Julia Hussein, 2005 Full document.

Funded by: European Commission; UK Department for International Development (DFID)

id21 Research Highlight: 28 July 2006

Further Information:
Lucia D’Ambruoso
IMMPACT
University of Aberdeen
Aberdeen AB25 2ZY
UK

Tel: +44 (0) 1224 559958
Fax: +44 (0) 1224 555704
Contact the contributor: l.dambruoso@abdn.ac.uk

IMMPACT, University of Aberdeen, UK

Mercy Abbey
Health Research Unit
Ghana Health Service
PO Box GP 184
Accra
Ghana

Contact the contributor: Mercy.Abbey@hru-ghs.org

Health Research Unit, Ghana Health Service

Other related links:
Partnership for Maternal, Newborn and Child Health

White Ribbon Alliance for Safe Motherhood

'Comparing maternal health services in four countries'

'Making practice perfect - clinical audit for better maternal health'

'Integrating family planning and sexual health: lessons from South Africa'

'Is there a fast track to better pregnancy outcomes in Kenya?'

'Maternal mortality in rural Gambia: levels, causes and contributing factors'