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.

Morethan half a million women die and one million children lose their mothers eachyear due to pregnancy and childbirth in developing countries. For every womanwho dies, another 20 develop a life-long health problem. Many of these deathscould be prevented. Two-thirds are caused by complications which can be dealtwith. However, health programmes which aim to tackle these problems have notalways been successful.

Whilemany women do not have access to good quality health services, there are factorswhich 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 anddelivery in developing countries called SAFE (Skilled Attendance for Everyone).

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

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

Thestudy found that the attitudes of health workers towards patients were a majorinfluence 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 tofamily and friends when they gave birth.
• Women expected kind, courteous and professional treatment from healthworkers.
• When women were treated badly they looked elsewhere the next time theywere pregnant and would not recommend those health services to other women.

Inorder to reduce mortality during pregnancy and childbirth, women need to belooked after by trained professionals who can spot complications at an earlystage. But for pregnant women to choose these services the health workers mustlearn to treat women with respect. One explanation for the health workers’negative behaviour may be the strong sense of social hierarchy found in manyparts 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, incounselling women, learning to communicate well and being sensitive todifferent cultures
• are properly supervised by trained managers
• need to work in an environment which has a reliable supplyof drugs, equipment and transport.