West African Birthing Perspectives: A Mixed-Methods Study of Obstetric Practices in Ghanaian Women in the Greater Accra Region

Principal Investigator: Wendy Hodsdon, ND

Abstract: The experience of labor and childbirth is multidimensional relating to both outcomes and the physical and cognitive process of the event. Maternal mortality and morbidity are commonly used indicators of a successful childbirth. Maternal mortality rates in Ghana, West Africa, although decreasing, still account for 12% of the deaths of women of reproductive age—540 deaths per 100,000 births [1]. Compared to the average of 10 per 100,000 in most developed nations, Ghana is ranked 34th in the world for maternal deaths [2]. In addition, it is estimated that of those women who survive childbirth, up to 21% experience post-delivery maternal morbidity [3]. Although less often used, subjective components of birth, such as a woman’s experience, are also used to gauge the quality of childbirth.

There is a significant need in places like Ghana to improve upon the quality of services presently available [4, 5]. Previous research shows that women’s perceptions play a key role in informing researchers of the factors affecting a woman’s utilization of different healthcare choices. By understanding women’s experiences and preferences, we can better understand what is working in the current system and have a positive impact on women’s future obstetric care seeking behavior, utilization of services, and reduction of maternal morbidity and mortality. The factors that have been identified as being most influential are: communication of information to patients, good communication and attitudes of medical personnel, and actual availability of doctors and resources at the facility [6]. Women’s perceptions have been used to gain a better understanding of quality of care [6], however, there is little known about women’s birth experiences and their choice of maternal care.

The three models for obstetric care currently used in Ghana are biomedical (western medical interventions), ethnomedical (traditional healers, herbalism and “folk remedies”), and faith-based interventions (fetish priests and voodoo) [7, 8]. The purpose of this study is to determine how and when different obstetric care models are utilized. All study participants will be asked to complete a 20-question demographic survey and a 22-item birth experience questionnaire. A subset of 15 study participants will also participate in a short (30 minute) recorded interview. By inquiring into women’s personal experiences during birth and their attitudes towards obstetric care, we can better understand why women choose certain care models. This study also aims to bring awareness to the importance of women’s experiences as a tool for improving obstetric care for other parous women in sub-Saharan Africa.