“Doing Magic With Very Little”: Barriers to Ghanaian Midwives' Ability to Provide Quality Maternal and Neonatal Care

Abstract

PURPOSEThis study identified barriers that affected Ghanaian midwives' ability to provide quality care to prevent maternal and neonatal mortality.DESIGNGlaserian Grounded Theory was the framework of this study. Interviews were conducted with 33 participants from 10 facilities in seven districts in one region in southern Ghana.FINDINGSMidwives are committed to do their best to provide quality care to women and newborns. Barriers to their care included a lack of resources of care, unsupportive facility management, and client related barriers.CONCLUSIONSMeasures to reduce barriers for midwives to provide quality care must improve health financing at a national and facility level; the encouragement of supportive supervision and management at a facility level; and actions to enhance midwife engagement with clients and communities.

Midwives’ strategies for coping with barriers to providing quality maternal and neonatal care: a Glaserian grounded theory study

“…Ghanaian midwives are striving to provide quality care for women and neonates to help reduce the countries high maternal and neonatal mortality. However, low midwife numbers together with other challenges such as inadequate essential equipment, supplies, and infrastructure, poor referral resources and negative client attitudes adversely affect their efforts to ensure positive outcomes for women and neonates [ 9 ]. Nonetheless, the midwives in the study context adopted coping strategies to enable them to still get good outcomes for women and neonates because of their strong motivation.…”

“…One measure adopted to improve outcomes for women and neonates is the improvement of skilled attendance at birth by the training and recruitment of more midwives, but the country still faces a shortage of midwives [ 9 , 30 ]. This shortage combined with other barriers such as inadequate essential equipment and supplies, inadequate infrastructure and referral resources, low incentivisation and insufficient in-service training and the physical, psychological and social effects of these barriers negatively affect the ability of midwives to provide quality care to women and neonates [ 8 , 9 , 31 , 32 ]. Nonetheless, the midwives seem to be coping with these challenges to still provide care to women and neonates [ 9 , 12 , 33 ].…”

“…This shortage combined with other barriers such as inadequate essential equipment and supplies, inadequate infrastructure and referral resources, low incentivisation and insufficient in-service training and the physical, psychological and social effects of these barriers negatively affect the ability of midwives to provide quality care to women and neonates [ 8 , 9 , 31 , 32 ]. Nonetheless, the midwives seem to be coping with these challenges to still provide care to women and neonates [ 9 , 12 , 33 ]. Currently, only a few studies have focused on how Ghanaian midwives cope with the challenges in their work.…”

“…In recent years, high demands on midwives, due to their increasing workload because of a rise in birth rates and a growth of the complexity of pregnancy and birth care, has become a source of pressure on them, thereby affecting their efforts to provide quality care to women and neonates [5,6]. Additionally, midwives are facing professional, social, and economic barriers such as absence from policy dialogue, insufficient supplies and equipment, lack of recognition of skills, lack of support for housing and transport, lack of safety and security, and sex inequality [7][8][9]. Barriers to midwives' ability to provide quality care to women and neonates have physical, psychological, and socioeconomic consequences on them.…”

“…As a lower middle-income country, Ghana's maternal and neonatal mortality of 310 per 100,000 and 25 per 100 live births respectively are both high and this is attributed to poor quality maternity services [27][28][29]. One measure adopted to improve outcomes for women and neonates is the improvement of skilled attendance at birth by the training and recruitment of more midwives, but the country still faces a shortage of midwives [9,30]. This shortage combined with other barriers such as inadequate essential equipment and supplies, inadequate infrastructure and referral resources, low incentivisation and insufficient in-service training and the physical, psychological and social effects of these barriers negatively affect the ability of midwives to provide quality care to women and neonates [8,9,31,32].…”