Understanding the relationship between access to care and facility‐based delivery through analysis of the 2008 Ghana Demographic Health Survey

Moyer, Cheryl A.; McLaren, Zoë M.; Adanu, Richard; Lantz, Paula M.

doi:10.1016/j.ijgo.2013.04.005

Cited by 20 publications

(21 citation statements)

References 20 publications

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“…Our findings are similar to the few previous studies in Ghana, which reported women experiencing physical abuse, scolding, shouting and abandonment during childbirth, as well as health facilities that are unresponsive to their needs, or unable to provide the necessary emotional and physical support during childbirth. [12][13][14]19,20 Failure to push, young age and inability to bring all items required for the birthing process were reported in our study as potential triggers for mistreatment, also echoing previous studies in Ghana. 13,14,20 Mistreatment during facility-based childbirth is increasingly recognised as a widespread problem.…”

Section: Discussionsupporting

confidence: 89%

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Maya

Adu‐Bonsaffoh

Dako-Gyeke

et al. 2018

Reproductive Health Matters

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Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to "correct" disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman's experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.

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Section: Discussionsupporting

confidence: 89%

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Maya

Adu‐Bonsaffoh

Dako-Gyeke

et al. 2018

Reproductive Health Matters

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“…This is lower compared to estimates from other sSA settings which range from 33% to 94% [9,10,14–20] but higher than 9% to 25% reported in yet other sSA settings[8,11–13]. What is less clear is whether these findings can be generalised to HIV-infected women from the same setting.…”

Section: Introductioncontrasting

confidence: 61%

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

et al. 2018

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BackgroundHome delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya.MethodsA cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively.ResultsOverall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers.ConclusionA quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting.

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“…Jomeen (2010) noted that women are considered to be consumers of maternity services and commodification of giving birth, which is extended to the childbirth setting. Actually, this expectation and image is a part of today's life and ritual of giving birth, and women may feel short-changed if they do not Along with previous studies (Javed et al 2013;Moyer et al 2013), the present study showed that insurance coverage can increase the odds of hospital birth, yet it cannot necessarily guarantee hospital birth (Abed Saeedi et al 2013;Ghazi Tabatabaie et al 2012). Two pivotal issues exist.…”

Section: Discussionsupporting

confidence: 66%

Predictors of decision making about childbirth setting in the southeast of Iran: home or hospital

et al. 2015

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Aim This study is designed to explore how childbirth setting (homebirth or hospital birth) can be predicted by independent variables. Subjects and methods A cross-sectional study was conducted among 380 mothers who had planned home or hospital births within the past 6 months in Zahedan city in the southeast of Iran. Logistic regression analysis was performed on the data, which were collected by an interview-led questionnaire.Results Bivariate analysis showed that men's occupation, health insurance coverage, affordability of the hospital costs, the number of living children, a previous history of homebirth, social adherence, belief in medical care, and final score of preference for hospital, including opposition to hospital and a preference for home or opposition to home, appear as significant factors in decision making regarding the (home or hospital) childbirth setting. Conclusion Decision making about childbirth setting among women depends on their socio-economic status and perceived quality of care. Overall, suitable and available childbirth services with the women's perceived quality of care and a comprehensive understanding of how to decide about childbirth setting, which is made at a local level, can lead to more appropriate services and utilization of available childbirth services.

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Understanding the relationship between access to care and facility‐based delivery through analysis of the 2008 Ghana Demographic Health Survey

Abstract: Affordability was an important determinant of facility delivery in Ghana-even among women with health insurance-but social access variables had a mediating role.

Cited by 20 publications

References 20 publications

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

Predictors of decision making about childbirth setting in the southeast of Iran: home or hospital

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