At a glance: Ghana

Ghana Health Service and UNICEF encourage mothers to deliver with help from skilled birth attendants

UNICEF Image
© UNICEF Ghana/2012/Logan
Traditional birth attendant Kasua Musah encourages her patients to give birth in health facilities in Moglaa, Ghana.

By Madeleine Logan

TAMALE, Ghana, 14 May 2012 – Midwife Doris Azuma Bugri was sitting on the veranda of the Moglaa clinic, in northern Ghana, when she saw a pregnant woman walk into a compound across the street.

She turned to her boss and said, “I think that woman is about to deliver.”

He didn’t believe her. The clinic was less than 20 steps away. Surely a woman in labour would cross the road.

An hour later, they heard the cry of a newborn.

Why didn’t that woman seek the help of Ms. Bugri or her clinic? The reason is often cultural in Ghana, where only 57 per cent of births are attended by a skilled health professional.

Delivering without skilled assistance

A group of 20 mothers recently gathered on the clinic veranda. They were a rainbow of veils with children at their laps and feet. All but a few of the mothers had given birth at home.

Kasua Musah also attended the meeting. She is the community’s traditional birth attendant and has helped bring three generations of babies into the village. She delivers up to three babies every week – about as many as the clinic delivers.

But Ms. Musah does not want to deliver any more babies. She says she is getting weak and believes that women should go to the clinic for the best care. She even brings women to the midwife when they are showing early signs of labour.

Still, many women wait until the last moment before they call for Ms. Musah, and by that stage, they cannot walk to the clinic. Ms. Musah has no choice but to spread a scrap of material on the floor, squat beside the mother, and receive the baby in a cloth in her hands.

The women tried to explain why they prefer to deliver at home, even when their traditional birth attendant believes skilled delivery is safer.

Hushama Emmanual said that mothers-in-law, who hold a lot of power in traditional families, believe that only difficult labours should be sent to the hospital.

“They want us to deliver in the house. It means we’re strong and can endure pain. Pregnancy is not a sickness. They believe that only the difficult cases should go to the hospital,” she said.

Adisah Mahama said that traditional birth attendants carrying out important rituals. “It is our custom for the traditional birth attendant to bury the placenta. She has a way of washing it before burying it that is very important. We have to inform her before we go to the hospital. Sometimes we run out of time and she ends up delivering the baby at home with us.”

UNICEF Image
© UNICEF Ghana/2012/Logan
Caption: Sadia Adam holds her son Fawzan, in Moglaa, Ghana. After giving birth to three children in her home, she had Fawzan at the local hospital. She is now an advocate of skilled delivery.

Money is also a concern, Abibatah Abukari said. “They are scared that if they go to a clinic and there is something wrong, they will be referred to the hospital in the next town. They don’t want to leave their community, and they don’t have the money to fuel the ambulance.” 

Ms. Abukari had two babies at home before deciding to give birth to her next four children at a clinic. Her daughter-in-law, Adamu Abraham, also chose to give birth in the clinic, with the support of her husband. But Ms. Abukari said many husbands think the option is expensive and unnecessary.

“Men feel that if you go to the clinic, you just want to spend their money,” she said. 

Changing minds

This year, the Ghana Health Service and UNICEF will harness the power of community radio, street theatre and house-to-house visits to encourage mothers to choose skilled delivery. The approach is being adopted in four of the most deprived regions of Ghana. Interactive dramas performed by community members will encourage women in 360 target communities to deliver in clinics. Two health volunteers in each village will visit the homes of young mothers to reinforce the message.

Radio has already changed ideas about skilled delivery in the Central Region. One of the region’s largest hospitals, at Winneba, has increased the number of women in its maternity ward by responding to radio complaints about hospital staff disrespecting patients’ culture. In-house training for nurses and a meeting with the community have helped change the relationship between the hospital and its patients.

And things are slowly changing in Moglaa, where mothers like Sadia Adam advocate for skilled delivery. After giving birth to three children in her home, she had her son Fawzan at the hospital.

In the days following her home births, she had suffered from severe abdominal pains. “But after delivering at the hospital, they gave me drugs, and I didn’t get that pain,” she said.

She is now convinced that skilled delivery is best.

“I will have the rest of my children at the hospital,” she said.


 

 

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