Skilled birth attendance (SBA) is widely accepted as being crucial for reducing childbirth-related deaths [1]. Although 95% of women in Ghana report receiving prenatal care, only 57% of all deliveries occur in healthcare facilities with SBA [2]. Among Ghanaian women reporting more than 4 prenatal care visits, the facility delivery rate is 68%—far short of the United Nations goal of 90% SBA by 2015 [2,3]. The present study investigated the beliefs, delivery intentions, and subsequent delivery locations among women receiving prenatal care in the Eastern Region of Ghana, where the reported rate of deliveries in healthcare facilities with SBA is 59% [2].
Qualitative interviews were conducted between May 31 and June 17, 2010, at St Dominic’s Hospital Antenatal Clinic, Akwatia, Ghana. This 356-bed mission hospital is one of the largest healthcare facilities in the region and has a strong pregnancy education program. In 2009, there were 2904 deliveries at St Dominic’s. A convenience sample of sequentially selected women (who were ≥18 years of age and ≥27 weeks pregnant, as reported in the participants’ prenatal care records) were invited to complete audio-recorded semi-structured interviews regarding prenatal care, previous delivery experiences, and delivery intentions. Interviews were conducted in English, Twi, and Ga, and transcribed verbatim into English. Sampling continued until thematic saturation was reached (n=85; Table 1). Participants who delivered before July 5, 2010, completed post-delivery interviews. Incomplete post-delivery data were the result of limited on-site researcher availability. The study protocol and instruments were approved by the Institutional Review Boards at the University of Ghana, Korle Bu Hospital, Accra, Ghana, and the University of Michigan, Ann Arbor, USA.
Table 1.
Demographic and pregnancy characteristics of third-trimester pregnancies, St Dominic’s Hospital Antenatal Clinic, Akwatia, Ghanaa
| Characteristic | Value |
|---|---|
| Participants interviewed (n=85) | |
| Age, y | 29 ± 6 (18–41) |
| Weeks pregnant at interview | 33 ± 4 (27–40) |
| Number of prenatal care visits | 5 ± 2 (1–14) |
| Number of previous deliveries | 1 ± 1 (0–5) |
| Education, y | |
| 0 | 7 (8.2) |
| >0–6 (primary school) | 17 (20.0) |
| >6–9 (junior secondary school) | 32 (37.6) |
| >9–12 (senior secondary school) | 15 (17.6) |
| ≥12 (university) | 14 (16.5) |
| Ethnicity | |
| Akan | 48 (56.5) |
| Ewe | 19 (22.4) |
| Other | 18 (21.2) |
| Work outside the home | 67 (78.8) |
| Religion | |
| Christian | 75 (88.2) |
| Muslim | 10 (11.8) |
| Married | 75 (88.2) |
| Preparing for first delivery | 27 (31.8) |
| Intended delivery location | |
| Healthcare facility | 85 (100.0) |
| Other | 0 (0.0) |
| Participants with previous delivery (n=58)b | |
| ≥1 previous home delivery | 9 (15.5) |
| ≥1 previous facility delivery | 52 (89.7) |
| Participants who had confirmed or potential deliveries during the study period (n=36) | |
| In-study delivery locations | |
| Hospital | 31 (86.1) |
| Unconfirmed | 5 (13.9) |
Values are given as mean ± SD (range) or number (percentage).
Participants could select both options.
All of the women interviewed stated that they intended to give birth in a healthcare facility. Qualitative analysis of the transcripts is underway to understand these intentions more clearly.
Of the 45 women expected to deliver during the study period, 9 had not delivered at the conclusion of the study. Of the remaining 36, 5 (13.9%) were lost to follow-up and 31 (86.1%) had confirmed deliveries in a healthcare facility.
Although it was preliminary and subject to limitations (owing to a small sample size, single site, potential for selection bias, and short follow-up period), the present study raises interesting questions for further research. Given the higher-than-expected intention to deliver in a healthcare facility and the actual healthcare facility-based delivery rate observed, it must be asked whether the present sample of women was different from those previously observed, whether the observations are attributable to particular characteristics of St Dominic’s Hospital, and/or whether the study design was such that women intent on a facility-based delivery were selectively observed. Further research is required to determine whether these findings are replicable with larger samples.
Synopsis:
Rural Ghanaian women receiving prenatal care reported a higher-than-expected intention to deliver in healthcare facilities. Actual facility-based delivery rates were also higher than expected.
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Conflict of interest
The authors have no conflicts of interest.
References
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- [2].Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF Macro. Ghana Demographic and Health Survey 2008. http://pdf.usaid.gov/pdf_docs/PNADO176.pdf. www.usaid.gov. Published 2008.
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