Utilization of maternal health services in the Amansie East District, Ghana

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In developing countries, it is estimated that, more than 500,000 women die every year from complications related to pregnancy and childbirth. Lack of access to maternal health services contribute significantly to the high maternal mortality rates especially in developing countries including Ghana. Amansie East District is a rural district in the Ashanti Region of Ghana. The district is no exception to the inadequate development and lack of health resources in rural areas in the country. There has therefore been low utilization of Maternal Health Services resulting in a high Maternal Mortality Ratio when compared with the National and Regional averages. ANC coverage for Amansie East District (2003) was 75%, Post Natal; 24%, Supervised Delivery 9%, and Maternal Mortality 1,270/100,000 live birth. National target is 180/100,000 live birth and coverage for that same year was 205/100,000 live birth. This study is aimed at determining the underlying factors that limit women in rural settings from accessing health services taking into cognisance: geographical, financial and socio-cultural access. The study also examined the sources of maternal health information and staff perspective on limiting factors to low utilization of maternal health services. This study was a descriptive study with a cross-sectional design. A sample size of two hundred respondents was interviewed using the multistage approach in four sub-districts in the Amansie East District. In addition, ten health workers were also interviewed in the health facilities in the four sub-districts. Interviews were conducted using a structured questiormaire for the purpose of the collection of the data. The data was analyzed using the Statistical Package for Social Scientist (SPSS) software 11.0 version. The study revealed that even though over eighty percent (85.5%) of the respondents live within 5 kilometres radius to the available health facilities, fifty four percent (54.1%) did not use the health facilities because of long distance and thirteen percent (12.8%) was due to lack of vehicle. From the perspective of health professionals in the sub-districts, distance to health facilities contributes to eighty percent (80%) of the factors to low utilisation of maternal health services. This evidence shows that living in 5km radius to health facilities alone may not improve access to maternal health services in rural areas because in such settings, access roads are usually unmotorable, hence few vehicles are available. In addition, due to the poor nature of roads it takes a longer time to transport persons to health facilities. Also, the financial background of rural women is very poor and is a reason for which over forty percent (42.0%) of respondents did not use maternal health services. This is with the background that over eighty percent (87.5%) are engaged in productive work that earn them not more than three hundred thousand cedis (¢300,000.00) a month. Obviously, the income levels are very low and it is suggestive of the economic activities of women in the District. To affirm the magnitude to which lack of funds limit women in accessing maternal health services, health professionals perceived that it is the major contributor (90%). Interestingly, cultural practices were not identified as a limiting factor to maternal health services, however, the decision making process is mostly influenced by the partners of the women in the rural areas. This was indicated by over fifty percent (5 5%) of the respondents. The health professionals suggested that gender issues (20%) is a contributory factor as far as low utilization of maternal health services is concerned. This buttresses the need to include men in the crusade to empower women since they play an important role in health issues of women especially in rural settings. Sixty percent of clients had information on maternal health services from health workers. The other sources of information were the media and relatives/friends. Fifteen percent (15.1%) of the women did not access maternal health services due to poor staff attitude towards clients even though; eighty five percent (85%) indicated that they were satisfied with the care given at the health facilities. With the above findings, appropriate recommendations have been made for the District Assembly, the District Health Administration and other stakeholders to improve access to the maternal health services and thereby improve the health of women especially those in the rural areas.
A thesis submitted to the Department of Community Health in partial fulfilment of the requirements for the degree of Master of Science in Health Services Planning and Management, 2004