Factors contributing to low supervised delivery in the New Juaben Municipality, Ghana

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One of the main aims of the safe motherhood programme, which was initiated in Ghana in 1987, is to increase the access to Ghanaian women to supervised delivery. The programme has been reported to be making more progress in the urban areas than in the rural settings. The New Juaben municipality is one of the areas in the country having a problem of low coverage of supervised delivery-23.7%, 26.7% and 26.1% for 2002, 2003 and 2004 respectively. This is inspite of the almost 100% (92%) of ANC attendance of the women in the municipality. The study was therefore undertaken to investigate the factors leading to the low coverage of supervised delivery in the municipality. The study was a descriptive cross sectional study using both qualitative and quantitative methods. Two RCH departments (located within two municipal health centres) and eleven communities were selected for the study. Hundred (100) mothers with children 2 years and below were simply randomly selected from each of the two health facilities and interviewed using a semi-structured questionnaire. In-depth interviews were conducted with health providers such as TBAs and midwives, and six focus group discussions were held with men and women who were randomly selected from the various communities in the municipality. Both the men and women in the focus discussion groups had poor knowledge of the complications of pregnancy and delivery. The TBAs and the midwives on the other hand were assessed to have satisfactory and good knowledge respectively of such complications. Majority of the women in the study (67.5%) had supervised delivery while 29% of them had their babies delivered by trained TBAs. The cost (50,000-300,000 cedis and more) of delivery at the various places of delivery in the municipality was identified as having an influence on the coverage of supervised delivery as the women said they spent more when they went for supervised delivery (including the cost of transport in the case of pregnant women who were referred to the regional hospital) as compared to delivering at the TBAs. The availability of transport especially for referred cases and the delivery skills of both midwives and TBAs did not have an influence on the coverage of supervised delivery. However the logistics which both the TBAs and midwives used in their work were inadequate and therefore contributed to the low coverage of supervised delivery in the municipality. It is recommended that the municipal health authority should organize health education programmes (especially in association with the local electronic media) to sensitize the residents on the danger signs and complications of pregnancy and childbirth and also provide the needed logistics to enhance the work of the TBAs and midwives. The municipal assembly should set up a transport scheme in collaboration with the local transport authorities to provide readily available and affordable transport especially for pregnant women who are referred to the regional hospital.
A dissertation presented to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of Master in Public Health degree in Population and Reproductive Health, 2005