Maternal mortality rates are still alarmingly high in
Sub-Saharan Africa. Skilled
delivery care during childbirth is the most critical intervention for improving
Despite the importance of skilled delivery services, performance of skilled
delivery care is still low in the Bongo District. The researcher, being an
indigene of this district, and a professional nurse, observed that skilled
birth care during pregnancy, labour and childbirth has been low within the
Bongo community and its environs. The study aimed at determining the barriers
to utilisation of skilled birth care services provided by healthcare
professional from the perspective of mothers in the Bongo District of Upper
East Region of Ghana. A descriptive
study with cross-sectional design of 610 mothers, selected through simple
random sampling technique was conducted. Data were collected using a structured
questionnaire, and analysed using SPSS statistics. The study identified women’s
age; education; marital status; religion; husband’s education; parity and
health insurance status as the socio-demographic characteristics of women that
were significantly associated with utilisation or non-utilisation of skilled
delivery services. The study also identified lack of money to pay for
transportation and cost of treatment; poor quality of services and poor
attitudes of health personnel;
availability and influence of TBAs; long distance and lack
of means of transportation; and cultural reasons as the major barriers to the
utilisation of skilled delivery services.
The recommendations emerging from the study reinforce the importance of skilled
attendants’ awareness regarding attitude, and the need for development of
interpersonal communication skills into education and training that women are
treated with respect, understanding and dignity. It is also recommended that
midwives and other skilled attendants in deprived areas should reorient their
caring practices to more culturally appropriate and evidenced- based maternity
care. Further research on women’s experiences of care received, and health care
delivery in rural areas is needed.
Abor, P. A., Abekah-Nkrumah, G., Sakyi,
K., Adjasi, C.K.D and Abor, J. (2011). “The socio-economic determinants of
maternal health care utilisation in Ghana”, International
Journal of Social Economics, 38 (7), 628-648
Addai, I. (2000). “Determinants of use of
maternal-child health services in rural Ghana”, Journal of Biosocial Science 32(1):1-15.
J.A. (1994). Infant mortality in Nigeria:
effects of place of birth, mother’s education and region of residence, Harvard
Center for Population and Development Studies, Cambridge, Massachusetts, USA
Adetunji, J. A., (1991). “Response of Parents to Five
Killer Diseases among Children in a Yoruba community, Nigeria”, Social
Science & Medicine 32(12):1379-1387.
Adjei, M. (2008). “Factors contributing to Low
Utilization of Skilled Delivery in Ahafo – Ano South District Ashanti Region”, West African Journal of Medicine, 14(13) 22-38.
Amankwa, B. (2008). “To Assess the Determinants of
Skilled Birth Attendance in Bolgatanga Municipality”, Maternal Child Health
Journal, 12(23): 43-51
R.M. and Newman, J.F. (1973). “Social and individual determinants of medical
care utilisation in the United States”, Milbank
Memorial Quarterly, 51: 95-124.
Andersen, R.M. (1995). “Revisiting the behavioural
model and access to medical care: does it matter?” Journal of Health and
Social Behaviour, 36(1): 1-10.
Bongo Health Directorate (2010). District
Annual Health Report.
D. (2004a). “Determinants of utilization of health services by women in rural
and urban areas in Ghana”, Geo Journal,
M. and McCall, M. (2005), “Skilled
birth attendance; what does it mean and how can it be measured? A clinical
skills assessment of MCH workers in Nepal”, Int Journal of Gynecology and Obstetrics, 89: 200-208.
Chakraborty, N., Islam, M.A., Chowdhury, R.I. and
Bari, W. (2001). “Utilisation of postnatal care in Bangladesh: evidence from a
longitudinal study”, Health and Social Care in the Community, 10 (6),
A.J. (2007). “Barriers to the utilization of maternal health care in rural
Mali”, Social Science and Medicine,
65 (8), 1666-82.
14. Ghana Statistical Service
(2012). Multiple Indicator Cluster Survey 2011. Accra. Government Press.
Ghana Health Service Annual Report (2007). Reproductive and Child Health Unit,
Public Health Unit, Ghana
16. Ghana Statistical
Service, Ghana Health Service, and ICF Macro (2009). Ghana Demographic
and Health Survey 2008: Key Findings. Maryland: ICF Macro.
S. and Bertrand, J. (2005). “Use of
health professionals for obstetric care in Northern Ghana”; Stud Fam Plann,
18. Mrisho, M., Schellenberg, A.J., Mushi, K.A., Obrist B.
and Schellenberg, D. (2007). “Factors affecting home delivery in rural
Tanzania”. Tropical Medicine and International Health 4, 927-944.
Nketiah, E.A. (2009). “Expectant mothers and the
demand for institutional delivery: Do household income and access to health
information matter? Some insight from
Ghana”. European Journal of Social
Sciences, 2 (8):3-8.
20. Obeng J.B. (2008). “Factors Influencing the
Utilization of Skilled Delivery Services in the Offinso South District of
Maternal Child Health Journal, 14(23): 67-89.
Owusu, J.D. (2007). “Factors contributing to low utilisation of maternal
health services in Kumasi”. Accra.
Available at: http://web.knust.edu.gh/downloads/newsletter1
Sepehri, A., Sarma, S., Simpson, W. and
Moshiri, S. (2008). “How important are individual, household and commune characteristics in
explaining utilisation of maternal health services in Vietnam?” Soc Sci Med, 67(6):1009-17.
C, Lawn J.E, Rahman H, Wilczynska‐Ketende K, Hill K. (2006). “Stillbirth rates: delivering
estimates in 190 countries”. Lancet; 367(9521):1487‐94.
R. and Tsui, O. A. (2002). “Contextual influences on reproductive health
service use in
Uttar Pradesh, India”, Studies in Family Planning, 33(4): 309 –321.
S. and Maine, D. (1994). “Too far to
walk: maternal mortality in context”, Social Science and Medicine 38(8):
UNFPA (2004). In
good hands: progress report from the field. Available online www.UNFPA.Org (accessed 1/10/2011)
WHO, UNICEF, UNFPA and the World Bank
(2014). Trends in Maternal Mortality:
1990 to 2013, WHO, Geneva, Available online http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf
Accessed: April 10, 2014
28. WHO (2010). Progress Report 2010 on
Maternal and reproductive health, Available at http://www.who.int/reproductivehealth/publications/family/en/
(accessed http://www.who.int/gho/maternal_health/en/index.html.(accessed on 20th April, 2012)
WHO, UNICEF, UNFPA, World Bank (2010).Trends in Maternal Mortality: 1990 to 2008.
Available online at http://whqlibdoc.who.int/publications/2011/9789241500265_eng.pdf prenatal use in the Philippines, Social
Science & Medicine, 24(11), 927-944.
30. WHO (2009).World Health Statistics 2009. Geneva: Available at http://www.who.int/gho/maternal_health/countries/en/index.html acessed on 5th June, 2012)
Proportion of birth attended by a skilled
health worker; 2008 updates. Retrieved from http://www.who.int/reproductivehealth/...health/2008_skilled_attendant (accessed on 4th May,
WHO, (2007). Skilled Attendant Updates: Available at: http://www.who.int/reproductive
health data.html Accessed on 10/09/2011.
(2005). The World Health Report 2005: Make every mother and child count. World
Health Organization, Geneva. Switzerland
WHO (1994). Coverage
of maternal care: a listing of availability of information. Geneva: http://www.who.int/maternal_child_adolescent/countries/gha_rev.pdf.
(accessed on 10th November, 2011).
Yakong, V. (2014). Ethnographic Perspective on Rural Women’s Reproductive Health Decisions
in Ghana: The Cultural Influences of Gender Relations, Kinship and Belief
System: Doctoral Thesis, the College of Graduate Studies University of
British Columbia Okanagan.