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“It’s up to the Woman’s People”: How Social Factors Influence Facility-Based Delivery in Rural Northern Ghana

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Abstract

To explore the impact of social factors on place of delivery in northern Ghana. We conducted 72 in-depth interviews and 18 focus group discussions in the Upper East Region of northern Ghana among women with newborns, grandmothers, household heads, compound heads, community leaders, traditional birth attendants, traditional healers, and formally trained healthcare providers. We audiotaped, transcribed, and analyzed interactions using NVivo 9.0. Social norms appear to be shifting in favor of facility delivery, and several respondents indicated that facility delivery confers prestige. Community members disagreed about whether women needed permission from their husbands, mother-in-laws, or compound heads to deliver in a facility, but all agreed that women rely upon their social networks for the economic and logistical support to get to a facility. Socioeconomic status also plays an important role alone and as a mediator of other social factors. Several “meta themes” permeate the data: (1) This region of Ghana is undergoing a pronounced transition from traditional to contemporary birth-related practices; (2) Power hierarchies within the community are extremely important factors in women’s delivery experiences (“someone must give the order”); and (3) This community shares a widespread sense of responsibility for healthy birth outcomes for both mothers and their babies. Social factors influence women’s delivery experiences in rural northern Ghana, and future research and programmatic efforts need to include community members such as husbands, mother-in-laws, compound heads, soothsayers, and traditional healers if they are to be maximally effective in improving women’s birth outcomes.

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Acknowledgments

The authors would like to acknowledge Global REACH and the African Social Research Initiative at the University of Michigan, the Department of Pediatrics at the University of North Carolina, the University of Ghana School of Public Health, the Navrongo Health Research Centre, and the numerous individuals involved in the collection and coding of data. These include: Sarah Rominski, John Richardson, Elizabeth Hill, Rebekka Hess, Mira Gupta, Gideon Logonia, and Gideon Affah. Most importantly, the authors would like to thank the people of the Kassena-Nankana District of northern Ghana.

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Authors and Affiliations

  1. Global REACH, University of Michigan Medical School, 5115 Med Sci 1, 1301 Catherine St., Ann Arbor, MI, 48109, USA

    Cheryl A. Moyer & Raymond DeVries

  2. University of Ghana, Legon, Ghana

    Philip B. Adongo

  3. Navrongo Health Research Centre, Navrongo, Ghana

    Raymond A. Aborigo & Abraham Hodgson

  4. MONASH University, Melbourne, Australia

    Raymond A. Aborigo

  5. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Cyril M. Engmann

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  1. Cheryl A. Moyer
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  2. Philip B. Adongo
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  3. Raymond A. Aborigo
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  4. Abraham Hodgson
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  5. Cyril M. Engmann
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  6. Raymond DeVries
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Correspondence to Cheryl A. Moyer.

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Moyer, C.A., Adongo, P.B., Aborigo, R.A. et al. “It’s up to the Woman’s People”: How Social Factors Influence Facility-Based Delivery in Rural Northern Ghana. Matern Child Health J 18, 109–119 (2014). https://doi.org/10.1007/s10995-013-1240-y

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