On the move: Displacement of traditional birth systems from the home to the hospital in Greater Accra, Ghana

Background: Recent efforts to reduce maternal mortality (MM) have resulted in a shift of traditional birth systems from domestic to biomedical settings. This shift has created socio-cultural and logistical challenges in countries like Ghana where traditions maintain that childbirth should occur in the home among female kin and community elders. In order to participate in MM reduction initiatives, the Ghanaian Ministry of Health has begun training more midwives while simultaneously promoting the benefits of clinically supervised deliveries.

Methods: This mixed-method study consisted of 34 semi-structured interviews with Ghanaian women in the third trimester of pregnancy or recently (≤6 months) postpartum; participant observation; key informant interviews; and one focus group with six midwives. All interviews were tape-recorded and subsequently analyzed using template and inductive analysis.

Results: Pregnant and recently-delivered women agreed that hospitals were the best and safest place to deliver. Women described hospitals and associated staff as fulfilling supportive roles during the birth process, although the “house” was also identified as a site of preeminence for the transmission of symbolic, spiritual, and social meaning. Biomedical advice was considered to be commensurate with that of traditionally revered elders.

Conclusions: Accra is undergoing significant change with regard to traditional birth systems. The presumed “development” of re-locating birth practices from the home to the hospital, however, may come at a cost. Care should be taken to design and implement maternal health initiatives that minimize conflict and prevent the erosion of traditions that provide meaning and support to women in pre- and post-natal settings.