227616 On the move: Displacement of traditional birth systems from the home to the hospital in Greater Accra, Ghana

Wednesday, November 10, 2010 : 11:30 AM - 11:45 AM

Stephanie A. Sterling, MD MPH , Master Program in Global Public Health, New York University, New York, NY
Laura O'Hara, MSN MPH , ChildFund-Liberia, Monrovia, Liberia
Laura E. Rueff, MD MPH , Master Program in Global Public Health, New York University, New York, NY
Olamide Kolade, MD MPH , Master Program in Global Public Health, New York University
Kristin Bright, PhD , Master Program in Global Public Health, New York University, New York, NY
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.

Learning Areas:
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
1) Describe the cultural and kin-based support roles of “the hospital” with respect to pregnancy and birth among women in Greater Accra; 2) Discuss traditional birth systems and role of “the home” in pregnancy and birth; 3) Describe the shift of birthing practices from the home to the hospital as well as the potential conflicts and benefits accompanying that transformation.

Keywords: International MCH, Maternal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-author for the study protocol, conducted the research, and performed data analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.