Please understand when I cry out in pain: womens accounts of maternity services during labour and delivery in GhanaReport as inadecuate

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BMC Public Health

, 5:140

First Online: 22 December 2005Received: 12 April 2005Accepted: 22 December 2005DOI: 10.1186-1471-2458-5-140

Cite this article as: D-Ambruoso, L., Abbey, M. & Hussein, J. BMC Public Health 2005 5: 140. doi:10.1186-1471-2458-5-140


BackgroundThis study was undertaken to investigate women-s accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana.

MethodsTwenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women-s perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services.

ResultsOne component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour.

ConclusionThe findings suggest that inter-personal aspects of care are key to women-s expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women-s views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements.

List of abbreviationsFGDFocus group discussion

FIGOInternational Federation of Gynecology and Obstetrics

GNPGross national product

ICMInternational Confederation of Midwives

SAFESkilled Attendance for Everyone

TBATraditional birth attendant

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-5-140 contains supplementary material, which is available to authorized users.

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Author: Lucia D-Ambruoso - Mercy Abbey - Julia Hussein


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