Background
This study examined barriers to utilization of maternal health services in the Dangme West District
and factors influencing the dropout rate between Antenatal care (ANC) and skilled delivery/Postnatal
care (PNC). Understanding the reasons why women are not fully utilizing the services, especially the
free delivery, will help district health workers effectively target pregnant women and promote the use
of maternal health care.
Objectives
The general objective was to determine factors and barriers that influence a woman’s decision to utilize
free maternal health services in the Dangme West District, including antenatal care, skilled attendance
at delivery, and postnatal care.
Specific objectives include:
• To identify the full range of factors that influence a woman’s decision to seek maternal health
care services
• To identify the perceived importance of overall maternal health services among women in the
district
• To describe determinants influencing a woman’s choice of location of delivery
• To identify reasons why women make initial contact with maternal health services during
pregnancy but do not utilize ANC and delivery services to the full extent
• To use the findings to make recommendations on how to encourage women to utilize maternal
health services to receive the maximum health benefits for the mother and child
Methods
This study was a descriptive study and used focus groups and cross-sectional, retrospective surveys of
a sample of women in Dangme West who have delivered since July 2008. Data was collected through
four focus groups and 190 questionnaires administered to the sample population.
Results
In making the decision of where to deliver, women were influenced by a variety of factors. In the
survey, women were allowed to list as many influential factors as they wished. The most common
responses included: Safety of the place of delivery (48.9%), Cost of transportation (27.4%) and
Recommendation from a health worker (16.8%). Of the 38.9% of women who didn’t utilize delivery services in a health facility, their reasons for
choosing not to deliver in a health facility include no money for transport (43.1%), Preference of
the TBA (31.9%), No one to take care of her at the hospital (18.1%) and no money for hospital care
(15.3%).
The drop out between delivery in a health facility and PNC utilization was 9.3%. Of this 9.3% of
women, 30% of them said that no health care worker at the place of delivery suggested they seek PNC
following birth. The most common reasons why women were not seeking PNC were: the mother and
baby were healthy so it was not important, no money for transportation, and no money for drugs and
injections at PNC.
Although there appears to be an increase in maternal health service utilization over the past couple
years in Dangme West, only 52% of women are fully utilizing the free services available. The District
Health Administration should focus on, eliminating indirect costs at the health facilities, and increasing
the friendliness of health care workers.
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