Childbirth in Ghana

Due to the cultural implications and the importance of bearing children, infertility in Ghana can be devastating. Throughout the years, Ghanaians have believed that both physical and spiritual ailments are the cause of infertility.[2] Some people believe that a womb could be too hot or too cold to support a developing baby. Others believe that the cause of their infertility is witchcraft, and this belief is often supported by traditional priests who assert that the woman can be rid of a witch's curse and be allowed to conceive if the priest performs a rite in which he asks fertility gods how they can be appeased.[2]

Other spiritual beliefs involving infertility include the belief that infertility is the result of a woman's disobedience to God, in which the remedy is prayer and repentance.[2] Women who consult a tradition birth attendant are likely to be told that prayer is the medicine for infertility, although they acknowledge that infertility is sometimes caused by a physical ailment. In these cases, the traditional birth attendant may blame the infertility on stomach aches and advise the woman to visit a hospital and take the medicine given by the doctor.[2]

Cultural influences and sociodemographic characteristics play an important role in a woman's decision to seek maternal-child health services. These influences and characteristics include level of education, religious affiliation, region of residence, ethnicity, and occupation.[3] In most communities, maternal-child health services coexist with traditional indigenous health care, and pregnant women in these rural areas may choose between modern medicine, herbalists, diviners, and spiritualists for care.[3] The use of a doctor for prenatal care is low among women living in rural areas of Greater Accra and the Northern and Upper regions of Ghana.[3] 23.1% of Protestant and Catholic women, and 10.3% of traditional women consult a doctor for prenatal care.[3]

The majority of women believe that antenatal care from a health professional is necessary to determine that their pregnancy is normal, to see that the fetus is well-positioned, to learn about when they were expected to deliver, to obtain a tetanus immunization, for the diagnosis and treatment of illnesses during pregnancy, and nutritional advice. The barriers to seeking antenatal care include travel time and distance from health care facilities, the high cost, and the inconvenient hours of operations of the clinics. Some women also did not want people to know they were pregnant until their third month of pregnancy, and would wait until then to seek antenatal care.[4] Inexpensive care from traditional birth attendants included routine antenatal care, however untrained attendants and traditional healers did not provide antenatal care.[4]

Baked clay ayilo eaten by pregnant women.

Knowledge about nutrition in Ghana is obtained through formal education, community health services, friends and families, cultural practices, traditions, and beliefs of the community.[5] The majority of foods consumed by Ghanaian women during pregnancy were foods indigenous to Ghanaian diets in general such as green leafy vegetables, meats, fish, fruits, and legumes. They also consume foreign foods such as dairy products, biscuits, and beverages such as tea and powdered mixes.[6]

Recommended raw foods during pregnancy include: bananas, oranges, papaya, pineapples, carrots, cabbage, lettuce, honey, and other vegetables. Recommended cooked foods include bean stew with palm oil and boiled white rice, bread, fried anchovies, smoked mackerel, snails in soup, stews with eggs and vegetables, palm nut soup with fufu and rice, and Nkontomire stew which is made with palm oil and boiled sweet cassava, or plantain, or yam.[5] The beliefs about beneficial foods during pregnancy are based on their understanding of how certain foods can prevent anemia, enhance physical strength, support the development of the fetus, and minimize physiological disruption.[5]

Women in Ghana also believe there are foods one must avoid during pregnancy. Most women agree that excess fat and sugar are harmful during pregnancy, and Fante and Akwapim women have beliefs about specific foods to avoid which include sugarcane, coconut, oranges, pineapple, chilli pepper, ground nut soup, eggs, high fat and high sugar foods, cooking oils, salt, and clay.[5]

In 1985, the abortion law passed in Ghana allowed for legal and safe abortion by a qualified medical practitioner for pregnancies that resulted from rape or incest, if the pregnancy threatens the life of the woman or her physical or mental health, or if there is substantial risk that the fetus would suffer from a serious physical anomaly or devastating disease.[7] Many women in Ghana are not aware that abortion is legal in their country and tend to seek unsafe abortion providers and receive unsafe care afterwards. As a result, more than 11% of maternal deaths are due to unsafe abortions, making it the second most common death in women in Ghana.[7]

According to the 2007 Ghana Maternal Health Survey (GMHS), 7% of all pregnancies end in abortion. The incidence of abortion is higher in women who are 20–24 years old, educated and wealthy women, and women who live in urban areas.<[7] Contraceptive use is low in Ghana with about 24% of women using contraceptives in 2008. 35% Of married women in Ghana are in need of contraceptives, but are not using any.[7]

Most deliveries in Ghana are attended by untrained personnel, including traditional birth attendants, and most traditional birth attendants in rural areas are illiterate elderly farmers.[9][8]

Many women choose traditional birth attendants because of the lower cost, and because they live in the community and are able to assist quickly. They are known to assist with bathing the newborn, and giving advice on breastfeeding and newborn care. Traditional birth attendants deliver in cases on uncomplicated labor and are able to refer women to health care facilities when complications arise.[8]

Place of delivery

Labor ward in Ketu South Municipality.

The majority of Ghanaian women deliver at home with a traditional birth attendant and are referred to the hospital in cases of complicated labor. Although most deliveries are attended by a traditional birth attendant, most women prefer to deliver with a health professional. Barriers to obtaining professional health care include high costs, inadequate transportation, long distances to health care facilities, and poor road conditions.[8] Some women were also too embarrassed to go to a hospital because they did not have nice clothes and preferred to deliver at home where no one could see that they were poor.[8] Attempts on using telemedicine and portable ultrasound have been carried out,[10] though they have not been converted into national policies.

The older women in the compound or community look after women in their postpartum period and assist with cleaning the baby and massage. Mothers receive postpartum teaching from the older women in the community. In the early postpartum period, there is great emphasis placed on the health and well-being of the mother and infant. Breastfeeding and postpartum abstinence is mandatory. Both mother and baby receive massages using shea-butter, palm kernel oil, and other oils. During this time, different colored and sized beads are tied around the wrist, waist, and ankles to monitor the growth of the infant. Older women will also keep a brass bowl full of herbs, mixtures, white clay, soft sponge, and charcoal. These items are believed to prevent health problems for the infant and mother.

When babies are born, they are kept indoors for seven days because Ghanaians believe that this is the period in which they are most vulnerable to both physical and spiritual harm.[1] During this period, it is believed that the child is wandering between the spiritual and physical world and may decide to go back to the spiritual world at any point. They are known as strangers until the end of the seven days when they are acknowledged and welcomed into society with an elaborate naming ceremony, or outdooring ceremony.

• Health in Ghana
• Women in Ghana