Social Science &
Medicine. Volume 148, January 2016, Pages 8–17

Highlights

• The ban of TBAs in resource poor settings may be counterproductive.

• Policies banning TBAs may need revisiting in skilled worker deprived contexts.
• Women in remote locations expressed relevance of TBAs in context.
• Targeted training of TBAs in remote locations is advocated.

Abstract

This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth
attendants (SBA) regarding Ghana’s recent policy that forbids TBAs from undertaking deliveries and restricts their role
to referrals. In the larger context of Ghana’s highly underdeveloped and geographically uneven health care system, this
study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses
intersect with local socio-cultural and political environments of Ghana’s Upper West Region (UWR). This study reveals
that futile improvements in maternal health and the continued reliance on TBAs illustrate the government’s inability to
understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions
(FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana’s UWR, the findings suggest that mothers
generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no
SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization’s
guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in
remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion
among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore,
participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between
TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes
by suggesting relevant policy recommendations.

Key words

• Ghana;
• Upper West Region;
• Maternal health;
• Traditional birth attendants;
• Rural;
• Access to care

Author: Andrea Rishworth, Jenna Dixon, Isaac Luginaah, Paul Mkandawire, Caesar Tampah Prince