Chapter one
Introduction
This chapter discusses the background of the study, problem statement, purpose of the study, significance of the study, objectives.
1.1 Background
In order to achieve the Sustainable Development Goals (SDGs) also known as Global Goals for Sustainable Development set by world leaders at the United Nation. One important goal is to improve maternal health (SDG 3) with a target of reducing maternal mortality to less than 70 deaths per 100,000 live births and universal access to reproductive health services by all women. The global maternal mortality ratio is 210 per 100,000 live births (World Health Organization, 2012). In 2010, there were 287, 000 maternal deaths with 99% contributed by developing countries. Over 50% of these occurred in Sub-Saharan Africa (United Nations, 2012). To achieve the Sustainable Development Goal 3, there must be a 5.5% annual reduction in maternal mortality but the figures in 2010 showed a reduction rate of 2.6% in Sub-Saharan Africa (WHO, 2012).
Ghana, like many other developing countries has a high maternal mortality ratio of 350 per 100,000 live births, a far cry from the target of 185 per 100,000 live births for 2015 (WHO, 2012). Supervision by skilled health attendants during pregnancy, delivery and the post-partum period has been recognized as key in the reduction of maternal mortalities (Ministry of Health, 2011). The Ghana Demographic Health Survey (GDHS) 2008 showed that 78% of pregnant women made at least 8 visits to the ante-natal clinic. This is the minimum number of visits recommended by the World Health organization (WHO). Only 57% of births were attended by skilled professionals.
Forty-Two per cent (42%) of births occurred at home without professional supervision and 23% had no post-natal care (Ghana Statistical Service et al, 2009a).
A lot of programs and interventions have been put in place to promote maternal health and thus reduce maternal mortality. Maternal health issues have often been seen as feminine or as a “woman thing” so most of these interventions have focused on women. They have aimed at women empowerment, increasing female autonomy and their decision-making powers. These are laudable but whereas women autonomy may increase maternal health service utilization, increasing women autonomy alone has not always been associated with increased utilization of maternal health services (Fotso, Ezeh, & Essendi, 2009; Mistry, Galal, & Lu, 2009). In our socio-cultural environment, men still wield a lot of power in decision-making in the family (Story & Burgard, 2012). Some women’s access to and utilization of antenatal care services depend on their male partners. Involving male partners and encouraging joint decision-making will lead to greater utilization of health services and thus better maternal outcome (Story & Burgard, 2012.; Allendorf, 2007; Mullany, Hindin, & Becker, 2005).
The three main delays that affect access to maternal health care are the delay in deciding to receive care, delay in reaching the service delivery point and delay in receiving care at the facility. Male partner involvement among other factors can significantly influence the first two delays. The decision to seek care in some homes is made by the man or requires the man’s approval. Seven per cent of the women who delivered at home in the GDHS (2008) stated lack of permission as the reason for not going to a health facility. For those who obtain permission, there may be delays in obtaining the permission. There may also be delays in reaching the point of the service because of lack of personal resources and relying on the male partner to make resources available to be able to reach the point of service delivery. As many as 45% stated lack of money as the reason for not accessing health care (GSS et al, 2009a).
A lot of women depend on their male partners for funds to access health care. Male partner involvement is a key factor that cannot be ignored in the quest for improvement in maternal health (USAID, 2010). When men are part of ante-natal and post-natal clinic, they partake in the education given at these clinics. This leads to increase in men’s knowledge of and appreciation of the need for these services. They are able to identify danger signs and so facilitate women’s utilizations of health care services especially in emergencies (Tweheyo, Konde-Lule, Tumwesigye, & Sekandi, 2010; Kakaire, Kaye, & Osinde, 2011; Kunene et al., 2004). When women are educated together with their partners, not only do the men also learn but the women are better able to assimilate and comply with information so acquired (Mullany, 2006; Mullany, Lakhey, Shrestha, Becker & Hindi, 2009).
A lot of effort is being made to increase male involvement in reproductive health. Areas of reproductive health that have seen improvement as a result of male involvement include: contraception and family planning and treatment of sexually-transmitted infections (Dudgeon & Inhorn, 2004). Various factors including cultural, socio-economic, demographic, policy issues and conditions at health facilities influence male partner involvement in antenatal care (Mullany, 2006; Nanjala & Wamalwa, 2012). A number of researches concerning male involvement in reproductive health have been carried out but very little has been done locally to assess the level of male involvement in antenatal care and the factors that determine it. In our bid to improve maternal health in Ghana and reduce our maternal mortality ratio, there is the need to assess the women attitude towards men involvement in antenatal care and their presence during delivery and to determine factors that affect their involvement. These factors can then be taken into consideration when planning interventions to improve maternal health and make them more effective.
1.2 Statement of the Problem
Developing countries continue to have a high maternal mortality ratio (240/100,000 live births), about 15 times that of developed countries (16/100,000 live births) (United Nations, 2012). The situation in Sub-Saharan Africa is worse with a maternal mortality ratio of 500/100,000 live births. Ghana, a Sub-Saharan African country has a maternal mortality ratio of 350/100,000 live births, a long shot from its target of 185 per 100,000 live births for 2015. Some progress has been made since 2000 when this goal was set but the rate of the decline has been very slow. Ghana’s annual rate of reduction in maternal mortality is 2.6% but to achieve the goal, there should be a 5.5% reduction annually (WHO, 2012; United Nations, 2012). This poor performance has persisted in spite of numerous programs and interventions carried out in the country that are aimed at reducing maternal mortality. Tamale, the third –most populous Metropolitan area in Ghana, is not exempt from this national problem.
One of the key factors contributing to the high maternal mortality is women’s low utilization of health services and thus, the services of skilled professionals during the ante-natal, labour and post-partum period. From the GDHS (2008), 22.2% of pregnant women did not make the minimum recommended 4 visits to the antenatal clinic. Forty-two per cent (42%) delivered at home without skilled health professional’s supervision and 23% had no post-natal care. Of those who did not seek health care, 45% and 7% respectively stated lack of money and not obtaining permission from spouse as the reasons.
In our socio-cultural setting, men wield a lot of power in decision making in the home and they play a vital role in the health seeking behavior of women. Funding and permission to seek Antenatal care often come from the male partner. Male partner involvement in Antenatal care is perceived to be low and has therefore contributed to the slow pace of the decline in maternal mortalities. There are various factors that could affect or determine male partner involvement in Antenatal care and during delivery. These include socio-demographic factors, cultural factors, economic factors, religious factors, programed factors and health facility factors. In Ghana, not much work has been done on male involvement in Antenatal care and during delivery. The levels of male partner involvement in Antenatal care and during delivery and the factors that determine this in the study area, Tamale Teaching Hospital, have not been clearly elucidated. This study focuses on women and seeks to assess their attitude towards their partners involvement in Antenatal care and during delivery and determine the factors that influence it in Tamale Teaching Hospital, Ghana.
1.3 Objectives
1.3.1 General Objective
1. To ascertain women’s attitude towards their partners involvement in antenatal care and delivery.
1.3.2 Specific Objectives
1. To establish women’s attitude towards their partners attending Antenatal care services with them.
2. To assess the level of male partner involvement during labour and delivery.
3. To provide recommendation where possible towards encouraging male participation in antenatal care services with their women.
4. To establish women’s knowledge on antenatal care
1.4 Operational Definition of Terms
Antenatal care: The care given to a woman during her pregnancy by a health care professional.
Intrapartum care: The care given to a woman during labour and delivery by a health care professional.
Male involvement: Refers to men participating in and having joint responsibility with women in all areas of maternity care.
Male partner: The man biologically responsible for the pregnancy of a woman.
Maternal health: Refers to the health of women during pregnancy, childbirth and the postpartum period.
Antenatal care: Refers to the care given to a woman during her pregnancy, labour, delivery and the postpartum period by a health professional.
Postnatal care: The care given to a woman from the delivery of the placenta up to six weeks after delivery by a health care professional.
Attitude: refers to inclination to react in a certain way to certain situations, to see and interpret events according to certain predisposing or to organize opinions into coherent and interrelated structures (Badran, 1995).
Knowledge: the ability to acquire, retain and use information; a mixture of comprehension, experience, discernment and skill (Badran, 1995).
Skilled Attendance: Refers to childbirth managed by a skilled attendant under the enabling conditions of a functional emergency obstetric care and referral system.
Skilled Attendant: Refers to an accredited health professional such as a licensed midwife, doctor or nurse who has adequate proficiency and the skills to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and also in the identification, management and referral of complication in women and newborns.