Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis

Background: Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana’s maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Methods: Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. Results: The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Conclusions: Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions

Motivations for food prohibitions during pregnancy and their enforcement mechanisms in a rural Ghanaian district

© 2015 Arzoaquoi et al. Background: Food taboos are known from virtually all human societies and pregnant women have often been targeted. We qualitatively assessed food taboos during pregnancy, its motivating factors, and enforcement mechanisms in the Upper Manya Krobo district of Ghana. Methods: This was an exploratory cross sectional study using qualitative focus group discussions (FGDs). Sixteen FGDs were conducted. Participants were purposively selected using the maximum variation sampling technique. Tape recorded FGDs were transcribed verbatim and analyzed using Malterudian systematic text condensation technique. Results: All the participants were aware of the existence of food prohibitions and beliefs targeting pregnant women in Upper Manya Krobo. The study identified snails, rats, hot foods, and animal lungs as tabooed during pregnancy. Adherence motivators included expectation of safe and timely delivery, avoidance of "monkey babies" (deformed babies); respect for ancestors, parents, and community elders. Enforcement mechanisms identified included constant reminders by parents, family members and significant others. Stigmatization and community sanctions are deployed sparingly. Conclusions: Food taboos and traditional beliefs targeting pregnant women exist in Upper Manya Krobo. Pregnant women are forbidden from eating snails, rats, snakes, hot foods and animal lungs. To a large extent, socio-cultural, and to a lesser, health concerns motivate the practice

The effects of individual and community-level factors on maternal health outcomes in Ghana

Background Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. Methods and findings Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. Conclusions The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana

The Emerald International Handbook of Feminist Perspectives on Women’s Acts of Violence

Over the past twenty years, interest in women’s violence has grown as an area of academic research and teaching across disciplines such as criminology, sociology, history, international relations, public health and film and literary studies. This handbook makes a timely contribution by acting as a comprehensive introduction to a wide range of international, interdisciplinary scholarship which applies feminist perspectives to the phenomenon of women’s violence. Violence is enabled and enacted by individuals, organisations and states with interconnections between these different levels (Collins, 1998, 2017). We adopt this multilevel understanding of violence in the handbook, bringing together contributions on interpersonal and intimate violence by women, women’s violence as agents of institutions, and women’s political violence as state and non-state actors. The handbook is international in scope with contributions from scholars across countries in the Global South and North. Women’s acts of violence are rarer than men’s and frequently perceived as more shocking. Violence by women is regularly sensationalised and stigmatised, especially in media discourses. This sensationalisation and stigmatisation relies on and reproduces misogynistic tropes about violent women as ‘evil’, ‘unnatural’ and masculinised. The chapters in this handbook are written from a feminist perspective and eschew or deconstruct stereotypical portrayals in favour of more considered and complex analyses of the violence women enact and the relevance of their social and political positioning, as well as cultural understandings of womanhood and how these inform understandings of and responses to this violence. Previous literature has emphasised that women’s violence is frequently understood as deviant and transgressive, violating norms of ideal femininity. Such ideas are explored throughout the handbook in contributions which consider, for instance, the vilification and monsterisation of women who kill. These chapters tease out the ways in which violent women are profiled as unnatural and abject. The handbook therefore retains a focus on scholarship which considers the ‘abnormality’ of violent women while also including contributions which demonstrate that women’s violent acts can be normalised and made invisible, for example when perpetrated during a professional role. Adding further nuance, various chapters address how, due to marginalisation across axes of race and class, certain women are not always presumed to be non-violent or perceived through norms of ideal femininity. The handbook explores how these assumptions can lead to overcriminalisation and harsh treatment within the criminal justice system. The significance of women’s intersectional identities is a consistent theme throughout the handbook. Running through the chapters too is the seemingly intractable problem of agency – including the obstacles to fully assigning agency to violent women as well as the frequently unwanted consequences when they are considered to have acted with agency and are punished more harshly. Throughout the handbook, authors grapple with questions of women’s volitional capacity, considering difficult questions of how far we should consider the contexts in which women commit violence, which include structural oppression, domestic- and gender-based violence, and cultural norms. The contributions reveal the necessity of abandoning a binary view of victim-perpetrator, agency/non-agency and evolving a more complex framework in which to gauge questions of intention and deliberation. The handbook is divided into eight sections: historical perspectives; understanding women’s acts of violence; women as perpetrators of interpersonal and intimate violence; power and women’s violence; women and non-state political violence; cultural interpretations of violent women; fictional representations of violent women; and violent women and girls in the criminal justice system. The rest of this introductory chapter outlines the handbook’s structure and summarises each contribution

Pursuit of University Education among the Children of Immigrants in Canada: The Roles of Parental Human Capital and Social Capital

Using the 2002 Ethnic Diversity Survey, this article examines the roles of parental human capital and social capital in the pursuit of university education among immigrant youth in Canada. We find segmented patterns across the largest minority groups in Canada, with the Chinese and the south Asians, such as Indians, Pakistanis and Bangladeshis, obtaining the highest levels of education, while Blacks show the lowest rate of university education. Our study highlights the need to go beyond human capital models by assessing the benefits of and downsides to social capital. Minority language retention at home is beneficial for post-secondary education while language usage with friends outside the minority community entails the need to be proficient in one of the official languages of Canada, English or French. Having a strong sense of trust is crucial for the pursuit of university education, especially for Blacks. Our findings underscore the importance of examining what forms of social capital are unique to each minority group and the various ways these different forms of social capital are utilised in achieving success in the educational sphere

A multi-level model of condom use among male and female upper primary school students in Nyanza, Kenya

Although several studies have emphasized the relevance of community level variables to AIDS prevention among young people in sub-Saharan Africa, few have tested the empirical connections between such variables and sexual behaviors. Using data from 3645 sexually experienced grade 6 and 7 students from 160 schools, modeled on (Fisher and Fisher, 2000) and (Fisher and Fisher, 1993) and Campbell's identification of community influences (2003), this study applies hierarchical linear models to estimate the effects of individual and community level variables on condom use among youth in Nyanza Province, Kenya. Four separate models were fit for both males and females. Results show significant differences across schools and communities regarding condom use. The predictors of reported condom use at last intercourse for both males and females were ethnicity, pressure to engage in sexual intercourse, and condom self efficacy. While age, religion, rejecting myths about the spread of HIV, and talking to male relatives about HIV/AIDS were all positively related to condom use for males, risk perception, socio-economic status of the school and school sponsorship by a religious group were negatively related to the outcome variable. For females, abstinence self efficacy and HIV prevention programming in community festivals were additional significant predictors, both increasing the odds of condom use. Our results suggest that there are marked differences in factors influencing reported condom use among males and females in Nyanza, Kenya. While some of these factors exist at the individual level, others exist at the school/community level. Based on our findings, we recommend that AIDS prevention interventions take account not only of individual-level factors, but also school/community influences on the sexual behaviors of youth.Kenya HIV/AIDS Condom use Youth Schools Communities Gender

Online_supplemental_table_1 – Supplemental material for Revisiting the Housing–Health Relationship for HIV-Positive Persons: Qualitative Evidence From the Lower Manya Krobo District, Ghana

<p>Supplemental material, Online_supplemental_table_1 for Revisiting the Housing–Health Relationship for HIV-Positive Persons: Qualitative Evidence From the Lower Manya Krobo District, Ghana by Mabel Teye-kau, Eric Y. Tenkorang, and Paul B. Adjei in Qualitative Health Research</p