Women’s Perception and Use of Maternal Health Services in Ga Mashie, Accra: Implication for the Free Maternal Healthcare Initiative

Abstract

Due to the high maternal mortality ratios in sub-Saharan Africa, the United Nations has prioritized maternal health as part of its broad Millennium Development Goals. In line with this, Free Maternal Health Initiative (FMHI) was introduced in Ghana in 2008 to address the challenges of maternal health services in the country. The FMHI is an integral part of Ghana’s National Health Insurance Scheme. This study therefore examined the perceptions of women in the Ga-Mashie community, Accra, Ghana regarding the use of maternal healthcare services with special reference to the Free Maternal Health Initiative. It is hoped that the findings will help to improve the utilization of the free maternal health care in this community. Guided by the theory of planned behaviour, this study adopted a qualitative research approach. Specifically, in-depth interviews were used to explore the perceptions of women on FMHI in Ga-Mashie. A total of 20 women were interviewed. These included six pregnant women, six women who had their first delivery within the last 12 months and six women who have had deliveries before and after the introduction of FMHI. Two health workers were the key informants in the interview. The study established that all the women did not know the existence of a technical name called FMHI they rather called it “health insurance for pregnant women”. Women’s perceptions on FMHI clustered around three themes: financial, spiritual and physical. Many of them still perceived FMHI as not free because they still pay during antenatal, delivery and postnatal attendance and therefore were reluctant to use the service. Some participants argued that pregnancy disrupts the physical body and so there is the need to go to the hospital for treatment. Others believed the antenatal period is a time to seek spiritual protection for oneself and the baby and it is also an acknowledgement that the pregnancy belongs to God. All of these perceptions reduced visits during antenatal, delivery and postnatal periods. This study further revealed that women still have misconceptions about the FMHI. It recommends that the components of the FMHI must be explained to both women and nurses in order to address the ambiguity and reluctance of women in accessing the free maternal health services. Such explanation would allay some of the fears women had about unexpected payments at clinics. It would also prevent misunderstanding between patients and nurses about the services that are free and the one which are not free. On the side of the Nurses, measures such as increasing staff ratio to patients and making the necessary logistics available will ease their work load.