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Date of Award


Access Type

Campus Access

Document type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

First Advisor

David Ross Buchanan

Second Advisor

Aline Gubrium

Third Advisor

Ralph Faulkingham

Subject Categories

African Studies | Public Health | Public Health Education and Promotion


This study sought to examine health care decisions and choices that women make during pregnancy and childbirth in selected low-income and poor urban communities in Ghana. Specifically, it examined women's and community members' knowledge and perceptions about pregnancy and childbirth; existing forms of health care available to women during pregnancy and childbirth; and factors that influence preference for the type of health care that women use during pregnancy and childbirth. The study employed a two-phased data collection strategy involving in-depth interviews and focus group discussions to examine maternal health care seeking behavior of the target population.

The findings revealed that the poor urban women have a wide range of perceptions and knowledge about pregnancy including knowledge about what constitutes a successful pregnancy and risk factors of pregnancy and childbirth complications. The study found that three major forms of health care exist for pregnant women: biomedical care; herbal-traditional birth attendant care; and spiritual care. While some women use or prefer to use either solely medical care or herbal-traditional birth attendant care for their pregnancy and delivery, others combine two or all the three forms of health care. Pregnant women seek traditional birth attendants (TBAs) and spiritual care for spiritual protection against death, due to affection and cultural attachment to TBAs, fears about medical care and health facilities, and due to cost of seeking medical care.

Long waiting time and early reporting time at antenatal clinic were identified as partly limiting the use of medical care during pregnancy. Intimate partners of pregnant women were identified as negative normative influence since most of them do not support their wives during pregnancy. Quality and safety of care were the major reasons why pregnant mothers seek biomedical care other than other forms of care. However, majority of women who seek biomedical care do not seek timely antenatal care. Only 42 percent made their first antenatal visit in the first trimester. These findings have implications for policies and programs that are likely to help increase the use of skilled attendance and improve maternal health outcomes in the study population and other similar low-income urban communities in Ghana.