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Background: Male involvement in maternal healthcare has been widely recognized as essential for positive health outcomes for expectant mothers and their unborn babies. However, few studies have explored men's experiences of maternal health services. The purpose of this paper is to explore men's involvement in antenatal care in urban Ghana and to discuss how men navigate their roles in a space that has been constructed as feminine. The study draws upon theories of space, place, and gender. Methods: A qualitative exploratory study using semistructured interviews, focus group discussion, and observation was conducted in Accra, Ghana. Expectant fathers and health workers were interviewed, and observation was conducted at a selected public hospital in Accra. Results: The findings suggest that the few men who attend antenatal care with their expecting partners become involved to a limited extent in the clinic's activities. Beyond a few who take an active role, most men stay on the outskirts of the hospital grounds and rarely participate in consultations with their partner and midwife. Men still view their presence as necessary to acquire knowledge and as sources of emotional, financial, and physical support for their partners. On the health workers' side, the study found no clear agenda for engaging men at the clinic, and nurses/midwives felt there was a lack of staff who could engage more directly with the men. Conclusion: The study indicates that most expecting fathers feel too shy and uncomfortable to locate themselves in the female space that makes up antenatal care/maternity wards. Health workers do not feel they have the necessary resources to involve men fruitfully. Thus, men do not engage in the activity as hoped but rather remain on the outskirts of the maternity clinic. However, if men continue to negotiate their involvement at the clinic and become more assertive in their roles, the maternity clinic as a female space could, with time, be transformed into a space in which both expecting mothers and fathers can actively participate and be engaged to the benefit of all. Plain Language Summary: This article discusses men's roles and involvement in health workers' activities when they accompany their pregnant partners to the maternity clinic. Health workers organize antenatal care services (ANCs) for expectant mothers to receive regular check-ups during pregnancy. Since pregnancy and childbirth are generally viewed as women's domains, men have not traditionally been expected to attend antenatal care with their partners. However, recent national and global agendas have recognized men's inclusion in maternal healthcare as central to improving mothers' and unborn babies' health. Men are being encouraged to play an active role in supporting their partners during pregnancy, and as part of this role, they are encouraged to attend antenatal care services. In the health facility where this study was conducted, we found that the few men who attended antenatal care most of the time stayed outside the maternity clinic under trees or in other empty spaces around the clinic. They opted to remain in the outside areas because they felt shy sitting among women who were a substantial majority at the clinic. We also found that health workers rarely involved men in ANC activities because of a lack of staff to engage men in separate sessions. Although the fathers attending antenatal care were disappointed that they were not engaged in activities, they still found it necessary to attend to give their partners emotional, physical, and financial support. Without the consideration of how ANC activities are structured and the appropriate resources for health workers, men's active participation in ANCs will remain minimal. [ABSTRACT FROM AUTHOR]

Background: The importance of men's involvement in facilitating women's access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men's involvement in issues of maternal healthcare, the barriers to men's involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men's involvement in maternal healthcare in the Upper West Region of Ghana. Methods: Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20-50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling's thematic network analysis framework was used to analyse and present the qualitative data. Results: Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men's involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers. Conclusions: The findings in this paper highlight the need to address the barriers to men's involvement, engage men and women on issues of maternal health, and improve the healthcare systems -- both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. Methods: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. Results: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. Conclusion: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. Methods: A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. Results: Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. Conclusion: The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs. Plain Language summary: People with disabilities make up 16 percent of the world population, but their sexual and reproductive health (SRH) needs are often unmet, especially in poorer countries, contributing to adverse outcomes. This study assessed factors influencing the sex lives of PwDs in two districts of Ghana. Quantitative data were collected from 402 respondents, while qualitative data were collected from 37 participants. The results showed that age, severity of disability, and household size influence sexual activity. Many respondents also reported adverse SRH issues including STIs and unintended pregnancies. Sixty-five percent reported experiencing violence or abuse, which is related to their disability type and severity. The study also found that PwDs encounter many challenges in their sexual lives, including abuse and neglect. The findings suggest the need to pay attention to the sexual health needs and the social issues that make PwDs vulnerable to various abuses. [ABSTRACT FROM AUTHOR]

Introduction: The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. Methods: This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. Results: The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. Conclusion: Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent sexual and reproductive health continues to be a major public health issue in low-and middle-income countries. While many countries have policies aimed at reducing adolescent pregnancy, evidence of their impact is unclear. This study sought to explore the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. Methods: We employed a cross-sectional, qualitative study design involving semi-structured interviews with 30 key informants (health and education professionals and grassroot workers) in the Central Region of Ghana. We also conducted a desktop review of policies aimed at reducing adolescent pregnancy in Ghana. We used content analysis to analyse the data. Results: Eight of the 30 participants demonstrated awareness of policies aimed at reducing adolescent pregnancy but only two could elaborate on this. By contrast, 19 of the 30 participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under each programme. Despite participants' low policy awareness and knowledge, their descriptions of the activities carried out under each programme aligned with the strategies and activities of the policies mentioned, as evident from the desktop review of the policies. Conclusion: Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. Plain Language Summary: Adolescent pregnancy is a major public health issue in low-and middle-income countries. Efforts to reduce adolescent pregnancy have become major health priorities globally. Several international organisations, including the United Nations, have adopted strategies such as those featured under the Sustainable Development Goal (SDG) 3.7. These strategies seek to ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes by 2030. Many countries have policies and programmes with implementation strategies aimed at reducing adolescent pregnancy; however, evidence of their impact is unclear. We explored the knowledge and awareness of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals and grassroot workers in Ghana. We conducted interviews among 30 key informants in Ghana. Few of the participants demonstrated awareness of policies aimed at reducing adolescent pregnancy and only two could elaborate on this. By contrast, most participants were aware of relevant programmes and provided detailed description of their implementation and activities carried out under them. Greater engagement of stakeholders in future policy development should increase policy awareness. Dissemination of policy content through community-based media channels and in local languages should promote and facilitate stakeholder engagement, which in turn should increase effective policy implementation with subsequent reduction of adolescent pregnancy. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. Objective: To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. Methods: A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. Results: Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider–client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. Conclusion: Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP. Plain language summary: High blood pressure (hypertension) in pregnancy can have severe complications for both mother and fetus including loss of life. The outcome of pregnancy for women who develop hypertension during pregnancy can be improved by ensuring optimal quality of care. In this study, we explored the opinions and experiences of women whose pregnancies were affected by hypertension concerning the care they received during their recent admission at different hospitals in Ghana and the challenges they faced. In four major referral hospitals in the Greater Accra Region of Ghana, we interviewed the women and had focus group discussions. Women who were pregnant for 26 weeks up to 34 weeks and had hypertension in pregnancy were invited for inclusion in the study. We conducted in-depth interviews with fifty women and three focus group discussions with 22 women. Most women who participated in the study were between 20 and 30 years old, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. The women reported both positive and negative experiences of care during their admission at the hospitals. Examples of positive experiences were receiving good quality of care, satisfaction with care, and adequate counselling from the health workers. Examples of negative experiences were poor communication between the providers and affected women, inappropriate attitudes by the healthcare providers, and disrespectful treatment such as verbal and physical abuse. The major factors in the health system that influenced women's experiences of care were lack of logistics, substandard professionalism, inefficient national health insurance system and long delays at health facilities prior to receiving treatment. The individual women's factors that affected the quality of care included financial constraints, psychosocial stress and inadequate knowledge about hypertension during pregnancy. In conclusion, we determined that women with hypertension in pregnancy experience both positive and negative aspects of care and these may be due to challenges associated with the healthcare system, health providers and women themselves. There is the need to ensure optimal quality and respectful maternity care considering the nature of hypertension in pregnancy. These women require dedicated hospital staff with significant experience to improve the quality of care provided to women with hypertension in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Biological fathering, especially in patrilineal societies, was traditionally acceptable only in the context of marriage to the mother of the child. Many men were polygynous, often staying in one household with all their wives and children. However, this phenomenon has been on the decline in recent times, mainly due to Christianity, which encourages monogamy while frowning on polygyny. The Ghanaian family has for the past few years been undergoing changes due to migration, urbanization, and industrialization. With an increase in non-marital births and the dissolution of marital unions, multi-partner fertility is likely to increase. Contemporary Ghanaian perspectives on the circumstances that lead men to engage in paternal multi-partner fertility, otherwise referred to in this study as serial fathering, are scanty, hence this study examines the factors that lead to serial fathering among Ghanaian men. Methods: The study employed the qualitative method, using in-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women. Results: It was found that factors such as the attitude of women in relationships, the duolocal post-marital residential pattern, and the age at first birth are some of the reasons why some men father children with multiple partners. Conclusion: The study concludes that both situational and personal factors account for the phenomenon of serial fathering amongst men in Prampram, Ghana, and these factors bring about distinctions in serial fathering as occurring either within or outside of marriage. Plain Language Summary: In Ghana, men are increasingly having children with numerous women, whom they refer to as their "baby mamas." Contemporary Ghanaian viewpoints on the factors that motivate males to engage in this behavior are minimal. Consequently, this study examines the factors that predispose Ghanaian men to father children by multiple women. In-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women from Prampram, a suburb of Accra, Ghana, were utilized in this qualitative study. The results of the study show that men had children with different women due to the negative attitudes of women, which pushed them to frequently change partners. The lack of a friendly relationship with in-laws, duolocal residence patterns, the non-observance of marriage rites, the young age of the first birth, and a continual need for companionship and sexual satisfaction were all factors that contributed to the practice. If these factors are addressed, it is anticipated that the prevalence of "baby mamas" in Ghanaian society will decrease significantly. This study also shows that family therapists and counselors should consider involving male clients' spouses when counseling them about having many "baby mamas." [ABSTRACT FROM AUTHOR]

Background: An estimated one-third of women in Ghana use contraceptives without the knowledge of their partners, a phenomenon known as Covert Contraceptive Use (CCU). Most research on CCU to date has focused on individual women to the neglect of the role of health system. This study explores CCU in urban poor communities of Accra, Ghana, from the experiences and perspectives of health providers. Methods: Qualitative in-depth interviews were conducted with health care providers in both the public and private sectors at multiple levels, from the community clinic to the tertiary hospital, to gain insights into the strategies women use and the ways in which the health system supports the practice of CCU. Results: Five major thematic areas emerged: use of easily concealed-methods, discrete-access-and-information-keeping, time-of-day, non-verbal-communication and use of relationships. The study further revealed that fear, mistrust, shyness, myths, and misperceptions regarding contraceptives explain CCU among women in the communities that the providers serve. Conclusion: Importantly, disclosure of methods used by providers without women's consent could potentially lead to violent outcomes for both women and the providers. Our results highlight the pivotal role that providers play in confidentially supporting women's choices regarding the use of contraceptives. Plain Language summary: Sometimes women use contraceptives without the knowledge of their sexual partners. That is to say, they hide their contraceptive use. Many studies have explored why women hide their contraceptive use. Reasons include the desire of men to have absolute control of their women's bodies including their sexuality and fertility regulation. This occurs in cultures where women do not have as much power as men. In Ghana, as much as one-in-three women hide their contraceptive use from their partners. This study explores the ways in which health facilities assist women to hide their contraceptives use by talking to leaders of units responsible for providing contraceptives in the hospitals. First, people prefer contraceptives like injectables that are not visible on the bodies of those using them. Second, some hospitals have modified their space to provide ample privacy and security for women. Third, some women visit the facilities at odd hours, such as very early in the morning, very late at night and at other favorable times. Sometimes nurses arrange to meet women outside the facility. Lastly, nurses create avenues through various personal relationships. For example, leaving their contacts in market spaces and arranging meeting places with market queens. [ABSTRACT FROM AUTHOR]

Background: Globally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities. Methods: A qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0. Result: Health workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women's non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment. Conclusion: Health workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities. Plain language summary: Respectful maternity care is vital to achieving positive pregnancy and childbirth experiences for women and their families. Mistreatment of women during childbirth at facilities can negatively impact women's future health seeking behaviors and utilization of maternal care services. The experiences and perspectives of doctors, midwives and nurses working in labour wards are vital in understanding how women are treated during childbirth, and what measures can be taken to prevent it. In this study, we explored the opinions of health workers and hospital administrators on how women are treated during childbirth to determine the gaps in the quality of maternal care in health facilities in Ghana. Participants expressed mixed feelings concerning mistreatment of women during childbirth. Most were aware of the occurrence of mistreatment in health facilities including physical and verbal abuse, and denial of preferred position for childbirth and companionship. The reasons provided for mistreatment included low staff capacity, high workload, non-compliance by women and poor attitudes towards health workers. Most health workers were against mistreatment during childbirth. Participants thought mistreatment could be minimized by improving staff skills, refresher training, and childbirth preparation education for women. Our study indicates the need to motivate, retrain or encourage health professionals to provide respectful care to women during childbirth to improve their experience of care. Further research to help implement better maternity care devoid of mistreatment in health facilities in Ghana is needed. [ABSTRACT FROM AUTHOR]

Background: Infertility is detrimental to the health of married couples, especially women. Despite the consequences associated with the condition, little is done to reduce the repercussions. This study throws more light on the lived experiences of infertile women and on how they can be helped to improve their own condition. Methodology: We interviewed 30 infertile married women in the Northern and Ashanti regions of Ghana, 15 from each region. A qualitative method, phenomenological study design and thematic analysis was employed to explore their lived experiences. Results: Due the huge stigma, some women reported that their loved ones encouraged them to try to conceive. Others revealed that, they were considering relocating from their current communities to reduce the insults, intense pressure, stress, and stigma. Though some revealed maltreatment from their husbands and in-laws, others stated their husbands disclosed their fertility status to their own family members to avoid these families pressuring these women. Conclusions: To reduce the stigma, pronatalist societies urgently need education and sensitization. Would-be couples should be counselled to have a plan to deal with such occurrences should they experience them. [ABSTRACT FROM AUTHOR]

Background: Due to the debilitating effects of severe labour pains, labour pain management continues to be an important subject that requires much attention. Thus, this study sought to gain a detailed insight into the experiences of midwives on pharmacological and non-pharmacological labour pain management strategies in a resource limited clinical context. Methods: A descriptive exploratory qualitative design was adopted for this study which allowed in-depth follow-up of the midwives' comments resulting in a full understanding of emerging findings. Face-to-face individual interviews were conducted, transcribed and data were analysed using content analysis procedures. Verbatim quotes were used to support the findings. Results: Midwives employed different pain control measures including pharmacological and non-pharmacological methods such as psychological care, sacral massage and deep breathing exercises. Doctors prescribed analgesics most of the time while in some cases, the midwives independently administered the drugs. They assisted women who had epidural anaesthesia given by anaesthetists. The midwives did not administer adequate analgesics because of fear of side effects of analgesics. Although the midwives exhibited knowledge on drugs used for labour pain management, they did not regularly administer analgesics and non-pharmacological care provided were inadequate due to increased workload. Some of the midwives showed empathy towards women and supported the women. Most of the midwives perceived labour pain as normal and encouraged women to bear pain. Conclusion: Midwives require regular education on labour pain management and they should pay attention to women in labour individually and administer the care that meets their need. [ABSTRACT FROM AUTHOR]

Background: The burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2010 only 68 percent of mothers in Ghana gave birth with the assistance of skilled birth attendants. In 2005, the Ghana Health Service piloted a strategy that involved using the integrated Community-based Health Planning and Services (CHPS) program and training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). The study assesses the feasibility of and extent to which the skilled delivery program has been implemented as an integrated component of the existing CHPS, and documents the benefits and challenges of the integrated program. Methods: We employed an intrinsic case study design with a qualitative methodology. We conducted 41 in-depth interviews with health professionals and community stakeholders. We used a purposive sampling technique to identify and interview our respondents. Results: The CHO-midwives provide integrated services that include skilled delivery in CHPS zones. The midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. They refer pregnant women with complications to district hospitals and health centers for care, and there has been observed improvement in the referral system. Stakeholders reported community members' access to skilled attendants at birth, health education, antenatal attendance and postnatal care in rural communities. The CHO-midwives are provided with financial and nonfinancial incentives to motivate them for optimal work performance. The primary challenges that remain include inadequate numbers of CHO-midwives, insufficient transportation, and infrastructure weaknesses. Conclusions: Our study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana. [ABSTRACT FROM AUTHOR]

Background: Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. Methods: A cross-sectional qualitative study was conducted with WWDs aged 18–49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. Results: Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. Conclusion: Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, awareness and use of emergency contraceptive pills (ECPs) among young women has rapidly increased in Ghana; however, the rate of unintended pregnancy among this group remains high. We conducted a qualitative study to better understand the context and patterns of ECP use among young unmarried women in Ghana. Methods: We conducted in-depth interviews with unmarried sexually active women aged 18–24 in Accra, Ghana to explore their perceptions, experiences, and opinions regarding sexual relationships and contraceptive methods, and to examine the factors that influence choice of ECPs. A total of 32 young women participated in the study. Results: Most participants had used ECPs at least once. Participants described being unable to plan for sexual encounters, and as a result preferred ECPs as a convenient post-coital method. Despite being widely and repeatedly used, women feared the disruptive effects of ECPs on the menstrual cycle and were concerned about long-term side-effects. ECPs were sometimes used as a back-up in cases of perceived failure of traditional methods like withdrawal. Misinformation about which drugs were ECPs, correct dosage, and safe usage were prevalent, and sometimes spread by pharmacists. Myths about pregnancy prevention techniques such as urinating or washing after sex were commonly believed, even among women who regularly used ECPs, and coincided with a misunderstanding about how hormonal contraception works. Conclusions: ECPs appear to be a popular contraceptive choice among young urban women in Ghana, yet misinformation about their correct usage and safety is widespread. While more research on ECP use among young people is needed, these initial results point to the need to incorporate information about ECPs into adolescent comprehensive sexuality education and youth-friendly services and programmes. [ABSTRACT FROM AUTHOR]

Background: Adolescent sexual and reproductive health is recognized as a key developmental issue of international concern. However, adolescents' access to sexual and reproductive health (SRH) information and services is largely inadequate in sub-Saharan Africa. With increasing enrollment in schools, this could be an avenue to reach adolescents with SRH information and services. This study was therefore conducted to assess the acceptability and stakeholders' perspectives on the feasibility of using health workers and trained psychologists to provide school-based SRH services in Ghana. Methods: Fourteen (14) focus group discussions (N = 136) were conducted; 8 among adolescents aged 12–17 years (4 boys, 4 girls groups), 4 among parents (2 males, 2 females groups) and two among mixed teacher groups. We also conducted 18 in-depth interviews with teachers, managers of schools, health workers, clinical psychologists, as well as adolescent SRH program managers in the Ghana Health Service, Ghana Education Service, UNICEF, UNESCO and National Population Council, Ghana. We audio-recorded all interviews and took field notes. Interviews were transcribed and transcripts imported into NVivo 11 for analysis using grounded theory approach to qualitative data analysis. Results: Many respondents reported that it was challenging for parents and/or teachers to provide adolescents with SRH information. For this reason, they agreed that it was a good idea to have health workers and psychologists provide SRH information and services to adolescents in school. Although, there was general agreement about providing SRH services in school, many of the respondents disagreed with distribution of condoms in schools as they believed that availing condoms would encourage adolescents to experiment with sex. While majority of respondents thought it was acceptable to use psychologists and health workers to provide school-based sexual and reproductive health to adolescents, some teachers and education managers thought the implementation of such a program would oppose practical challenges. Key among the challenges were how to pay for the services that health workers and trained psychologists will render, and the availability of psychologists to cater for all schools. Conclusion: Stakeholders believe it is feasible and acceptable to use trained psychologists and health workers to deliver school-based SRH information and services in the Ghanaian school context. However, provisions must be made to cater for financial and other logistical considerations in the implementation of school-based SRH programs. [ABSTRACT FROM AUTHOR]