Factors Influencing Uptake of Institutional Delivery Service by Skilled Birth Attendant's in Ghana: A Framework Analysis of Existing Literature.

Background: Utilisation of institutional delivery service remains a challenge in most developing countries including Ghana and significant proportion of births assisted by skilled birth attendant's (SBA) remain low. To improve this, insight is needed in many factors inter-relating to influence women place of birth. This study therefore explored and analysed factors influencing uptake of institutional delivery services provided by skilled birth attendants in Ghana. Evidenced-based interventions that have helped improved facility-based deliveries by SBAs in low and middle income countries were also reviewed. Method: Using conceptual framework of Anderson and Newman (2005), literature from Ghana and other low and middle income countries were reviewed. Articles in English language and published between 2005 to 2015 in PUBMED, PsychINFO, EMBASE, GOOGLE SCHOLAR that met the inclusion criteria were included in the review. Result: The results indicate that, in spite of the high ANC attendance in Ghana (86.7%), uptake of institutional delivery services by SBAs was suboptimal. Several factors were identified in each of the three domains of the conceptual framework and they include predisposing factors (maternal age and education, parity, cultural, religion and traditional practices, and place of residence), enabling factors (household's wealth) and need factors (perception of safer pregnancy). In addition, health services related factors identified include perceived negative attitude of some SBAs, limited numbers of health facilities and SBAs, low quality of services and long distance to health facilities. Conclusion: Scaling up of Community-based Health Planning Program (CHPS) in hard to reach areas will remove barriers such as distance, transportation, and further ensure culturally sensitive health delivery services. In addition, increasing uptake of midwives and strict implementation of "train and retain" policy by Ministry of Health (MOH) will make a significant impact. [ABSTRACT FROM AUTHOR]