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Araba Paintsil (not her real name) is a 12-year-old pregnant teenager from Assin Domeabra, a village in the southern Assin district of the central region. At four months pregnant, Araba has yet to visit a health center for prenatal care.
Rather, he has been using herbal concoctions prepared by his parents for pregnant women. Other people have also come to prescribe a herbal or other medicine for you to use.
Araba does not have a National Health Insurance Scheme (NHIS) card. She has also not verified her HIV / AIDS or hepatitis status, as well as other health problems associated with pregnancy because there is no money. Araba is likely to give birth at home.
This is the situation of Araba and of many other teenagers and pregnant mothers in hard-to-reach communities in the country.
This also occurs in the context of efforts to provide free maternal care services to women to achieve universal access to qualified midwives.
THE SDGS AND MATERNAL HEALTH
Goal number three of the Sustainable Development Goals (SDGs) to “ensure healthy lives and promote well-being for all at all ages” aims to reduce the maternal mortality rate to less than 70 per 100,000 live births by 2030 .
It also aims to increase universal access to quality maternal, neonatal, sexual and reproductive health care services, among other objectives.
Furthermore, SDG 3 hopes to reduce neonatal mortality from 22 per 1,000 live births to just 12 per 1,000 live births and under-five mortality to at least 25 per 1,000 live births.
GHANA MATERNAL HEALTH POLICY
The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth and postpartum.
Ghana, within the framework of the National Health Insurance Scheme (NHIS) introduced in July 2008 a free maternal health policy that made it possible for all pregnant women to have the right to free health services during pregnancy, childbirth and all three months after delivery.
Mr. Mathew Ayamba Adam is the Agortime District Director of the Ghana Health Service (GHS). He says that considering the trend of maternal problems in the country, there was a need to implement interventions that increased access.
This, he said, is because many women died during pregnancy and delivery due to lack of access to prenatal care and maternal mortality was high due to complications of pregnancy or delivery.
The free maternity policy was aimed at facilitating access to quality free maternity care to reduce the high number of women and children who die from preventable death during pregnancy.
The policy is part of the country’s measures to achieve the SDGs of reducing maternal and child mortality and achieving the goal of Universal Health Coverage (UHC).
According to Mr. Ayamba, access to care (that is, assistance to OPD, prenatal services, and improved skilled delivery has increased since the introduction of free maternal health).
However, he says more needs to be done to ensure that the vulnerable population, especially in rural communities in the country, is registered under the insurance scheme in order to fully benefit from the policy.
“Despite the fact that there has been an increase in access and other uses, we still have to do a lot so that those in rural settings have more opportunities to have the insurance and also have the installation at their doorstep,” he said .
MATERNAL MORTALITY
The maternal mortality rate (MMRatio) is the annual number of deaths of women per 100,000 live births from any cause related or aggravated by pregnancy or its treatment.
The MMRatio includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, regardless of the duration and location of the pregnancy, during a specific year.
In 2015, WHO indicated that a total of 2,800 girls and women in Ghana died in childbirth and 60 percent of all deliveries in rural communities occurred without a trained midwife present. These numbers have declined in recent years, but there is still a long way to go.
THE DILEMMA OF THE RURAL PREGNANT ADOLESCENT
In rural communities in Ghana, adolescent girls who become pregnant face many challenges, and sometimes discrimination, in accessing quality health care due to the stigmas surrounding adolescent pregnancy.
Girls often have no money or their families do not support them to access health services. In addition, many do not seek medical care for fear that health workers will judge them or refuse to provide care.
This means that many pregnant teens have little knowledge about the risks associated with pregnancy and childbirth, and may choose to deliver their babies at home without trained help, a practice that increases the risk of complications and even death.
Akua, (not her real name) is a 17-year-old teenage mother from Assin Asamankese. She is seven months pregnant with the second child. Akua hardly ever visits prenatal care because she has no money.
She talks about “When the first pregnancy happened, there was a lot of talk about me for getting pregnant with a boy known in the community as irresponsible but I accepted my destiny and I stayed with the pregnancy.
Akua says she has visited the hospital for prenatal check only once in her seven-month period of pregnancy.
She is using herbal concoctions and has resigned herself to fate and prays for God to accompany her through the successful delivery.
She felt uncomfortable on the first visit and decided not to go back to the antenatal clinic after being questioned by the nurses about why she was pregnant a second time, if the first time was a mistake.
Knowing the shame, stigma and insults associated with teenage pregnancy, Araba is unwilling to associate with anyone to the point where she refuses to run an errand for her parents.
To add insult to injury, the last time she tried to get out, she was attacked by the sister of the man who made her pregnant who accused her of embarrassing her family and beat her.
Since then, Araba has felt very ill, looks pale and experiences general weakness and loss of appetite when we visit her.
Her problem also lies in the fact that she may not be able to continue her education after childbirth and even if she can, her peers may be making fun of her. He is always crying inside with the uncertainty of going back to school.
CHALLENGES IN THE FREE IMPLEMENTATION OF MATERNAL HEALTH
Mr. Ayamba identified the human resource gap as a critical factor in the implementation of free maternal health. He says inadequate nurses and midwives, especially in rural communities, have been a major setback in its implementation.
“We need more midwives and community nurses in the communities,” he said.
In addition, it talks about the unavailability of some essential medicines. “When essential drugs that are needed to help women in labor or even during the prenatal period to increase their blood levels are not available, it can become a problem,” he emphasized.
He also mentioned the lack of sufficient modern equipment as another challenge, as they were critical in
Another challenge, she said, has been delays in visits to health centers, as more often than not due to lack of transportation and other challenges, some pregnant women are late to deliver at the health center.
THE ROLE OF STAKEHOLDERS
Mr. Ayamba talks about participation and collaboration among stakeholders to ensure access for vulnerable groups. According to him, NGOs, local authorities and the GHS must do things together to avoid duplication and also to ensure inclusion.
In this regard, he said that the district assemblies should allocate some component of their common fund to maternal health, and said that “they should not focus only on infrastructure.”
Madam Gifty Nordzi is the Early Childhood Education Coordinator in Ajumako in the Central Region. She says her outfit is committed to expanding regular community engagements, adolescent reproductive health camps in partnership with GHS to ensure pregnant teens receive the best care.
She noted that due to financial constraints, stigma and the behavior of some nurses, many pregnant adolescents were reluctant to visit health centers for prenatal service.
“In general, we encourage pregnant girls to go to the hospital. Even through that we can get data on the actual number of girls who are pregnant, ”he said.
She praised the CHIPS Compound initiative saying that it has brought healthcare to the doorstep of many rural duelers.
To address the delays that mostly go beyond health facilities to the community and household level, Ayamba said that a maternal health conference was needed involving key stakeholders, i.e. chiefs, assembly members and family members to deliberate on the problems that the system would face.
I WALK FORWARD
To improve the system, she said the government and stakeholders should work to increase the number of midwives to match the growing population, adding that women should not suffer because there are no midwives on site.
Furthermore, he said that the supply of essential drugs and other consumables is an aspect that we have to consider.
Mr. Aymba further emphasized the need to work to improve the communication network between the ambulance system and health facilities to improve access to emergency care.
He also emphasized the need for modern equipment to be provided to support the system, while calling for regular training for midwives. This, he stressed, was necessary to ensure a reduction in maternity-related deaths due to mismanagement of work.
He also encouraged the government to review its policy that restricts the purchase of drugs from health establishments when they are not available in medical stores.
To strengthen maternal health services, Mr. Ayamba proposed the institution of maternal death audit units so that, if maternal death did occur, they could do an immediate assessment at the health center to identify gaps even before it occurred. a gynecologist or doctor comes to provide technical support.
Madam Nordzi of Girl Child Education advised parents and guardians to try to meet all the needs of their girls so as not to fall in prayer to other men who would make them pregnant and leave them to their fate.
This article was prepared as part of the People for Health (P4H) project being implemented by SEND Ghana, Penplusbytes and GNA with the aim of reducing inequities in the provision of health services through the promotion of good practices of accountability governance, transparency, equity and participation.
