D ELIVERY C ARE

Labour and delivery is the shortest and most critical period of the pregnancy-childbirth continuum because most maternal deaths arise from complications during delivery. Even with the best possible antenatal care, any delivery can become a complicated one and, therefore, skilled assistance is essential to safe delivery care. For numerous reasons many women do not seek skilled care even when they understand the safety reasons for doing so. Some reasons include cost of the service, distance to the health facility, and concerns about the quality of care. The availability of free maternity services and community-based health planning services (CHPS) has helped remove barriers to accessing skilled maternity care. The CHPS compounds are manned by community health officers or nurses, some of whom are midwives or have midwifery skills. They attend deliveries and make referrals if complications arise.

9.2.1 Place of Delivery

In the 2014 GDHS eligible women were asked to report the place of birth for each child born in the five years preceding the survey. Table 9.5 shows the percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics. Overall, 73 percent of births were delivered in health facilities, with the public sector accounting for the largest proportion (65 percent).

Delivery in a health facility decreases with increasing birth order, from 84 percent among first-order births to 54 percent among births of sixth or higher first-order. As expected, the proportion of births delivered in a health facility increases substantially with increasing number of ANC visits. Births in urban areas are much more likely to be delivered in an institutional setting than births in rural areas (90 percent versus 59 percent). Delivery in a health facility varies widely by region from 63 percent of births in Upper West to 93 percent of those in Greater Accra. There is a strong association between health facility deliveries and mother’s education and wealth quintile. The proportion of deliveries occurring in a health facility increases from 52 percent for births to women with no education to 95 percent for births to women with a secondary or higher education. Similarly, health facility deliveries are substantially fewer among births in the poorest households (46 percent) than those in the wealthiest households (96 percent).

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Table 9.5 Place of delivery

Percent distribution of live births in the five years preceding the survey by place of delivery, and percentage delivered in a health facility, according to background characteristics, Ghana 2014

Health facility

characteristic Public sector Private sector Mother’s age at birth

Note: Total includes 22 women for whom information on ANC visits is missing.

1 Includes only the most recent birth in the five years preceding the survey

9.2.2 Assistance at Delivery

Obstetric care from a health professional during delivery is recognised as critical for the reduction of maternal and neonatal mortality. Children delivered at home are usually more likely to be delivered without assistance from a trained provider, whereas children delivered at a health facility are more likely to be delivered by a trained health professional.

Table 9.6 shows delivery assistance for all live births in the preceding five years, by type of provider, according to background characteristics. Three-quarters of births in Ghana (74 percent) are delivered with the assistance of a skilled health professional: 14 percent are assisted by a doctor, 57 percent by a nurse/midwife, and 3 percent by a community health officer/nurse. Data further show that 16 percent of births are delivered by a traditional birth attendant, 7 percent are assisted by a relative or other person, and 3 percent of deliveries are not assisted by anyone. It is notable that, even though nationally, only 3 percent of births are assisted by a community officer/nurse, this is true for almost one in five births (18 percent) in Upper West, indicating the crucial role of these providers in this region. Furthermore, data show that traditional birth attendants play an important role in the Northern region, assisting in the delivery of 4 in 10 births (41 percent).

Delivery assistance by a skilled health professional shows little association with women’s age.

However, it decreases steadily with increasing birth order from 85 percent of first-order births to 55 percent of births of sixth or higher order. This proportion increases substantially with the number of ANC visits, and it is higher among births in urban than in rural areas (90 percent versus 60 percent). Skilled provider assistance at delivery increases notably with mother’s level of education and wealth quintile. For example, 52 percent of births to women with no education are assisted by a skilled health professional, as compared with 96 percent of births to women with a secondary or higher education. This percentage ranges from 47 percent of births in the poorest households to 97 percent of those in the richest households.

Table 9.6 Assistance during delivery

Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage of birth assisted by a skilled provider, and the percentage delivered by caesarean-section, according to background characteristics, Ghana 2014

Person providing assistance during delivery

Total Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation.

Totals may not add up to 100 percent because women with missing information have been deleted. Total includes 22 women for whom information on ANC visits is missing and 2 women for whom information on place of delivery is missing.

1 Skilled provider includes doctor, nurse/midwife, and community health officer/nurse.

2 ANC visits includes only the most recent birth in the five years preceding the survey.

Table 9.6 also presents data on the prevalence of deliveries by caesarean section (C-section).

Nationally, 13 percent of births are delivered by cesarean section, an increase from 7 percent in 2008.

Delivery by C-section is highest among births to women age 35-49 (17 percent), first-order births (18

Maternal Health • 117 percent), births for whom mothers had four or more ANC visits (15 percent), births in urban areas (19 percent) and in the Greater Accra region (23 percent), births to mothers with a secondary or higher education (27 percent), and those in the richest households (28 percent).

Figure 9.1 shows the percent distribution of mothers with a birth in the five years preceding the survey who delivered their last birth in a health facility, by duration of stay in the health facility and type of delivery. As expected, the large majority of women with a vaginal birth stayed at a health facility for two days or fewer (88 percent). In contrast, the large majority of women who delivered by C-section (89 percent) stayed at a health facility for three or more days.

Figure 9.1 Mother’s duration of stay in the health facility after giving birth