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Abstract

Birth preparedness and complication readiness (BPCR) involves preparing for childbirth, bearing in mind the possible complications. The concept of BPCR has the potential to improve the awareness and utilization of suitable medical facilities to ensure safe delivery and minimize maternal and neonatal mortality. The purpose of the study was to explore pregnant women’s perspectives on the benefits and barriers of BPCR in the Northern Ghana. The study employed an exploratory descriptive design using a qualitative approach. Purposive sampling was used to recruit 13 participants. Data was collected through individual face-to-face interviews. The data was analyzed using qualitative content analysis. Out of the 13 participants, the age range for participants was 17 to 37 years; more than half were married, but less than half had no formal education. The participants indicated their understanding of BPCR by explaining the concept of BPCR, dangers signs, and prevention of danger signs. A varied source of information on BPCR was reported including the midwives or clinic, media, and family. The participants indicated that the benefits of BPCR include ensuring adequate preparation, delivery of a healthy child, and arranging for support. The barriers to BPCR were inadequate information, lack of finances, lack of transport, lack of support from the family, and lack of community support. The study findings indicate that the participants were generally informed about the concept of BPCR. However, to enable pregnant women prepare adequately for childbirth, there is a need to involve the husbands in the education on BPCR. The use of mass media to get families and communities educated on the importance of BPCR will enable them to support pregnant women.

Keywords

birth preparedness complication readiness pregnant women Ghana

Introduction

Pregnancy-related health problems are one of the leading causes of death of women of reproductive age in low- and middle-income countries (LMICs), accounting for about half a million deaths yearly during pregnancy and delivery (World Health Organization [WHO], 2019a). Globally, there are 830 maternal fatalities daily with most fatalities occurring in LMICs (WHO, 2015). Meanwhile, the Sub-Saharan Africa (SSA) accounts for around 62% of maternal fatalities worldwide (WHO, 2015, 2019a). Maternal mortality is a serious public health issue, particularly in LMICs. Birth readiness supports active planning for delivery and childbirth and the use of experienced birth attendants (Kaso & Addisse, 2014; Markos & Bogale, 2014; Moran et al., 2006).

Birth preparedness and complication readiness (BPCR) is described by the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) as preparing for childbirth while anticipating possible difficulties (Maternal and Neonatal Health, 2004). Birth preparedness and complication readiness is being promoted worldwide as a technique to reduce the risk of treatment delays during the antepartum, labor, and puerperium (Hailu et al., 2011; Udofia et al., 2013). According to a comprehensive assessment, BPCR resulted in an 18% reduction in neonatal death and a 28% reduction in maternal mortality (Soubeiga et al., 2014). BPCR is a comprehensive method and strategy for a healthy delivery and a substantial intervention to lower maternal and infant mortality (Mekuaninte et al., 2016; Sumankuuro et al., 2016). This BPCR can boost health-seeking behaviors as well as the utilization of suitable medical centers and qualified personnel for delivery, thus minimizing maternal and neonatal mortality (Markos & Bogale, 2014).

Regardless of its immense benefits, BPCR adoption among pregnant women remains low as many of them do not have the plan (Hailu et al., 2011; Mutiso et al., 2008). For instance, a study by Kiataphiwasu & Kaewkiattikun, (2018) in Thailand found that good BPCR was 78.6% compared to a previous studies from India (30%–57%; Mutreja & Kumar, 2015), Ethiopia (17%–54%; Musa & Amano, 2016), and Tanzania (58%; Bintabara et al., 2015). Also, studies have revealed that BPCR levels in Addis Ababa have been within the ranges of 16.5% to 56.3% (Kaso & Addisse, 2014; Nkwosa et al., 2017). Furthermore, age, socioeconomic status, education level, and geographical region are the most prominent predictors of BPCR (Ekabua et al., 2011).

In 2017, about 810 women died per day from avoidable pregnancy and childbirth-related factors of which LMICs account for about 94% of all maternal fatalities (WHO, 2019a). Sub-Saharan Africa (SSA) has the highest maternal mortality rate (MMR), with about 500 pregnancy-related deaths in 100,000 live births (Lomazzi et al., 2014). Ghana, a country in Sub-Saharan Africa, accounts for more than 10% of the global maternal mortality estimates (Ghana Health Service, 2017). In 2017, Ghana reported 308 maternal deaths per 100,000 live births (WHO, 2019b). A significant reason for the high MMR is the inadequacy or lack of birth and emergency preparation, a core component of globally established safe motherhood programs (Kaso & Addisse, 2014). A study on BPCR in Ghana’s rural areas showed that only a few expectant mothers knew three or more obstetric risk indicators (Kuganab-Lem et al., 2014).

Ghana failed in meeting the Millennium Development Goal 5 (MDG 5) objective of decreasing maternal deaths reported in the 1990s by 75% in 2015 (Ghana Health Service, 2017). The issue is considerably worse in Ghana’s impoverished districts, where pregnant women deliver at home with the assistance of unskilled Traditional Birth Attendants (TBA), midwives working in rural areas, relatives, and neighbors (Agarwal et al., 2010). A previous study conducted in the Northern Region of Ghana had over 99% of antenatal care utilization in 2017 (Abubakari et al., 2018), skilled deliveries were low (43.6%) over the same period (Dickson & Amu, 2017). This situation clearly shows a significant gap between pregnant women’s utilization of antenatal care services and their use of expert care during delivery. It is difficult to say why the high percentage of antenatal care usage does not correspond with the use of health facilities during birthing.

An earlier study conducted in the Hohoe Municipality in the Volta Region of Ghana reported a low (15%–19%) BPCR levels among pregnant women (Wurapa et al., 2016). Also, recent research conducted in rural northern Ghana showed that 46.5% of pregnant women were sufficiently prepared for delivery (Bapula et al., 2021). Though BPCR is critical for improving mother and child health, there is a dearth of studies documenting the scope of BPCR in the study area. This study aimed to explore the perceptions of pregnant women visiting an antenatal clinic on BPCR. The outcome of this study will contribute to Ghana’s realization of Sustainable Development Goal (SDGs) 3.1 and 3.2 of reducing maternal, neonate and under 5 years mortality by 70, 12 and 25 per 10, and 1,000 live births respectively.

Methods

Study Design

This study used a descriptive qualitative design to assess birth preparedness and complication readiness among pregnant mothers in the Tamale Metropolis in the Northern Region of Ghana. This design allowed the researchers to explore the perspectives of the women.

Study Setting

The study was conducted in the Tamale metropolis. In 2004, the Tamale Municipal Assembly was upgraded to a Metropolis. The Tamale Metropolitan area is around 180 m above sea level and is located in the central part of the Northern Region. The landscape is primarily flat, with just a few tiny valleys that serve as stream channels. There are a few isolated hills, but they do not impede physical growth. Savelugu Municipality to the north, Yendi Municipal Assembly to the east, Tolon District to the west, Central Gonja District to the south-west, and East Ganja Municipality to the south form the Metropolis’ borders. According to the 2021 population and housing census, the Metropolis’ population is 374,744, with 185,051 males and 189,693 females.

Participants and Sampling Technique

The study participants were pregnant women who attended antenatal clinics at the selected facility. The criteria for inclusion in this study were women between the ages of 18 and 44 years who were willing and able to give informed consent. The participants were those who could speak Dagbani and English language. The participants were pregnant women with more than two antenatal care visits. Pregnant women who were not residents of Tamale Metropolis during the study period were excluded. A purposive sampling technique was used to select the participants. The sample size for this study was 13 pregnant women based on data saturation.

Data Collection Tool

The tool for data collection was a semi-structured interview guide developed by the researchers based on the purpose of the study. The interview guide had four sections. Section A had questions on the socio-demographic data of the participants. Section B, C, and D had guiding questions on knowledge of BPCR, benefits of BPCR, and barriers of BPCR, respectively. Some of the key questions asked were: what do you understand by BPCR? In your opinion, what are some of the danger signs a pregnant woman may experience that can lead to complications? What are the good things associated with knowing BPCR? What are some of the things that will make it difficult for you to adopt the BPCR strategy? Probes were used in most cases to elicit further information.

Data Collection Procedure

Formal permission was obtained from the authorities of the selected hospital. Potential participants were contacted with the assistance of the Antenatal Clinic manager. Based on the inclusion criteria, participants were screened for suitability. The study was explained to the participants, and those eligible and accepted to participate were recruited. Individual face-to-face interviews were conducted in an office in the antenatal clinic after the participants had finished receiving their antenatal services. The participants had the choice to reschedule the date, time, and venue for the interviews but none of them did. The participant then willingly signed or thumb printed a consent form after receiving adequate information on the study and answering their questions. Permission was obtained from the participants for the interviews to be audio-recorded. The interviews were conducted in either the English language or the local Dagbani language, depending on the participants’ preference. The transcripts were discussed with an expert in Dagbani to ensure accuracy. Each interview lasted 25 and 40 minutes. The data were collected between October 2021 and December 2021.

Methodological Rigor

Lincoln and Guba (1985) criteria for ensuring the trustworthiness of a qualitative study, such as credibility, dependability, transferability, and confirmability, were ensured. A member check was conducted to ensure credibility by contacting some of the participants to confirm if the transcribed data and the emerging themes represented their views. A detailed description of participant selection and a thick description of the study setting were provided to allow for transferability. To ensure dependability, the technique for data collection, analysis, and interpretation was included in the report. Also, an audit trail comprising the printed transcripts, analysis notes, and audio recordings was kept for confirmability.

Data Analysis

Data analysis was done alongside data collection using inductive thematic analysis. The interviews conducted in English were transcribed verbatim. The interviews that were conducted in Dagbani were transcribed in English based on the meaning of the statements. An expert in Dagbani was contacted to authenticate the accuracy of the transcripts, and anonymity was ensured throughout the process. The actual analysis involved reading the transcripts repeatedly to become familiar with the data. Key ideas in the form of phrases, sentences, or paragraphs were labeled as initial codes. These codes were categorized into themes and subthemes based on how they were related. The analysis was performed by three of the researchers, of which two are experienced qualitative researchers (BNB, GTN, and VNY). The identified themes and subthemes were revised repeatedly until suitable for presenting findings, following a series of discussions among the researchers.

Results

Socio-Demographic Characteristics of Participants

Table 1 below shows that the age range for participants was 17 to 37 years; 7 (53.8%) were married, 5(38.5%) had no formal education, 8 (61.5%) were Muslims, and 9(69.2%) were Dagombas.

Table 1.

Socio Demographic Characteristics of the Respondents.

Participant number	Age	Marital status	Religion	Educational level	Ethnicity	Occupation
P1	21	Single	Islam	Primary	Dagomba	Farmer
P2	23	Married	Islam	Primary	Dagomba	Trader
P3	22	Married	Islam	SHS	Dagomba	Trader
P4	30	Married	Islam	SHS	Dagomba	Nurse
P5	35	Divorced	Islam	Tertiary	Dagomba	Teacher
P6	33	Married	Islam	Tertiary	Dagomba	Teacher
P7	25	Married	Islam	Tertiary	Dagomba	Teacher
P8	27	Married	Islam	Tertiary	Dagomba	Trader
P9	17	Single	Christianity	No formal education	Dagomba	Farmer
P10	22	Married	Christianity	No formal education	Gonja	Hair-dresser
P11	19	Single	Christianity	No formal education	Gonja	Seamstress
P12	20	Single	Christianity	No formal education	Gonja	Hair-dresser
P13	37	Divorced	Christianity	No formal education	Gonja	Seamstress

Themes and Sub-Themes

In all three (3) main themes including the knowledge of BPCR, perceived benefits and barrier to BPCR were identified. The Knowledge of BPCR had four (4) sub-themes including the concept of BPCR, source of information on BPCR, Knowledge on danger signs and prevention of the danger signs. Also, the second theme, perceived benefits of BPCR had three (3) sub-themes including adequate preparation, ensure healthy baby and getting personal support. Finally, the third theme, barrier to BPCR has five (5) sun-themes including inadequate information, lack of community support, transportation difficulties, and lack of family support (Table 2).

Table 2.

Themes and Sub-Themes.

Themes	Sub-themes
Knowledge of BPCR	a. Concept of BPCR
	b. Source of information
	c. knowledge on the danger signs
	d. Prevention of danger signs
Perceived benefits of BPCR	a. Adequate preparation
	b. Ensure healthy baby
	c. Getting personal support
Barrier to BPCR	a. Inadequate information
	b. Lack of community support
	c. Transportation difficulty
	d. Financial difficulty
	e. Lack of family support

Knowledge of Birth Preparedness and Complication Readiness (BPCR)

In this main theme, the participants explain the concept of BPCR and sources of information on BPCR. The themes also have other subthemes, including knowledge on danger signs and prevention of danger signs.

Concept of BPCR

The participants described BPCR from their perspectives. The women’s description of the meaning of birth preparedness and complication readiness was centered mainly on household preparations related to buying clothes, saving money, and preparing for emergencies.

“What I know is how I will put things together for delivery like buying new clothes for the baby” Participant 1

Some participants indicated that environmental and financial preparation were central factors in BPCR. They explained that financial preparation was necessary to acquire material needs and proper feeding.

“I prepared many things. The surrounding environment are cleaned, I saved money for some expenditures like to buy bedsheets and groceries. When a woman gives birth, there is bleeding, so she needs to eat good diet.”Participant 4

Sources of Information

The participants identified various sources of information as sources from which they got information on BPCR. All the participants have heard of birth preparedness through the midwives or clinic, media, and family.

“I had this information when I came to clinic. The midwives talked about it when I came for my ANC visit”. Participant 1

Some participants have heard about birth preparedness through the media.

“I got to know about birth preparedness through television and radio discussions on the health of a pregnant woman”. Participant 6

Another participant explained:

“I read about it from someone’s post on Facebook and some educative pages I join”. Participant 9

Family and relatives were identified as a source of information on BPCR by some participants.

“My mother-in-law and my mother have equally been a source of information on birth preparedness and complication readiness”Participant 2

“My elder sisters who have given birth before taught me about preparing for birth”. Participant 10

Danger Signs

The participants indicated that knowledge of danger signs helps in the early identification and treatment of obstetric emergencies. Knowledge about the danger signs enables her to seek help from the skilled birth attendant early. Most of the respondents knew at least one danger sign that could occur during pregnancy.

“We were told to report to the hospital if we are experiencing vaginal bleeding”. Participant 8

Participants mentioned excessive vomiting as a danger sign;

“During health education at the ANC clinic, the midwives mentioned that, we should report to the hospital when we have severe headache and vomits profusely”. Participant 3

The participants expressed an understanding of the effects of danger signs. Some of them indicated that one could even die out of the signs if not treated. They also knew that; dangers could lead to complications during delivery and birth abnormalities.

This is what a participant had to say;

“If the danger signs are not detected early, it can affect the life of the mother and the unborn baby. The baby can develop some abnormalities at birth and the mother and the baby can also die in labour”. Participant 12

Another participant added that:

“The danger signs can lead to more serious medical conditions in both baby and mother”. Participant 9

Prevention of Danger Signs

The participants expressed how preventing danger signs could increase the chances of having a healthy baby, managing health conditions, and adopting healthy behavior. The participants stated how to prevent danger signs and how positive they were about doing them.

The participants believe that taking pregnancy medication and following the guidelines would prevent pregnancy-related death and complications.

“I think I prevent complications if I take my routine medications as prescribed and do all the things, I am told at ANC visits”. Participant 2

Other participants shared that visiting the hospital regularly could prevent dangers in pregnancy.

“I think that, coming for ANC regularly will allow the skilled birth attendants to identify dangers early and provide remedies. Also, making good use of the health education they give us during ANC”. Participant 3

Participants also expressed eating well and exercising as ways to prevent pregnancy-related complications;

“I think, I should eat well and must also engage in mild exercises that can be tolerated”. Participant 4

Perceived Benefits of Birth Preparedness and Complication Readiness (BPCR)

This theme explained the identification of benefits of BPCR by the participants. The expectant mothers perceived that BPCR would enable the pregnant woman to prepare adequately for the delivery, have a healthy baby, and arrange for personal support.

Adequate Preparation

The participants viewed pregnancy as a state where the women could face health problems. The participants thought this uncertainty made them live in fear. Therefore, birth preparedness was seen as a major step in getting themselves ready for childbirth. The responses given by the participants were mostly related to being ready for uncertainties, having no fear, and getting all items that will be needed.

Some participants indicated attending ANC was essential. They believed that pregnancy was associated with unpredictable outcomes; hence BPCR was necessary to deal with these unforeseen circumstances.

“Birth preparedness has helped me to prepare myself very well. In pregnancy, anything can happen, but I am always prepared. Adequate preparation has helped me, I will encourage others to attend ANC and prepare well for birth” Participant 13

The participants were of the view that preparing will make help do away with any fear.

“I will not be afraid because I know what I have to do so that I will be able to give birth without any problem”. Participant 2

The participants also indicated that financial preparation as part of BPCR is necessary for meeting the needs of the expected child. Participants overwhelmingly viewed being financially stable as an important benefit of birth preparedness and complication readiness. The responses given were basically about saving money. Respondents shared their experiences below;

“Birth preparedness will help to know how to put things together. To save some money towards delivery for any emergency and other medical bills” Participant 9

“Birth preparedness will help me to save money rather than waiting for my husband”. Participant 5

Another woman added that;

“This information will help me to keep some money so that I can buy all the things I need to buy when I am in labour”. Participant 9

Ensure Healthy Baby

The participants expressed how every pregnant woman faces the risk of sudden and unpredictable complications that could result in injury to her infant. According to their responses, giving birth in a hospital and detecting deviations from normal will help ensure that their babies remain healthy.

The participants responded to hospital delivery as part of BPCR to ensure a healthy baby.;

“My baby will be delivered at the hospital so that all the necessary care will be provided to him at birth”. Participant 4

“The baby will receive all the needed care at birth in the hospital during delivery”. Participant 6

Other participants also expressed detecting deviation from normal as a benefit of BPCR.

“Birth preparedness will help to identify somethings we might not be expecting like; when baby is not growing well and when baby is not breathing well” Participant 1

“Birth preparedness will help to detect any deviation in the baby’s condition to report early to the health facility”. Participant 3

Getting Personal Support

The respondents knew that having a companion improves the whole birth experience. They believed that women who lack support during pregnancy might experience intense fear of childbirth.

Participants explained that looking for assistance is necessary:

“Birth preparedness will enable me to find someone to assist me at home especially during my last trimester so that she can take care of the children when I am in labour”. Participant 6

“Birth preparedness will help to look out for a person who will support me in this condition (pregnancy) and during labour”. Participant 1

A participant also expressed getting blood donors as a form of personal support by mentioning that:

“Birth preparedness will help to get people who can donate in case there is the need for blood”. Participant 13

Barriers to Birth Preparedness and Complication Readiness

These are factors perceived by respondents to hinder BPCR. The barriers to BPCR identified by the participants include inadequate information, inadequate community support, transportation difficulty, financial difficulty, and inadequate family support.

Inadequate Information

Respondents noted that the inadequacy of information at the hospital could be a barrier to BPCR. Most of the women admitted that failure to attend ANC and lack of access to the media are barriers to women getting adequate information;

“If I don’t come for ANC, I don’t think I will get information on how to prepare myself, and If I come and the midwives do not provide me with this information, then it will be difficult to get this knowledge.” Participant 10

Some of the ’women’s understanding about barriers to receiving adequate knowledge on birth preparedness was lack of access to the media hence describing it as;

“When we do not have access to television or radio, we will not get enough information about how to prepare for birth since they show health programs that educate us on birth preparedness”. Participant 8

Lack of Community Support

The participants indicated that the communities where they find themselves do not provide the needed support for making their pregnancy safer, including timely use of life-saving emergency obstetric care services. The responses from the participants about the kind of support they get from the community indicated the promotion of home delivery and the use of previously used items.

They explained home delivery being promoted with such responses:

“Most women in my community deliver at home with the help of some old women and they don’t get any problem so they don’t say much about how to prepare for birth. In my community, not much attention is giving to pregnancy because its considered normal” Participant 10

Participants also shared that, old clothes and materials used is a barrier to birth preparedness and described it as such:

“In my community, much preparation is not done since items from older siblings are kept to be used during delivery. Old clothes are used in place of pads so we don’t see the need to buy when we can improvise especially with baby things” Participant 8

Transportation Difficulty

The participants expressed how transport is a critical issue in health care access serving as a link between home and health facilities. They mentioned that distance to health facilities, poor road networks, and non-availability of means of transportation have been identified as critical barriers to birth preparedness.

“Where I stay is far from the roadside so getting means of transportation to the hospital is difficult sometimes” Participant 5

Participants shared that poor road networks tend to be a barrier to birth preparedness;

“Because of the poor nature of our roads, coming to antenatal clinic becomes difficult sometimes, especially during the rainy season”. Participant 9

Financial Difficulty

The respondents explained how financial challenges hinder their BPCR. Most of the participants explained that they were not working hence it was difficult preparing for birth and emergencies.

The participants described unemployment as a barrier to getting the money needed for adequate preparation for delivery.

“I am a housewife, I depend on my husband since am not working which means that if he doesn’t give me money, I can’t prepare adequately for birth. I need to prepare for the childbirth and any unforeseen circumstance that may occur”. Participant 2

For some of the participants, their husbands do not even support them financially to take care of the pregnancy hence a barrier to BPCR

“I am a housewife and I don’t get support from my husband so I don’t normally plan before delivery”. Participant 10

Other participants mentioned insufficient funds as a barrier to birth preparedness.

“When there is no money or it is not enough, it will be difficult to get all the things you need for yourself and the unborn baby”. Participant 3

“I don’t earn much from my trade so I have to manage when buying the items for delivery”. Participant 7

Lack of Family Support

The participants recognized that family members were a major source of support, but this was not forthcoming. They expected that family members would help with house chores and take them to the hospital when the need arose. However, the lack of support from family was attributed to family members being busy, and staying far away from the family members.

“If we have family members around us during pregnancy, they help us with house chores, give some advises and accompany you to the hospital most times.”. Participant 5

Some participants shared how they were affected by the lack of support from family members.

“I think when family members are around to help, it makes the preparation easy but when you do not have such support, you easily get tired and frustrated” Participant 14

Participants explained why some could not support from family members.

“These days, everybody seems to be busy and some of us have left our families to settle at other places making it difficult for us to get the needed help”. Participant 8

Participants also talked about the importance of family members in decision-making.

“When making decisions and plans alone, we tend to forget some important aspects of the plan, so with people around to support, preparing will be easy and simple”. Participant 1

Discussion

The study was conducted among pregnant women on birth preparedness and complication readiness in the Tamale Metropolis in the Northern Region of Ghana. Birth preparedness and complication readiness (BPCR) is an important process involving planning for normal birth and anticipating the actions needed in case of an emergency (Ekabua et al., 2011). The current study revealed that all the participants have heard of birth preparedness and complication readiness. Their major sources of information on birth preparedness and complication readiness were the midwives, media, family members, and relatives. Similarly, in Nigeria, respondents received information on BPCR from their healthcare providers, community health workers, their mothers, mass media, and the internet (Ekabua et al., 2011; Nkwocha et al., 2017). Contrary to this finding is a study in Ethiopia by Markos and Bogale (2014), where the vast majority of the respondents had never heard of birth preparedness and complication readiness. The high level of awareness of participants in the present study on birth preparedness and complication readiness could be attributed to the high antenatal care coverage by skilled providers in Ghana, which is above 80% (Ghana Statistical Service et al., 2018).

The present study showed that the participants’ description of the meaning of birth preparedness and complication readiness was centered mainly on household preparations related to buying clothes, saving money, and preparing for emergencies. Nkwocha et al. (2017) expressed a similar study finding in Nigeria, where nearly 80% of the respondents knew about BPCR. However, another study in Lagos, Nigeria, by Mbonu (2018) reported that 63.6% of the respondents had good knowledge on the components of the birth preparedness and complication readiness concept.

The present study further suggests that most of the participants knew at least one danger sign that could occur during pregnancy. Some participants remarked that pregnant women could die from a danger sign or develop birth complications if not treated. These findings corroborate with other studies where participants knew some of the danger signs in pregnancy and agreed to birth complications and death if the danger signs are not identified and treated early (Kaso & Addisse, 2014; Mbonu, 2018; Nkwocha et al., 2017). In sharp contrast to this finding is a study by Idowu (2015), where the majority of the respondents demonstrated poor knowledge of danger signs in pregnancy. In the present study, knowledge of at least one danger sign in pregnancy could be attributed to regular antenatal visits, where education is given on these danger signs and their implications for their health.

The present study found that birth preparedness made participants ready for uncertainties, having no fear and getting all items needed before, during, and after birth. A similar finding is reported by Kaso and Addisse (2014) where respondents indicated BPCR makes them prepared for any uncertainties during pregnancy. Relatedly, the World Health Organization reports that BPCR plans contain the following elements: money for any expenditures, location of the nearby health facility for birth, preferred place of birth; desired birth attendant; and in case of complications, supplies and materials to bring to the facility; an identified labor and birth companion; an identified support person to look after other children at home; identified transport to a facility for birth or in case of complications; and identification of compatible blood donors if needed (Campbell & Graham, 2006).

As part of BPCR the pregnant woman is required to save some money. The women viewed this as essential factor because the emergency arising from child birth have financial implications. Consistent with this finding is a study conducted in Egypt by Aziz et al. (2020), where the most frequently mentioned practice of BPCR was the preparation of essential items for delivery and newborn care, followed by saving money for emergencies. Most of the participants in the present study also expressed that getting personal support from the home in the last trimester of pregnancy and blood donors in case of emergency will improve pregnancy outcomes. This finding is supported by a study in Nigeria (Onayade et al., 2010) and Egypt (Aziz et al., 2020) in which participants arranged for blood donors and a transport method in readiness for birth.

Another standpoint of the current study is that communities in which participants find themselves do not provide the need-based support for making their pregnancy safer, including timely use of life-saving emergency obstetric care services. Contrary to this finding, a qualitative study in Tanzania showed community members were prepared for childbirth and had moderate knowledge of some danger signs of complications but could not translate it into practice due to limited autonomy for women’s decision-making (August et al., 2015). Community resources were poorly known or recognized by the majority of the women in this study. Considering the importance of community support, there is the need to extend education and communication to the women’s families and the general community members on BPCR and obstetric danger signs.

The participants of the current study explained how transport is a critical factor in accessing health. They bemoan poor road network and non-availability of means of transport as a critical barrier to BPCR. This finding is in tandem with a study in Tanzania, where difficulty in finding transport to health facilities, long distances from health facilities, cost of transport, and hospital bills were linked to the high maternal deaths (Orwa et al., 2020). On the contrary, a study by Aziz et al. (2020) in Egypt showed that participants made little effort in arranging transportation due to the proximity of the health facilities to the pregnant women. The present study findings call for increased access to good road networks to facilitate easy access to the nearest health care facility. Also, pregnant women as part of BPCR need to make sufficient transport arrangements when the need arises.

The participants indicated that financial constraints are a major barrier to access to maternal health services. Some participants in this study are not getting financial support from their spouses, yet they are unemployed, making it quite difficult to prepare financially for the delivery. Similar results have been shared in a study in Egypt where lack of funds was a major barrier to BPCR (Aziz et al., 2020). Women in the study agreed that women may not go to the health facility due to financial difficulty (Aziz et al., 2020). There is a need for financial empowerment of women to make them financially independent.

Participants in the present study reported that stress could develop as a result of a lack of family support for pregnant women, and they tend to forget the important aspect of birth preparedness. In rural Tanzania, August et al. (2015) posited that women who received adequate support from partners during antenatal care and general preparedness for birth were ready for complications. According to Kakaire et al. (2011), in a study conducted in Uganda, out of 140 women in rural Uganda, only 43% received spouse support to ANC; 42% had their husbands look after children; 25% received support in doing household chores while the husbands accompanied 68.6% of the mothers during labor.

Strengths and Limitations

The paper provides new insights on birth preparedness and complication readiness as it is the first STUDY to explore this concept in northern Ghana were medical resources are constrained and the people also are generally poor. The qualitative approach allowed for in-depth exploration of the pregnant women’s perspective on the concept.

The findings may not be generalizable to other settings because of the qualitative approach which comes with a small sample size. The non-involvement of husbands in the study did not allow for a broader understanding of how the couples together perceive birth preparedness and complication readiness.

Conclusion

This study’s findings indicate that BPCR is a concept that has received some attention. Pregnant women who attend antenatal clinics have a general awareness of BPCR and its benefits. The barriers identified by the study show the need to involve other stakeholders such as husbands, family members, and the community as a whole. These stakeholders should be educated on BPCR through mass media, religious bodies, and community durbars. Their involvement will enable them to understand the need for them to support pregnant women with BPCR.

Footnotes

Acknowledgements

We appreciate all the pregnant women who availed themselves to be part of the study at will.

Author Contributions

All the authors were responsible for study. They all contributed intellectually, and proofread and approved the final version of the manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

The Ethics Committee on Human Research, Publications, and Ethics of the Kwame Nkrumah University for Science and Technology granted ethics to this study with reference number (CHRPE/AP/455/21). Participants gave informed written consent after they got full information about the study. Privacy and confidentiality were ensured throughout the data collection process and reporting of the findings. Anonymity was ensured by representing the participants with codes such as participant 1, 2, and 3, depending on their chronologic recruitment into the study.

ORCID iDs

Gilbert Ti-enkawol Nachinab

Mubarick Nungbaso Asumah

Data Availability

The data used to support this study are available from the corresponding author upon request.

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Perceptions on Birth Preparedness and Complication Readiness: Perspectives of Pregnant Women

Abstract

Keywords

Introduction

Methods

Study Design

Study Setting

Participants and Sampling Technique

Data Collection Tool

Data Collection Procedure

Methodological Rigor

Data Analysis

Results

Socio-Demographic Characteristics of Participants

Themes and Sub-Themes

Knowledge of Birth Preparedness and Complication Readiness (BPCR)

Concept of BPCR

Sources of Information

Danger Signs

Prevention of Danger Signs

Perceived Benefits of Birth Preparedness and Complication Readiness (BPCR)

Adequate Preparation

Ensure Healthy Baby

Getting Personal Support

Barriers to Birth Preparedness and Complication Readiness

Inadequate Information

Lack of Community Support

Transportation Difficulty

Financial Difficulty

Lack of Family Support

Discussion

Strengths and Limitations

Conclusion

Footnotes

Acknowledgements

Author Contributions

Declaration of Conflicting Interests

Funding

Ethical Approval

ORCID iDs

Data Availability

References