Barriers to Ghanaian midwives’ ability to provide quality care: A Glaserian grounded theory study

The midwifery model of care that promotes the employment of trained and regulated midwives for the provision of maternal and neonatal care has been found to be beneficial, especially in Low and Middle-Income Countries that have high maternal and neonatal mortalities. Midwives in those setting are however, facing a myriad of barriers which negatively affect their ability to provide optimal care. Although Ghana is implementing the midwifery model of care, maternal and neonatal mortality remains high in the country. Little is known from the point of view of midwives, who are the primary providers of maternal and neonatal care, about the barriers that they face in their bid to provide optimal care to women and neonates. This study explored the barriers to Ghanaian midwives’ ability to provide quality care, investigated the consequences of these barriers on the midwives, and unearthed the processes that they employ to be able to complete their duties. Glaserian Grounded Theory was utilised in this study as it provides a way to explain ongoing behaviours of participants and the way they solve their issues of concern. Nonparticipant observation and semi-structured interview data were collected in the Greater Accra Region of Ghana. The analysis of the data led to the discovery of a middle range grounded theory titled “Doing magic with very little” that explains the barriers for midwives at the personal, professional, organisational, socioeconomic and macro-economic levels, affecting their ability to provide quality care; and the personal and professional consequences of these barriers, and the coping strategies that they adopted to be able to fulfil their roles. The findings of the study identified that although Ghanaian midwives are devoted to providing quality care to women and neonates, they are faced with several challenges to doing so. These include resource deficiency in the form of inadequate infrastructure, equipment and supplies, and inadequate referral and human resources. Participants were also faced with unsupportive facility management and an inability by clients to contribute to their own care for various reasons. The barriers to participants’ ability to provide quality care were found to have physiological, psychological and socioeconomic consequences for them and implications for those in their care. Despite the quality care barriers that midwives face and the consequences of those barriers, it was discovered that they were still able to complete their duties due to their ability to employ coping strategies. The midwives’ ability to cope was identified to emanate from their motivation to see women give birth safely to healthy babies, and their strong affection for the midwifery profession. Midwives’ motivation was identified along with othercoping strategies that included improvising, ensuring close monitoring of their clients and maintaining a support network. The study reported in this thesis presents the first known report of contemporary Ghanaian midwifery, its challenges, and its rewards from the direct perspective of midwives. The clear insights that this work provides into what hinders quality midwifery care in Ghana, how those hinderances impact midwives personally and professionally, the coping mechanisms that midwives employ to handle the difficulties they face in their workplaces, and the recommended areas for further research will be of value to policy makers, maternity service leaders, and educators of midwives