Globalization and changes in the culture of survival and care the case of ghana
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Globalization and changes in the culture of survival and care: the case of Ghana. Dr Phyllis Antwi January 2007. Introduction. “There are certainly good and bad sides of globalisation. It is a challenge for us all to make sure it all moves in the right direction.” David Heymann-WHO.

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Globalization and changes in the culture of survival and care: the case of Ghana

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Globalization and changes in the culture of survival and care: the case of Ghana

Dr Phyllis Antwi

January 2007


  • “There are certainly good and bad sides of globalisation. It is a challenge for us all to make sure it all moves in the right direction.” David Heymann-WHO

The Care Gap

  • Poverty of women and children remains one of the challenges for Ghana.

  • To address this issue, Ghana has adopted a Poverty reduction strategy to launch it into a middle income country by 2015

  • However the strategy does not address the care gap that exist and continues to undermine human development in the country

Research studies being conducted on care

  • Patterns of child care and neglect in the Wa area in the North West of Ghana

  • Care of elderly women (barren and grand mothers in Teshi district of Accra

  • Child care by itinerant market women on the edge of the Volta Lake

  • Maternal care during pregnancy in the context of continuing high fertility


  • Maternal mortality is a good indicator of the quality of life of women. It signifies the CARE women receive during one of the periods in their lives when they are most vulnerable


  • Worldwide more than 500,000 women die during childbirth every year.

  • The major causes of all maternal deaths are:

    • hemorrhage

    • Infections

    • Unsafe abortion

    • Obstructed labour

    • Hypertensive disorders of pregnancy

What is the situation like in Ghana?

  • Total Fertility rate 4.4

  • Contraceptive prevalence 20%

  • Maternal mortality Rate 214 per 100,000

  • Antenatal care 90%

  • Supervised delivery 46%

  • HIV prevalence less than 3 per cent

What is being studied?

  • Making motherhood safe: Gender, culture and socio economic context of maternal care in the Ashanti region

Objectives of the study

  • To review Ashanti norms and cultural practices relating to pregnancy, childbirth and motherhood

  • To examine the cultural and social factor that influence the use of modern amenities, and the perception, knowledge, attitudes and practices with regard to pregnancy and delivery

District profile

  • Sekyere West is one of the 18 districts in Asanti region

  • The district capital is Mampong-57kilometres from Kumasi

  • The population is 134,116 (GSS-2000)

Health infrastructure

  • There is one District hospital,

  • 11 health centres

  • 2 MCH clinics

  • 8 private/mission clinics

The process of childbirth

  • Preparation during pregnacy

  • Labour

  • Delivery

  • Post partum care of the woman

  • Care of the baby

Preparation for child birth

  • The preparation starts at puberty

  • “Kwasi Broni mmae no na ye wo yen ammammere” We had our traditions before we were colonised. We had to stop or modify them when (they) arrived

  • “Nafifidee ba abonten na ya kata ne nufuso” A girl starts to dress properly and cover herself when the physical signs of maturityappears. This is about age 10 years

  • “Abayewa tware mprenu na kyere se wa ye bra” When a young girl begins to have her bath twice a day, it is assumed that she has had her period.

  • “”

Preparation for child birth

  • “Abusua pe se ye hye wo animoyam” The family wants to mark (celebrate) her entry into womanhood. This is important because among the Asantes, (matrilineal society), prolific childbearing is honoured.

  • “Se wo nkyima a ,yen goro wo bra” The nubility rites cannot be performed until after the onset of a girl’s first menstruation

Health care systems available to pregnant women

  • Women use multiple systems of care when pregnant

    • Biomedical care

    • Traditional herbal care

    • Spiritual care

Herbs used in pregnancy

  • “Busummuru adwera”-to make the baby strong.Taken from the third month until delivery

  • “Kookoo ahahan”- to ensure a healthy child

  • “Hagoro”- to make the baby strong. Taken from the sixth month

Herbs used in pregnancy

  • Easy delivery

    • “Bonhon”-given to women during the eight month until term to ensure easy delivery

  • Induction of labour

    • “Abooto”- used only once.This is to initiate labour

  • Retained Placenta

    • “Akandedua”-given to women with retained placenta

Emergency obstetric care

  • Availability of facilities for emergency obstetric care is in Mampong only

  • The hospital serves other district in Ashanti region as well as Brong Ahafo

Case Study 1

  • Madam Afua Serwah is 32 years

  • Multip of one from Aframso

  • First child was delivered at home

  • Attended antenatal care at the maternity wing of the Mampong district hospital during her second pregnancy

  • She made eight (8) visits

  • Went into labour 1st January 2005 at 4.30am

  • Was attended by a trained TBA

Case study 1

  • At 8.00am husband was requested to look for transport to send her to Mampong District Hospital

  • Got a vehicle at 3.00pm and was charged 460,000 cedis ($50).The normal fare per person is 12,000 cedis ($1.2)

  • At the District hospital she had a C-section however the baby was fresh still birth

Case Study 1

  • She is currently not on any contraception

  • She suspects she is three months pregnant but has not told the husband

  • She intends going to the clinic at Mampong.

  • She has not been able to inform her husband that she is pregnant. She wants to be sure that this pregnancy “will stay”

Case study 2

  • Maame Akua Addai

  • Multip of 14

  • Last delivery had prolapsed arm

  • Was sent to Mampong but the nurses were on strike ( better conditions of service)

  • Was eventually sent to Komfo Anokye Teaching Hospital

Globalisation and human resource crisis

  • International migration for labour is the most striking manifestations of globalisation of the world economy

  • Global liberalisation of trade has led to an increase in the international migration of professionals, including physicians

Estimated vacancy levels of health professionals 1998-2002

No. of health professionals who left in 2003

  • Doctors 166

  • Professional nurses 583

  • Auxiliary nurses 449

Implication for prevention of mother to child transmission

  • Few pregnant women are offered voluntary counselling and testing for HIV

  • Most pregnant women do not know their HIV status

  • Low uptake of anti-retrovirals by HIV positive pregnant mothers because they deliver at home


  • The Akan society is guided by the philosophy that “It is a human being that has value”.

  • High fertility continues to be the norm in Ghana

  • Women try to reach adequate services when an emergency occurs

  • Health system failures (major human resources crises) have been identified as a major contributory factor to maternal deaths

Thank you

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