Stakeholder's experiences, expectations and decision making on reproductive care: An ethnographic study of three districts in northern Ghana

BACKGROUND In Ghana, priority-setting for reproductive health service interventions is known to be rudimentary with little wider stakeholder involvement. In recognizing the need for broad stakeholder engagement to advance reproductive care provision and utilization, it is necessary to jointly study the varied stakeholder views on reproductive care services. METHODS We applied an ethnographic study approach where field data was collected between March-May 2015 in three rural districts of northern Ghana. Data was collected among women with recent births experiences (n = 90), health care providers (n = 16) and policy actors (n = 6). In-depth interviews and focus group discussions was applied to collect all data. Each stakeholder participant's audio file was transcribed, and repeatedly read through to identify similar and divergent views in data. A coding scheme guided coding processes. All transcripts were then imported into QSR NVivo 11 for further analysis. RESULTS Four themes emerged. Women participants accentuated that sex and sexuality values of men have changed over time, and drives gender roles, parity levels and decision making on reproductive care needs at community levels. Sexual stigma on reproductive care reduces the willingness of women to voice poor experiences related to their previous reproductive experiences. All stakeholders' highlighted clinical treatments for post-abortion care are minimally covered under the fee exemption policy for antenatal and postnatal care. Policy processes on service delivery protocols still is top-down in Ghana. CONCLUSIONS Health teams working to improve sexual and reproductive health care must find suitable context strategies that effectively work to improve women reproductive care needs at their operational levels. Private sector participation and informal community support clutches are encouraged to advance the delivery of reproductive care services.