Compliance with emergency obstetric care referrals among pregnant women in an urban informal settlement of Accra, Ghana

This study examines the situation that women face when they require emergency obstetric care in urban Accra. The analysis clarifies the referral options available to women needing emergency obstetric care, assesses the constraints they face in accessing the obstetric referral system and identifies the drawbacks associated with the obstetric referral system for women living in informal settlements of a rapidly growing district in Ghana. This research was a descriptive cross-sectional study using structured questionnaires administered to antenatal care clinic attendees and in-depth interviews of principal healthcare personnel. Sixty-five women had referrals in their previous pregnancies of which 62 went to the referral centre at varying time intervals. Three respondents did not go due to lack of financial resources and preference for traditional services. With regard to adherence to referral advice, lack of finances was the major constraint (46.2 %) followed by client complaints about the attitudes of nurses at the referral centres (10.8 %), fear of surgery (7.7 %) and concerns about the distance to referral centres (4.6 %). Moreover, analysis identified a significant positive association between parity and time elapsed between service encounter and compliance with referral (p = 0.001). Major constraints are faced by women when they attempt to utilize referral healthcare services such as financial problems, perceived remoteness of care points, fear of surgical procedures and concerns about the discourteous attitude of nurses at the referral centres. Healthcare providers however, emphasized other elements of the climate of care such as their perceived need for increasing staff strength.