Socio-cultural barriers to midwifery services and Maternal Health care outcome in the Ashanti Region of Ghana.

Abstract: Background: Despite significant national progress, Ghana continues to face disparities in maternal mortality, largely concentrated in rural areas. The Ashanti Region, a cultural and economic hub, exemplifies this paradox, with relatively strong health infrastructure yet persistent socio-cultural barriers to skilled midwifery care. Methods: This desk review synthesizes current data from the Ghana Demographic and Health Survey (2022), Ghana Health Service Annual Reports (2022-2023), and recent peer-reviewed literature to analyze the socio-cultural determinants influencing the utilization of midwifery services in rural Ashanti. Results: Key barriers identified include a strong cultural preference for Traditional Birth Attendants (TBAs) as spiritual and cultural custodians, matrilineal and gerontocratic decision-making structures that disempower pregnant women, spiritual interpretations of obstetric complications, and logistical challenges exacerbated by cultural norms of modesty. Ghana Health Service strategies, such as the revised CHPS model and TBA integration programs, show promise but require deeper cultural integration. Conclusion: The findings underscore that improving maternal health outcomes in such contexts requires moving beyond infrastructural investment to implement culturally intelligent policies that respectfully engage with traditional norms, leverage existing community structures, and redefine skilled birth attendance within a local socio-cultural framework.

Keywords: Maternal Health, Midwifery, Socio-Cultural Barriers, Traditional Birth Attendants, Ashanti Region, Ghana, Health Systems, CHPS