| Summary: | Ghana, one of the challenging contexts settings in sub-Saharan Africa, is a strong democratic nation and one of the area’s emerging economies, yet the country still faces poor maternal health with maternal mortality ratios at 350/100,000 live births. This statistic means that the country’s efforts to achieve Millennium Development Goal-5—the reduction of maternal mortality by 75 per cent by 2015—remains a mere dream. In this dissertation, I explore rural Ghanaian women’s perspectives on the influence of social structures—especially, kinship and gender relations, individual maternal practices, the social meaning of motherhood and cultural beliefs—on their reproductive health decisions and maternal health service utilization. Secondly, I explore rural midwives’ perspectives on providing services to women in Talensi-Nabdam district of the Upper East Region. Using ethnographic methods— participant observation, face-to- face interviews, focus groups, “deep hanging out”—I gathered data in six villages and four health clinics. Participants included 27 women of childbearing age as well as older women who provide traditional maternal health services to rural women and four midwives. My findings suggest that a complexity of socio-cultural structures and concepts, sustained gender-based violence and, an increased disproportionate gendered division of labour, affect women’s reproductive health decisions at the household level. At the level of the health care system and government, poor health care provider attitudes, over medicalization of reproduction, application of unrealistic, unsustainable and culturally inappropriate local and foreign policies, poor infrastructural development and weak social protection policies all impact women’s reproductive health decisions and access to care with profound negative implications for maternal wellbeing. I highlight not only typical issues, often taken-for-granted by many scientists, but also how these issues have extreme negative impacts on women’s wellbeing. This diverse perspective offers a better understanding of maternal health services provision and utilization that will challenge the status quo and prompt improvements in maternal health in Ghana and other Sub-Saharan African nations. I offer recommendations, as well as future research, for health care providers, policymakers, medical and nursing education and government in an effort to promote a better understanding of rural women’s reproductive health and general wellbeing.
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