Midwives in Rural Ghana: Factors That Influence Students When Deciding Where to Practice

According to the UN Millennium Development Goals report, the risk of dying in pregnancy or childbirth continues unabated in Africa.  In Ghana, maternal death is estimated at 540 per 100,000, partially a reflection of the low rates of professional support during birth.  Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services.  Many women in rural areas of Ghana give birth alone or with a non-skilled attendant.  Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. In this mixed-methods study, 238 third-year midwifery students from two of the largest midwifery schools in Ghana completed a computerized survey and 35 students participated in focus groups to assess their willingness to work in a rural area following graduation. Findings from our research suggest opportunities to gain additional education is the most important factor for midwifery students in deciding where to eventually work.  Participants were deterred from working in a rural area because of perceptions it would be difficult to return to school. A lack of medical supplies, poor quality of clinics, and lack of social amenities were also major deterrents identified to working in rural communities. Midwife students willing to work in rural areas reported their top reasons as:  a commitment to serve humanity, to experience a more challenging or exciting work environment, and to have more opportunities to gain clinical experience. In general, more experiences within rural communities resulted in greater odds of being willing to work in a rural area. By better understanding these motivating factors, specific interventions can be established to improve the distribution of midwives and therefore decrease the burden of maternal and infant mortality.