Electronic Thesis and Dissertation Repository


Master of Arts




Isaac Luginaah


In 2008 the sub Saharan African country of Ghana implemented a Maternal Exemption Policy (MEP) within its National Health Insurance Scheme. This policy provides coverage for free antenatal, postnatal, and facility delivery to all pregnant women for a one year period. By removing the fees associated with maternal health services, the MEP was intended to reduce maternal mortality and provide equitable health care for pregnant women. While the MEP is generally regarded as beneficial to the women of Ghana, challenges remain, especially in the poor, marginalized and rural communities of the Upper West Region. Given that access to a skilled attendant for birth is widely recognized as the most important factor to prevent maternal deaths and achieve improved maternal health outcomes, this thesis explores barriers to access and utilization of maternal health services provided under the MEP. Using a multi-theoretical framework (political ecologies of health, feminist political ecology, behavioural access to healthcare model) and data from in-depth interviews (22), focus group discussions (10), and key informant interviews (12) collected in 2013 in the Upper West Region, this thesis examines factors which affect women’s navigation of maternal health services, in the context of the maternal exemption policy. Findings suggest certain socioeconomic, geographic, and cultural characteristics, such as hidden costs, lack of available transportation, and the banning of traditional practitioner delivery, dramatically influence the access and use of maternal health care. Although the MEP is technically free, barriers to access exist at every stage of pregnancy, posing detrimental health risks. Results from this study inform policy recommendations.