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Table 2 Thematic network analysis framework (from codes to global themes)

From: A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition


Basic themes identified

Organizing themes

Global themes

-There is joy in pregnancy & childbirth

1. Pregnancy & childbirth are fulfilling biological functions women perform

1. Pregnancy & childbirth is role fulfilment, self actualization and empowerment

Women’s experiences of pregnancy & childbirth

-Women feel accomplished in giving birth safely.

-A woman can die while pregnant or giving birth

2. Pregnancy & childbirth is dangerous

2. Pregnancy & childbirth can be a dangerous event


-you either die or live


-Pregnancy & childbirth is an anxious phase of woman’s life


-Pregnancy makes women highly dependent on others


-A Pregnant woman needs care, love and empathy to be able to deliver safety

3. Care during pregnancy is important for safe delivery

3. Women want skilled attendance at birth


-Women should go to hospital when pregnant

4. Hospital delivery is good


-It is good to deliver in a hospital


-Midwives can help to deliver women safely


-Some places do not have health facilities

5. Unequal availability and/or distribution of services gives rise to differential access


-There are no nurses/midwives/doctors at some health facilities

4. Health system failures

Barriers to access & equitable access

-Services are far away

6. Long distance travel & difficulties with arranging transport to health facilities discourage access


-It is difficult to travel

-Caregivers do not ask how women feel

7. Poor services quality discourage women from accessing and using services


-There is overcrowding in maternity wards

-Maltreatment and scolding is dehumanizing

-Caregivers want women to obey instructions without question

8. Lack of choice in health facilities is a disincentive to use of skilled care


-Poor communication between women and caregivers leads to misunderstanding

9. Women’s distrust in the ability of health care institutions & professionals reduces their willingness and ability to access skilled care


-Women do not believe their problems can be solved by some caregivers/health facilities

-Nurses are disrespectful

10. Culturally and linguistically inappropriate care and health information does not promote effective communication between caregivers & women


-Caregivers disrespectful and disregard women’s preferences and cultural values relating to pregnancy and childbirth

-TBAs advise women about what to do in an obstetric emergency, but health system does not recognize and rewards TBAs

11. Lack of recognition of the role of TBAs by the health system breeds mistrust and discourage cooperation even in times of obstetric emergnecies


-There is privacy in homebirth but not in hospitals.