Reducing Maternal Mortality in Sub-Saharan Africa: the Case of Ghana

Start date: 28 February, 2013 End date: 4 April, 2013 Project type: Master's Thesis (prior to 2018) Project code: A22470 Countries: Ghana Institutions: Aarhus University (AU), Denmark Grant recipient: Inge Trads Kjeldsen Total grant: 13,000 DKK


Every day women in developing countries risk their lives while bringing children to the world. Maternal mortality is thereby a grave and pressing problem demanding renewed academic, political and popular attention. Despite receiving increased international focus – most pronounced through the Millennium Development Framework where goal 5 concerns maternal health – only a few developing countries will be able to reach the target of reducing maternal mortality with three quarters in 2015.This thesis seeks to shed light on this empirical puzzle by looking at political and institutional explanations including democracy with the aim of increasing the understanding of the indirect causes of maternal mortality.


A quantitative analysis is conducted to test the relationship between democracy and the level of maternal mortality in Sub-Saharan Africa. Despite the theoretical expectations of the contrary no significant effect of democracy is found. A subsequent qualitative case study of Ghana revealed two main explanations for this surprising result. Firstly, the analysis finds that the institutionalised accountability mechanisms that were expected to lead to a redistributive effect of democracy and thereby entail a prioritisation of social policies benefitting the poor have not been yet been established in the young democracy of Ghana.


Secondly, acknowledging that decision-making and agenda setting cannot account for the outcomes of reform initiatives alone, the second part of the thesis focus on implementation challenges in reducing maternal mortality. It is established that characteristics of the issue of maternal mortality i.e. complexity and long-term perspectives as well as the costs and benefits related to the reform initiatives influences both the political will to prioritise as well as the societal reactions. This is so not least because poor women as a group are not empowered to demand better services and performance. Furthermore, the analysis revealed that a number of factors such as scarce resources (both financial and human), attitude problems among health workers, poor leadership by the Ministry of Health and lack of accountability within the system result in a weak and fragmented health sector that does not deliver the expected outcomes.


The results of the thesis lead to a discussion of the ability of young democracies in Africa to establish sound accountability mechanisms, despite of informal institutions such as neopatrimonialism. On the practical side the importance of avoiding ‘one-size-fits all solutions’ to development is emphasised, and it provides a warning against the tendency of the international donor community to be issue-specific instead of having a holistic focus.