Urban Poor and Social Exclusion: Exploring the Accessibility of Maternal Healthcare Services among Female Head Porters (Kayayei) in the Accra Metropolis

In Ghana, urban areas are the most equipped with facilities and social amenities. However, these benefits have not trickled down to the urban poor. Such is the case of female head porters, locally referred to as Kayayei working at informal markets in the Accra Metropolis, who although have greater reproductive health needs, still encounter barriers which limit their access to maternal healthcare services. To find out more about some of the challenges that these women face when seeking maternal healthcare services as a result of their status in society, a qualitative research design was adopted. Individual interviews were organised with 10 female head porters who provided information on their socio-demographic characteristics, their knowledge on maternal healthcare, the problems they came across in their attempt to access maternal healthcare services, their personal experiences with healthcare service providers, and the influence of social capital on their maternal health choices. The answers provided by the interview participants were then analysed using an adapted version of the Andersen Behavioural Model of Healthcare Service Utilisation as a conceptual framework for organising interview responses into the following main themes: environment, population characteristics, health behaviour and outcome. The results of this study revealed that although a majority of Kayayei accessed maternal healthcare services, they experienced many inconveniences such as high cost of medical care and drugs, long distance from residence to health centres and long waiting times. Moreover, despite a majority of the Kayayei receiving maternal healthcare services, they were found to engage in activities which exposed them and their children to health hazards. This study concludes that policies such as free National Health Insurance Scheme registration in markets, public education and awareness and reduced medical costs be adapted to enhance access to maternal healthcare services.