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Reducing maternal mortality is a conversation Ghana has been having since the 1990s, but dying in childbirth is still a risk many young Ghanaian women face in 2013. Eleven per cent of female deaths in Ghana occur during childbirth. According to the World Health Organization, childbirth related deaths in Ghana between the beginning of 2011 and the end of 2012 was 2,700. It also reported that the Northern Region of Ghana recorded the highest maternal mortality rates within the same period. The regions health directorate estimated a total of 250 women died during childbirth. The Weekend Globe wanted to find out what factors are causing such death rates in the North. So, in partnership with UNICEF, we traveled from Accra to Gushegu and to villages in-between. On arrival we realized that Traditional Birth Attendants were mostly the first point of call for most women in rural communities. They are older women who are seen as experts on delivery after having so many babies on their own. In a nearby town known as Kpatinga, lived a crippled and partially blind woman popularly called Gagajia. She is over 80 years old and has been delivering babies for almost 50 years. She boasts of delivering over 220 babies in Kpatinga alone. Her room is filthy and filled with flies attracted to the stench of several years of delivering babies in a room with only one tiny window. Despite the conditions of her home, women still come to Gagagia to deliver their babies. She understands the traditional ways of birthing these women are comfortable with. Hospitals do things differently, which women are suspicious of. When the baby is coming, she spreads a cloth under the squatting woman. Then they push until the baby comes out. She catches the baby with another dry cloth, which looked dirty, and wipes the new born with it. If the baby doesn�t cry right away she blows air into its ears and mouth and turns the baby over, until the baby cries. Gagagia told the Weekend Globe that health authorities have registered her, so they are aware that she is delivering children, but have given her no training on the basics of safe and clean delivery. Another major challenge we found out was the very deplorable nature of their roads and on our way past Yendi towards Gushegu, the road turns to dirt and the pot holes get tougher to avoid. The drive should take just over an hour, but the bad roads make it a three hour trip. At the new Gushegu hospital, pregnant women line the hallway, waiting for their checkup. But one patient is the talk of the doctors. Her name is Dalabra Wubei Paga, she came in the day before and she is lucky to be alive. Dalabra was brought to the hospital on the bucket of a tricycle popularly known as a �motorking,� which is meant to carry cargo, like vegetables and goats. She tried to deliver at home, but the baby was breached. By the time the she arrived at the hospital the baby was long dead and the fight came for her life. Dalabra lies in bed at the Gushegu hospital, covered with a cloth in a room shared with two other sick women. She is 30 years-old and this last baby was her eleventh. But what is most remarkable about Dalabra�s story is that she has delivered all her children by herself. �I delivered them on my own. When I am in labor, I deliver before drawing people�s attention and now this baby is the only one giving me complications.� Dalabra�s story is unfortunately not unique. She faced the same obstacles- bad roads, cultural beliefs and limited health facilities- that most women in rural areas face when giving birth but she�s lived to tell the tale. In this part of Ghana, the two wheel vehicle is king. The 4X4 truck had a hard time getting through the major potholes once leaving the capital Tamale. Bicycles, motorbikes and tricycles become ambulances when a woman goes into labour. Dr. Akwasi Twumasi is in charge of the health services in the Northern region. He says he is aware that the rough roads and transport make it difficult for women to go to the already limited hospitals, and that this is a factor keeping maternal mortality rates high. �The road network is a very big rate determining step. You can�t even get there, no medical emergency will go there, our own staff died� He said. Even when these women manage to the get to the hospital they cannot be guaranteed the best health care. There are few under resourced hospitals in rural areas with not enough doctors and nurses. The Gushegu hospital, for instance, has only two doctors. One of them is Dr. Zakaria Mankir who looked tired and defeated after performing two Caesarian -sections. Dr. Mankir and his colleagues are expected to deliver general health care including attending to maternity cases, which he has not specialized in. In Dr. Mankir�s experience, the problem is not so much maternal mortality as it is maternal morbidity. More women deal with severe physical problems after childbirth than women who die. Pregnant women need more iron than non-pregnant women. But in the North people live mostly on T.Z. If there is meat, the man eats the most of it, then the womn gets what�s left over and the children get what the women don�t finish. Dr. Mankir is still fairly new in Gushegu, so he has not had to deal with too many deaths. The one death he had on his surgery table was the week before. The patient was an 18 year-old woman who came in with mid-delivery. The baby had already died in her womb. The baby was delivered, but her uterus would not contract and filled up with blood. The decision to operate on the woman was tough for Dr. Mankir because taking out her uterus would mean she would be barren, and in this part of Ghana, being without a womb will greatly lower her chances of getting married. Dr. Mankir could use some more hands. But with little incentives for doctors to come to rural areas, help is hard to find. Gushegu hospital is not as rural as it gets. About an hour past Gushegu is a small village without electricity called Katani. There�s a young man there who has gained the respect of his counter-parts in Gushegu and the district health director. His name is Ebenezer Brown Holdbrook. He is the only health officer attendant in Katani and the surrounding villages. He learned about delivering babies on the job. Holdbrook�s small clinic only has three beds, which can be filled with three women in labour at the same time. He told The Weekend Globe he has not enough instruments to attend to these many patients at once, nor does he have an adequate sterilizer. The lack of facilities also makes it impossible to monitor the women after giving birth. The standard is to observe a woman for at least six hours. But women are put on the back of a motorbike with their newborns and sent home after 30 minutes. Midwife Augusta Dobu is one of the only two midwives serving the whole Gushegu district and she says there is nothing they can do about the situation. Dr. Twumasi says he has been advocating for better health facilities and more staff for years, but his pleas have fallen on deaf ears. Now he says he is fed up and is not making as he used to. Another interesting development The Weekend Globe found out was giving birth completely alone which is seen as a source of pride for women in these communities. Dalabra Wubei Paga�s rival is Maamo Kpisah. Maamo does not see the need for a woman to give birth at the hospital unless there are complications. Dr. Mankir says the situation is worsened if a woman has more rivals. To compete for the husband�s attention, they put their lives and that of their babies at risk to prove that they are strong wives. Going to a hospital, is a sign of weakness. Traditional family structures in this part of Ghana give husbands and in-laws all the power to make decisions on family matters. The mother is the last person allowed to make decisions. The husband and in-laws decide on how many babies she will have. Even if the babies are sending her to an early grave. They decide where the babies are delivered, and because of beliefs that a strong woman delivers on her own, most husbands and in-laws will advise against sending the woman to a hospital. Midwife Augusta Dodu runs into this problem often. She may be dealing with a woman and need a decision to be made. The woman won�t make a decision without her in-laws or husband. They�d rather die. Augusta sees this as a major roadblock to healthy maternal delivery. To breakthrough these traditional beliefs surrounding maternal care in the Northern region, the Gushegu district has experimented with different ways of teaching people on the importance of going to local clinics and hospitals for antenatal care and delivery as well as teaching family planning. One of the larger problems in maternal health is the lack of attention men give to their pregnant wives. The men rarely accompany their wives to the hospital or check on them after giving birth. According to midwife August Dove the men come for the babies and not the women after delivery. �When they come here I tell them no! The woman too has a father and a mother. Midwife Dodu said �You should ask for your wife and not the baby. I tell them send the woman home first and come back for the child� To reorient would-be fathers psyche on child bearing, the Gushegu district has created a men�s club. Men who have expectant wives gather together with a health official and discuss what role they can play as fathers and what their wife�s bodies are going through during pregnancy. This, according to the Gushegu health director, Mr. Rahman Yakubu has been successful as some men are gradually becoming more supportive of their pregnant wives. Another thing they attempted to do was train Traditional Birth Attendants (TBA) on proper birthing techniques and sanitation. But the Regional Health Directorate was concerned that training the TBA�s encouraged them further to deliver children in the village, rather than send them to a hospital. A few kilometres away from Kpatinga is Tindani. Another village where a TBA by name Ayishetu Kofi lives. Ayishetu is highly regarded by health officers in the area. She received training in 2007, since then she has been referring women to hospitals whenever possible. In the middle of our conversation Ayishetu proudly reached into a sack and brought out two note books filled with records of all the babies she had delivered. She then pulled out a box with a certificate of her training, a box of gloves and a bar of soap. Having training has been a point of pride in her life. Even though Ayishetu encourages women to deliver at the hospital�.she ends up doing most deliveries if they can�t make it to the local clinic. But her gloves are running low and she is worried that for the past six years she has not received any support from the district health directorate. Her heavily pregnant daughter-in-law entered the room with two children. Her name is Abibata and at age 30 she has three sets of twins. Two of the sets were delivered by her mother in-law, Ayishetu, and the other at the hospital. The only reason she went to the hospital on her last delivery was because she went for antenatal care and ended up in labour. But this decision is not Abibata�s to make. Her in-law quickly interrupted and reminded her of her child bearing role which can only be controlled by her husband. If Abibata refuses to have more children, Ayishetu said she will recommend to her son to marry another woman. But Abibata is not bothered by this threat and would welcome another woman to satisfy her husband�s needs. Many women in these communities are drained and look older than their ages from giving birth to so many babies who cannot be guaranteed a good future by their parents. For these women it is as though their lives worth have been reduced to only making babies. Midwife Augusta Dobu told The Weekend Globe that most of the women here care about their child bearing role more than they care about their babies or themselves. Ghana signed on to reduce maternal deaths as one of its millennium development goals, but with the deadline looming in less than two years, Ghana is a long way from its goal of 54 deaths per hundred thousand babies born. It is ranked 41st on the CIA world maternal mortality rate index.