Use of Indigenous Herbal Uterotonics in Pregnancy and Labour in Northern Ghana: Prevalence, Determinants, and Health System Complexities

Abstract

Introduction: Concerns remain regarding the safety of indigenous herbal uterotonics and their potential adverse effects on maternal and neonatal outcomes; nevertheless, their use remains common in sub-Saharan Africa. These practices are deeply embedded in sociocultural belief systems and are often sustained by long-standing traditions, perceived effectiveness, and limited availability of formal healthcare services. This study assessed the prevalence, determinants, and health-system complexities associated with the use of indigenous herbal uterotonics among women during pregnancy and labour in the Northern Region of Ghana. Method: An analytical cross-sectional, hospital-based study using a quantitative approach was conducted. A total of 1,347 mothers were selected using a probability sampling technique. Data were collected using a standardised questionnaire from mothers receiving postnatal care services in Ghana's Northern Region. The data were analysed using descriptive statistics, the chi-square test, and multivariable logistic regression at a 95% confidence level. Results: The results showed that 53% (95% CI: 50.4%-55.9%) of respondents experienced illness during pregnancy, with malaria (36.9%), urinary tract infections (27.5%), anaemia (23.7%), and abdominal pain (11.9%) being the most commonly reported conditions. Most respondents (82.7%) were aware of indigenous herbal uterotonics used during pregnancy. More than half (51.2%; 95% CI: 48.5%-53.8%) reported using indigenous herbal uterotonics during their recent pregnancy, while 63.1% had used indigenous uterotonics during labour and the postpartum period. Significant associations were found between indigenous herbal uterotonic use and inaccessibility of health facilities (X² = 4.847, p = 0.031), distance travelled to access healthcare services (X² = 11.022, p < 0.001), and medication availability at health facilities (X² = 7.205, p = 0.007). However, healthcare cost (X² = 0.187, p = 0.665) and use of indigenous herbal uterotonics for labour induction (X² = 0.652, p = 0.424) were not significantly associated with indigenous herbal uterotonic use. Occupational status significantly predicted use: farmers (AOR = 1.9, 95% CI: 1.05-3.6), public servants (AOR = 3.5, 95% CI: 1.2-9.6), and unemployed respondents (AOR = 2.5, 95% CI: 1.2-5.5) used indigenous herbal uterotonics more frequently than housewives. Conclusion: The study highlights the persistent coexistence of traditional and orthodox maternal healthcare practices among pregnant women. The findings emphasise the importance of strengthening access to maternal healthcare, improving health education on the potential risks and benefits of indigenous herbal uterotonic use during pregnancy, and promoting effective communication between healthcare professionals and pregnant women regarding the use of herbal products.