Factors influencing Ghanaian midwifery students' willingness to work in rural areas: a computerized survey

Background: Lack of midwives in rural and remote areas of Ghana is a national concern as the country attempts to reach targets set by Millennium Development Goals to reduce maternal and child mortality by 2015.

Objectives: To understand factors influencing third-year Ghanaian midwifery students' willingness to work in rural areas.

Setting: Two of the largest midwifery schools in Ghana.

Participants: Third-year midwifery students (n=238) about to graduate and enter the workforce.

Methods: Based on focus group discussions with midwifery students, we refined a computerized survey to assess students' preferences for rural posting after graduation. We then administered this survey to midwifery students in Ghana. We used Pearson's chi-squared to compare the top reasons for choosing job location between those students likely and not likely to work in a rural area. Logistic regression models were used to calculate the odds ratios.

Results: An opportunity to gain additional education was the most important factor for the midwifery students in deciding where they would eventually work (72%). Poor quality of clinical facilities (26%), poor quality of education for children (19%), and lack of social amenities (17%) were major deterrents to working in rural communities. For student midwives willing to work in rural areas the top reasons cited included to serve humanity (74%), and increased opportunities to gain clinical experience (62%). More experiences overall with rural communities resulted in greater odds of being willing to work in a rural area. Being born in a rural area (OR: 1.95, 95% CI: 0.736, 5.16) and living in a rural area after age 5 for one-year or more (OR: 1.52, CI: 0.857, 2.70). An exception to this was midwifery students who performed health work for six weeks or more in a rural area during training. These students were found to have 0.83 lower odds of willingness to work in a rural area (95% CI: 0.449, 1.55).

Conclusion: By better understanding the motivating factors for rural healthcare workers, specific policy interventions can be established to improve the distribution of midwives thereby decreasing the burden of maternal and infant mortality.