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

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.

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

Two of the largest midwifery schools in Ghana.

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

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.

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).

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.