MIGRANT HEALTH CARE PRACTICES: THE PERSPECTIVES OF WOMEN HEAD PORTERS IN KUMASI, GHANA PROSPER ASAANA Bachelor of Arts, University of Ghana, 2010 A Thesis Submitted to the School of Graduate Studies of the University of Lethbridge in Partial Fulfilment of the Requirements for the Degree MASTER OF ARTS Department of Women and Gender Studies University of Lethbridge Lethbridge, Alberta, Canada ©Prosper Asaana, 2015 MIGRANT HEALTH CARE PRACTICES: THE PERSPECTIVES OF WOMEN HEAD PORTERS IN KUMASI, GHANA PROSPER ASAANA Dr. Carol Williams Associate Professor PhD Supervisor Dr. Suzanne Lenon Associate Professor PhD Thesis Examination Committee Member Dr. Jean Harrowing Associate Professor PhD Thesis Examination Committee Member Dr. Carly Adams Associate Professor PhD Chair, Thesis Examination Committee ii Dedication To the hardworking Northern Ghanaian migrant women porters, for taking time off their busy schedules to share their stories of migration and health seeking with me. iii Abstract This thesis seeks understanding of how gender, as a system of power, facilitates, constraints, determines, and impacts not only women’s migration, but more significantly, women’s access to health services post migration in contemporary Ghana. Drawing on the stories of women head porters, via the application of the principles of feminist standpoint theory, I explore women porters’ experiences as deeply embedded in social and power struggles that women did not create, but yet find binding on their lives. Women porters discuss financial struggles, negative encounters with health staff, and the hurdles of dealing with the power that men exert over their decisions and actions as barriers that limit their access and utilization of health services. They also speak of strategies they adopt to challenge the barriers. The findings of this study indicate that the broader social struggles that disempower women persist in contemporary Ghana. Practical, sustainable suggestions for change are offered. iv Acknowledgements Wow, my journey of a thousand miles has finally ended. What a challenging, life- changing, yet gratifying and rewarding experience this has been for me. The lessons learned in this journey are for a lifetime, and for that, I reserve a special Thank You for the 12 women porters whose stories formed the bedrock of this scholarship. I share your stories and your struggles every single day. I am equally most grateful to my thesis supervisor, Dr. Carol Williams, for her honest but strict guidance, yet patient understanding and encouragement. Without your support, I would not be at the finish line right now. Words can never express my sincerest gratitude to you. I am also grateful to my thesis committee, Dr. Suzanne Lenon and Dr. Jean Harrowing, for your candid and thoughtful critique and constant encouragement from day one until now. Thank you for your time, particularly during committee meetings, and for sharing your knowledge with me. I am grateful. Last but not least, I would like to thank my mom, Madam Olivia P. Asaana, for all your love, and support. You have always been my strength, Mom, and to my three lovely sisters, Cynthia, Priscilla, and Isabella, this thesis is also dedicated to you. v Table of Contents Dedication .......................................................................................................................... iii Abstract .............................................................................................................................. iv Acknowledgements ..............................................................................................................v List of Tables ................................................................................................................... viii List of Figures .................................................................................................................... ix Chapter One: Migration and Health Research .....................................................................1 Study Objectives and Rationale .....................................................................................5 Theoretical Framework ..................................................................................................6 Outline of Thesis ..........................................................................................................11 Chapter Two: Ghana’s National Health Care System .......................................................12 Health Reforms in Ghana (1957 to 2014) ....................................................................13 Structural Adjustment Programs in Ghana: The impact on Ghana’s Health Care Sector and Ghanaian Women .................................................................................16 Kumasi’s Health Care System .....................................................................................21 Conclusion ...................................................................................................................25 Chapter Three: Literature Review .....................................................................................26 Health Research and Health Inequality for Women in Rural and Urban Ghana .........28 The Impact of Social Cultural Determinants of Health on Less Affluent Rural Ghanaian Women...................................................................................................31 Socio-Demographic and Socio-Cultural Factors .........................................................32 Gender and inequity ...............................................................................................32 Class, income and occupation……………………………………………………38 Education as a social determinant of Ghanaian women's health…………...……43 Cultural Beliefs ............................................................................................................47 Access Factors .............................................................................................................49 Geo-Physical Determinants .........................................................................................49 Practitioner-Patient Relationships ................................................................................51 Conclusion ...................................................................................................................53 Chapter Four: Methodology ...............................................................................................55 A Feminist Methodological Approach: Reflexivity, Locating Myself ........................55 Participant Sample and Recruitment ............................................................................63 Interview Methods and Process ...................................................................................64 Ethical Considerations .................................................................................................72 Data Analysis ...............................................................................................................74 Conclusion ...................................................................................................................77 Chapter Five: Research Findings .......................................................................................78 Demographic Profile of the Participants ......................................................................78 vi Reasons for Northern Women’s Migration to Kumasi: Economics, Family, Education ...............................................................................................................81 Economics ..............................................................................................................81 Family ....................................................................................................................83 Education ...............................................................................................................85 Living and Working Conditions ..................................................................................87 Health and Health-Seeking Practices: Meanings of Health .........................................89 Health-Seeking Behaviour before and after Migration ................................................92 Health-Seeking Behaviour after Migration: Relations with Health Practitioners, Delays, and Health Care Cost ................................................................................97 Relations with health practitioners.........................................................................98 Delays ..................................................................................................................101 Health care cost ....................................................................................................103 Self-Care and Traditional Health Care ......................................................................106 Conclusion .................................................................................................................107 Chapter Six Research Implications ..................................................................................109 The Northern Ghanaian Family .................................................................................109 The Role of Health Staff (Nurses) in Ghana’s Allopathic Health Care System ........111 Working Women Migrants Negotiate Power ............................................................113 Implications of My Research