Sociocultural and health system determinants of maternal mortality in Ghana: findings from a systematic review

Maternal mortality remains a significant public health concern that has received sustained global attention and substantial investment over the past few decades. However, this problem is high in Ghana, with most deaths attributed to direct or indirect causes and very little to sociocultural and system issues. This systematic review sought to map the multifaceted or related risk factors and causes of maternal mortality among women in Ghana. We conducted a comprehensive systematic search of PubMed, CINAHL, and EMBASE to identify studies published between 2000 and 2023, using the WHO definition of maternal mortality as a guide. The review adhered to the Joanna Briggs Institute’s (JBI) guidelines for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) framework. The methodological quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Nineteen (19) studies met the inclusion criteria. The synthesis revealed that maternal mortality in Ghana is primarily driven by direct causes such as hemorrhage and sepsis, and indirect causes including anemia and sickle cell disease. Sociocultural determinants, such as place of delivery, geographical location, cultural beliefs, lack of support, and poverty, further shaped maternal outcomes. Health system factors, including inadequate antenatal care, shortages of blood and essential medications, poor supervision and documentation, weak referral systems, and delays in care, were also critical contributors. This review underscores that maternal mortality in Ghana is driven not only by direct medical causes but also by systemic, socioeconomic, and cultural barriers. Addressing these requires strengthening emergency obstetric care, improving referral and data systems, and ensuring consistent provider training in managing obstetric emergencies. Equally important are policies that reduce sociocultural and financial barriers and promote community-based maternal care. These actions are critical to accelerating progress toward achieving national and global maternal health targets.