This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and
skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries
and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and
geographically uneven health care system, this study draws on the political ecology of health framework
to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and
political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements
in maternal health and the continued reliance on TBAs illustrate the government's inability to
understand local realities marked by poor access to SBAs or modern health care services. Using focus
group discussions (FGDs) (n ¼ 10) and in-depth interviews (IDIs) (n ¼ 48) conducted in Ghana's UWR,
the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural
isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate
that by adhering to the World Health Organization's guidelines, the local government may be imposing
detrimental, unintended consequences on maternal and child health in remote rural locations. In
addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs,
many of whom remain oblivious or have not been officially notified about the new policy. Furthermore,
participant accounts suggest that the new policy is seen as contributing to worsening relations and
tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in
the region. The study concludes by suggesting relevant policy recommendations.