Published in PLOS One on 2026-03-18, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Exploring the determinants of midwives’ perinatal bereavement support behaviour to mothers using the theory of planned behaviour in the Upper West Region of Ghana
Original authors: Veronica Sonasal Dooh, Evelyn Asamoah Ampofo, Adiza Atoko Mumuni, Michael Darko Ashaley, Mary Ani-Amponsah, Louis Nebayeng Mornah
Source: PLOS One • DOI 10.1371/journal.pone.0344531
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Perinatal loss presents profound emotional challenges requiring skilled bereavement support from midwives. Despite its importance, determinants of midwives’ bereavement support behaviour remain underexplored in low-resource settings. Using the constructs in the Theory of Planned Behaviour, this study examined factors influencing midwives’ bereavement support practices in Ghana’s Upper West Region. This study examined determinants of midwives’ behaviour in providing bereavement support to mothers experiencing perinatal loss in the Upper West Region.
A cross-sectional study was conducted among 269 registered midwives (response rate = 98%) across selected health facilities. Data were collected using structured questionnaires based on the Theory of Planned Behaviour (TPB). Analyses were performed in SPSS version 27.0 and AMOS, employing descriptive statistics, correlation analysis, and path analysis with bootstrapping to examine predictors of bereavement support behaviour.
Among 269 midwives (response rate = 98%; mean age = 34 years), attitudes (M = 3.26, SD = 0.41) and perceived behavioural control (M = 3.02, SD = 0.57) were generally favourable. Path analysis revealed that attitude (β = 1.00, p < .001) and perceived behavioural control (β = .32, p < .001) significantly predicted behavioural intention, which strongly predicted actual behaviour (β = .65, p < .001). Notably, subjective norms had a negative effect (β = −.21, p < .001), and bereavement training were not statistically significant predictors of midwives’ bereavement support behaviour.
Midwives demonstrated favourable attitudes toward bereavement support, yet actual practice was primarily driven by personal attitudes and perceived control rather than training or social norms. To improve bereavement care, health systems should build midwives’ confidence through experiential training and mentorship, establish institutional cultures that normalize bereavement support, and integrate bereavement care protocols into routine maternal health services. These evidence-based strategies can enhance compassionate support for mothers experiencing perinatal loss in resource-limited settings.
Introduction
Perinatal loss represents one of the most distressing and emotionally devastating experiences for mothers and families worldwide [1–4]. Defined as the loss of a foetus or newborn from the period of viability (around 22 weeks of gestation) through the first week of life [5,6], perinatal loss remains a significant contributor to global child mortality [7]. It may occur due to wilful termination of pregnancy or intrapartum death, miscarriage, late miscarriage, and ectopic pregnancy [8]. In 2021 alone, about 2.3 million babies died within their first month of life, accounting for nearly 47% of all under-five deaths globally [9]. In Sub-Saharan Africa, where healthcare systems often face resource and infrastructural challenges, the burden is even more pronounced, with one in every thirty-six babies dying within the neonatal period compared to one in every three hundred and thirty-three in developed regions [10,11]
In Ghana, perinatal loss continues to be a major public health concern. As of 2019, the neonatal mortality rate stood at 23.1 deaths per 1,000 live births, while the stillbirth rate was 23 per 1,000 total births in 2017 [12]. These losses are not only medical or statistical events but deeply personal tragedies that often leave profound psychological, emotional, and social scars on affected mothers and families. Studies have linked perinatal loss with increased risk of depression, anxiety, post-traumatic stress disorder, and even suicide [2,13,14]. The grieving process is further complicated by cultural beliefs, inadequate emotional support systems, and poor communication with healthcare providers, especially in many low- and middle-income countries, including Ghana [12,15].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Veronica Sonasal Dooh, Evelyn Asamoah Ampofo, Adiza Atoko Mumuni, Michael Darko Ashaley, Mary Ani-Amponsah, Louis Nebayeng Mornah. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Exploring midwives’ practice patterns and capacity for obstetric ultrasound imaging: Towards a multicentre longitudinal materno-foetal research readiness in a low-resource setting
- Evidence brief: Benchmarking newborn care quality in Ghana: Evidence from structured observations of clinical practice against WHO quality standards
- Evidence brief: Lived experiences of postpartum hypertensive women in Accra, Ghana
