Although the past decade has brought global reductions in maternal, infant and child mortality,
many low-resource settings have failed to make significant gains relative to their high-income
counterparts. In Ghana, nearly 50% of under-five mortality in 2014 could be attributed to deaths
during the first 28 days after birth. This article analyses the data across a mixed-methods study of
the factors impacting maternal and neonatal care in northern Ghana. The stillbirth and neonatal
death study (SANDS) was conducted in 2010 and included both quantitative (N ¼ 20 497) and qualitative
data collection (N ¼ 253) to explore the issues associated with the continuum of reproductive
health care. Findings were compared against an adaptation of the WHO/UNICEF framework for
integrated maternal and newborn care and used to generate concrete recommendations for clinicians,
policymakers and programmers across the continuum of care, from pregnancy through delivery
and postnatal care. SANDS elucidated epidemiological trends: 40% of neonatal deaths
occurred on the first day after birth, and the leading causes of early neonatal mortality were birth
asphyxia/injury, infection and complications of prematurity. Qualitative data reflect findings along
two axes—community to facility-based care, and pre-pregnancy through the postnatal period.
Resulting recommendations include the need to improving clinicians’ understanding of and sensitization
to local traditional practices, the need for policies to better address quality of care and coordination
of training efforts, and the need for comprehensive, integrated programmes that ensure
continuity of care from pre-pregnancy through the post-partum period. SANDS illustrates complex
medical–social–cultural knowledge, attitudes and practices that span the reproductive period in
rural northern Ghana. Data illustrate that not only are the first few days of life critical in infant survival
but also there are significant social and cultural barriers to ensuring that mothers and their
newborns are cared for in a timely, evidence-based manner.