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Accessibility to maternal health care by marginalised groups, such as poor migrant women, has remained an issue of concern in Ghana. While a number of studies have been conducted on the livelihoods of migrant female head porters (Kayayei) in cities in Southern Ghana, there is little understanding of their accessibility and utilisation of maternal health services. This paper examines the challenges that the migrant female head porters encounter in the process of seeking maternal health care in Accra. The data were collected through a questionnaire survey on a sample of 70 female head porters and in-depth interviews with key informants and some of the Kayayei. The findings indicate that the factors affecting accessibility to maternal health services by the Kayayei are unavailability of health facilities in the slums where Kayayei live, low-income levels, high cost of maternal health care, long queues and waiting times at modern health facilities, and the perception that traditional medicines are adequate for protecting pregnant women and their babies. It was therefore suggested that government should increase the number of health facilities and strengthen the National Health Insurance Scheme to enhance access to health care by this vulnerable and poor group of people as well as increase health educational campaigns.

In recent years, land use (LU) and landscape structure in ecoregions around the world have been faced with enormous pressures, from rapid population growth to urban sprawl. A preliminary account of changes in land cover (LC) and landscape structure in the ecoregions of Ghana is missing from the academic and research literature. The study therefore provides a preliminary assessment of the changing LU and landscape structure in the ecoregions of Ghana, identifying the causes and assessing their impact on land-based resources, and on urban and agricultural development. LU/LC maps produced from 30 m resolution Landsat TM5 in 1990 and ETM+ + + in 2000 were classified into dominant land cover types (LCTs) and used to survey the changing landscape of Ghana. LC-change map preparation was done with change detection extension "Veränderung" (v3) in an ArcGIS 10.1 environment. At the class level, Patch Analyst version 5.1 was used to calculate land use (LU) statistics and to provide landscape metrics for LU maps extracted from the satellite imagery. The results showed that commonly observed LCCs in the ecoregions of Ghana include conversion of natural forest land to various forms of cultivated lands, settlements, and open land, particularly in closed and open forest and savannah woodland. The dominant LU types in the ecoregions of Ghana are arable lands, which increased by 6168.98 km 2 2 2 . Forest and plantation LCTs decreased in area and were replaced by agricultural land, forest garden, and open land. Afforestation rarely occurred except in the rainforests. The mean patch size (MPS), a measure of fragmentation, was generally reduced consistently from 1990 to 2000 in all the ecoregions. Similar results that indicated increased fragmentation were an increased number of patches (NumP) and the Shannon diversity index (SDI). Habitat shape complexity inferred from mean shape index (MSI) decreased in all ecore-gions except for rainforest and wet evergreen. The SDI and Shannon evenness index (SEI) showed that habitat diversity was highest in the coastal savannah and the deciduous forest ecoregions. The main drivers of changes in the LUs and landscape structure are demand for land and land-based natural resources to support competing livelihoods and developmental activities in the different ecoregions.

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