Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

Abstract

Background: Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance. Objective: This study examined factors associated with ANC attendance in predominantly rural Ghana. Methods: We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women’s sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. Results: Of the 1497 participants, 86% reported attending ANC at least four times, which was positively associated with possession of national health insurance (AOR 1.64, 95% CI: 1.14–2.38) and having a partner with a high educational level (AOR 1.64, 95% CI: 1.02–2.64) and negatively associated with being single (AOR 0.39, 95% CI: 0.22–0.69) and cohabiting (AOR 0.57, 95% CI: 0.34–0.97). In site-specific analyses, factors associated with ANC attendance included marital status in Navrongo; marital status, possession of national health insurance, partners’ educational level, and wealth in Kintampo; and preferred pregnancy timing in Dodowa. In the youngest, least educated, and poorest women and women whose partners were uneducated, those with health insurance were more likely to report at least four ANC attendances relative to those who did not have insurance. Conclusions: Ghanaian women with low socioeconomic status were less likely to report at least four ANC attendances during pregnancy if they did not possess health insurance. The national health insurance scheme should include a higher number of deprived women in predominantly rural communities.

Utilization, Equity and Determinants of Full Antenatal Care in India: Analysis from the National Family Health Survey 4

“…Economic status and maternal education were highly associated with utilisation of ANC, which corroborates with previous literature [19,20,21]. Younger maternal age at conception is also common among these women.…”

Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review

“…Six studies reported on the influence of husband/partner’s education on ANC use. Women whose husbands/partners had some education were more likely to access ANC services than those with less educated husbands/partners22 30 41 63 73 74 (table 2).…”

“…In 14 studies, women of high socioeconomic status (SES) attended at least four ANC visits more than those in the lower socioeconomic/wealth strata15 25 27 29 30 32 41 54 64 69 77 89–91 (table 2).…”

“…In three studies, women who did not have health insurance were less likely to attend up to four ANC visits41 54 90 (table 2).…”

“…All the studies fulfilled the quality criteria except for six studies9 40–44 that did not report on sample size.…”