The social determinants of health facility delivery in Ghana

Abstract

Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen’s health care utilization model was used as the conceptual framework guiding this study.. Results Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions First, in spite of Ghana’s free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access.

Predictors of home births among rural women in Ghana: analysis of data from the 2014 Ghana Demographic and Health Survey

“…Such barriers also exist in Ghana and is predominant in rural areas, where home births are high compared to urban areas [17,18]. Despite the high utilization of home births among rural women in Ghana [19], most of the studies on uptake of skilled delivery services including health facility birth have focused on predictors of health facility birth as well as predictors of choice of place of birth among women [17,18,20,21]. To the best of my knowledge, no study has looked at the factors that influence home births among rural women in Ghana.…”

“…The social barriers include the social norms about place of delivery, the role of socioeconomic status (SES) and the influence of husband and other family relatives in the selection of a place of delivery [ 16 ]. Such barriers also exist in Ghana and is predominant in rural areas, where home births are high compared to urban areas [ 17 , 18 ]. Despite the high utilization of home births among rural women in Ghana [ 19 ], most of the studies on uptake of skilled delivery services including health facility birth have focused on predictors of health facility birth as well as predictors of choice of place of birth among women [ 17 , 18 , 20 , 21 ].…”

Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana

“…Finally, women's employment status was grouped into not working and working. The categorizations of the study predictors were adopted from the literature [34,35].…”

Determinants of health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016

“…This study included determinants of health facility childbirths basing on evidence from available literature and data [2,5,16,17]. Ten explanatory variables were used: (1) maternal age, (2) wealth index,…”

“…(3) level of education, (4) place of residence, (5) region, (6) marital status, (7) working status, (8) ANC attendance, (9) sex of household head and (10) household size. Maternal age was categorized as; (15)(16)(17)(18)(19) years, 20-29 years, 30-39years, 40-49years) [18]. Wealth index is a measure of relative household economic status and was calculated by DHS from information on household asset ownership using Principal Component Analysis and further categorized into poorest, poorer, middle, richer and richest quintiles [6] .…”