Empowerment and use of antenatal care among women in Ghana: a cross-sectional study.

Christopher Udry,Maureen Canavan,Angela Ofori-Atta,Heather Sipsma,Elizabeth Bradley

doi:10.1186/s12884-014-0364-4

Christopher Udry, Maureen Canavan + Show 3 more

Open Access

https://doi.org/10.1186/s12884-014-0364-4

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Abstract

BackgroundEmpowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana.MethodsWe conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education.ResultsApproximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001).ConclusionsResults suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women.

Highlights

Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; current literature examining this association is limited and inconsistent
We found that women who are less empowered, as measured by their experience of physical abuse, are far more likely to be in this at-risk population
They are consistent with analyses conducted among women in Bangladesh and Egypt demonstrating that physical abuse is significantly associated with antenatal care even after accounting for other indicators of empowerment [15,25]

Summary

Introduction

Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; current literature examining this association is limited and inconsistent. Evidence suggests that experiences of partner abuse may reduce the woman’s ability to use antenatal care [15,16,17] These studies are primarily derived from populations of women in Asia and East Africa and have limited generalizability to other low-income contexts. Last, none of these studies examine how the association between empowerment and antenatal care may be moderated by education, a potentially modifiable factor that is increasingly promoted by international development agencies

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