Abstract

IntroductionInequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services.MethodsWe analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables.ResultsFindings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003–2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana’s user-fee exemption policy, and the role of non-financial barriers or considerations.ConclusionExempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to maternal health services in Ghana. Ensuring equity in access will require moving beyond user-fee exemption to addressing wider issues of supply and demand factors and the social determinants of health, including redistributing healthcare resources and services, and redressing the positional vulnerability of women in their communities.

Highlights

  • Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals

  • In comparison with the baseline figure of 92% reported in Ghana’s 2003 Demographic and Health Survey, the number of births who received skilled antenatal care (ANC) during the first five years (i.e. 2003–2007) of implementing the user-fee exemption policy increased by an average of 4%

  • The percentage of pregnant women who received at least two dosages of tetanus toxoid protection increased from 50% in 2003 to 62% in 2007, while delivery in a health facility rose by 10%

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Summary

Introduction

Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. In an effort to achieve the Millennium Development Goal (MDG) 5 the government of Ghana introduced and is currently implementing a policy that provides free maternal health services to all women in all government, mission, and selected private health facilities [11,12]. That inequities in skilled care services accessibility and utilization exist across different sub-population groups in Ghana is worrying. It is worrying because Ghana’s user-fee exemption policy was intended to be universal. Government Government health Other public Private hospital Private maternity Other private Other Total Number home home hospital/polyclinic health center post/clinic health facility clinic home health facility of women Presbyterian

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