Abstract
BackgroundImproving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth.MethodsA database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization.ResultsThe rural–urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003.ConclusionsThe increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.
Highlights
Improving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa
There have been some improvements in the uptake of maternal health interventions such as antenatal care (ANC), skilled birth attendance (SBA), and facility-based delivery [4,5] but hardly any in resource poor countries that bear the highest burden of maternal mortality [3]
There was a general reduction in the prevalence of women who had less than four ANC visits during their last pregnancy, and those who had no skilled attendance at birth within the different socioeconomic groups
Summary
There have been some improvements in the uptake of maternal health interventions such as antenatal care (ANC), skilled birth attendance (SBA), and facility-based delivery [4,5] but hardly any in resource poor countries that bear the highest burden of maternal mortality [3]. Within these countries, the most vulnerable women have the worst maternal health outcomes [6,7]. The above definition developed due to the realisation that diverse groups of health care professionals with country-specific titles could provide the skills and competencies expected of a SBA [13,14,15]
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