Abstract
Non-utilization of obstetric services results in higher rates of maternal and child mortality, and is clearly a threat to achieving the sustainable development goals (SDGs) on maternal and child health in sub-Saharan African countries including Ghana. This study aims to: (1) identify communities with high risk of non-usage of health facility delivery and postnatal services to highlight areas that need critical attention, (2) examine the influence of community-level factors on non-utilization of health facility delivery and postnatal services in Ghana to inform targeted policies and programs to reduce these discrepancies across communities. This study used aggregated socio-demographic variables and Global Positioning System (GPS) data from the 2014 Ghana Demographic and Health Survey (GDHS) dataset to identify the community-level risk factors for non-utilization of health facility delivery and postnatal services using a negative binomial regression model. In addition, spatial Poisson-based models were conducted using Spatial Scan Statistics to identify communities with high rates of non-usage of health facility delivery and postnatal services. Hotspots of non-use of health facility delivery and postnatal services were identified and were found to be especially concentrated among communities in the Northern region of Ghana. The analyses indicated that a woman who dwells in a community that is rural with a poverty rate above national level and a longer distance to a health facility has an increased risk of non-utilization of health facility delivery. High-risk communities were identified in this study using special analyses. The concentration of non-utilization of obstetric services among certain communities highlights the need to formulate community-specific strategies to improve uptake of maternal health services. The empirical evidence generated by this research could help planning and resource allocation to reduce health inequities.
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