Abstract
BackgroundMany 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.MethodsNationally 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..ResultsOnly 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.ConclusionsFirst, 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.
Highlights
IntroductionThere are a over 200 million conceptions [1]. about 40% of these conceptions result in pregnancy-related problems among women around the world [1]
Every year, there are a over 200 million conceptions [1]
Plain English summary Delivery outside a health facility in a developing country context often occurs under unhygienic conditions and in the absence of professionally trained skilled birth attendants
Summary
There are a over 200 million conceptions [1]. about 40% of these conceptions result in pregnancy-related problems among women around the world [1]. Childbirths in health facilities have been recognized as one of the best strategies to avoid maternal mortalities and morbidities and to improve the health of newborns [2,3,4] Despite this recognition, a significant percentage of childbirths occur outside health facilities in low-income countries [3, 5]. One of the tragic consequences of this underutilization is the 830 maternal deaths that occur each day because of pregnancy and labour-related complications [6]. If this consequence is not tragic enough, delivery outside facility has ramifications for infants.
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