PurposeIn 2016, the World Health Organization (WHO) revised upwards the recommended contacts for antenatal care (ANC) by expectant mothers with a health provider from a minimum of four to eight over the pregnancy period. Although Ghana is yet to adopt the new recommendation, some women choose to adhere to the new protocol because of its enormous health benefits to the expecting mother and the unborn child. As part of ANC, family planning services are also provided to ensure child spacing and birth control. To reduce health costs, government introduced the free maternal health policy, Community-based Health Planning Services, Livelihood Empowerment Against Poverty and established the Northern Development Authority to increase access to healthcare and also create wealth. Given these interventions, the study hypothesizes that household wealth would not have a significant influence on antenatal visits and modern contraceptive use. Therefore, this paper aims to examine whether household wealth would play any significant role on the new minimum contacts proxied by antenatal visits and also on the use of modern contraceptives as a family planning counselling tool during ANC visits. The study further examines a possible heterogeneity effect of paternal characteristic on maternal health service utilization.Design/methodology/approachThe study used data from the most recent Ghana Demographic and Health Survey (GDHS, 2014). Both bivariate and multivariate analyses were used to investigate the effects of household wealth on the number of antenatal visits and modern contraceptive use. The bivariate analysis employed the use of chi-square test whiles, the multivariate analysis involved estimations using logistic regressions.FindingsThe findings show that household wealth would play a critical role given the revised WHO minimum ANC contacts by expectant mothers. Household wealth exerts a positive and significant effect on ANC for all wealth quintiles for women who attended at least eight ANC visits, but was insignificant for the poorer and middle quintiles of those who attended four to seven visits. Wealth, however, had an insignificant relationship with modern contraceptive use. Generally, education, age, birth order, media exposure as well as geographical locations had a significant influence on both ANC visits and modern contraceptive use. The study further revealed a heterogeneous effect on ANC attendance. In particular, despite the relatively poor conditions, women in rural areas whose partners/husbands have attained a minimum of secondary education are about twice more likely to attend 4–7 antenatal visits compared to their counterparts whose husbands/partners are without education. Hence, a holistic health education, which includes husbands/partners in the rural areas as well as strengthening interventions that improve livelihoods, is crucial.Originality/valueHealth guidelines are constantly reviewed, and government policies must adapt accordingly. This paper looks at the significant role household wealth still plays on modern contraceptive use and ANC visits, given the revised WHO minimum ANC contacts and uniquely underscores the influence of paternal characteristics on the utilization of these maternal health services.

Background At the end of the MDG era, although Ghana was one of the few countries commended to have halved extreme poverty, the under-five mortality rate (U5MR) was dire. Currently, U5MR is still below the national and global SDG target. Government has over the years introduced various social and policy interventions to improve on the socioeconomic status of households to aid in better health outcomes. In this regard, we hypothesize that household wealth should therefore not influence under-five child deaths significantly. Methods The paper first reports under-five mortality trend over the past 30 years in Ghana. It uniquely analyses the levels and trends in wealth as measured by the Gross National Income per capita at purchasing power parity (ln GNI/p, ppp) as a proxy of the mean Comparative Wealth Index (CWI) against under-five child deaths in Ghana. Using data from the 2014 Ghana Demographic and Health Survey and employing the logistic regression estimation technique, the paper further estimates the effect of household wealth and other control variables on under-five child deaths. Results The trend analysis reveal that if the current rate of reduction of U5MR persists, Ghana may not achieve the SDG target. Our empirical estimations also show that household wealth still has a negative and significant relationship with under-five child deaths despite existing poverty alleviating policies. In addition, the results show that regional differences, maternal age, the number of children alive and maternal attendance to postnatal healthcare services are crucial for child survival. Conclusion The results imply that targeted government interventions towards improving household wealth should be intensified especially at the Northern Savannah regions. A new child health policy is imminent to reflect strategies towards achieving the SDG target on U5MR. Additionally, intensive education on active maternal participation in postnatal care should be given critical consideration to improve child survival.

This working paper predicts the fiscal and public health outcomes from a change in the excise tax structure for cigarettes in Ghana. More than 5,000 people are killed by diseases caused by tobacco every year in Ghana (Tobacco Atlas 2018). Currently the country has a unitary tax administration approach, with a uniform ad valorem tax structure on all excisable products, including tobacco. However, the ECOWAS directive on tobacco control, in line with the WHO Framework Convention on Tobacco Control (WHO 2003), recommends a simple tax structure – using a mixed excise system with a minimum specific tax floor to overcome the limitations of an ad valorem system on tobacco products, especially cigarettes. The study therefore simulates mixed tax policy interventions, and assesses their effect on government revenue and public health relative to the current ad valorem tax system. Primary data collection of tobacco prices in three geographical zones of the country was conducted in February 2020, across both rural and urban localities. This was supported with secondary data from national and international databases. Based on the assumption that Ghana adopts a mixed tax structure, the simulation shows that, if the government imposes a specific excise tax of GH₵4.00 (US$0.80) per pack in addition to the current ad valorem rate of 175 per cent of the CIF value, the average retail price of a cigarette pack would increase by 128 per cent, cigarette consumption decrease by 27 per cent, tobacco excise tax revenue increase by 627 per cent, and overall tobacco-related government tax revenue increase by 201 per cent.1 Additionally, there would be significant declines in smoking prevalence (3.3%), smoking intensity (1,448 cigarettes per year), and 3,526 premature smoking-related deaths would be avoided. The paper advocates for a strong tax administration and technical capacity, with continuous commitment by the government to adjust the tax rate in line with the rate of inflation and per capita income growth.

During the last two decades, the use of maternal health services has increased dramatically in Pakistan, with nearly 80% of Pakistani women making an antenatal care (ANC) visit during their pregnancy. Yet, this increase in use of modern health services has not translated into significant increases in the adoption of contraception. Even though Pakistan has had a national family planning programme and policies since the 1950s, contraceptive use has increased slowly to reach only 35% in 2012-13. No evidence is currently available to demonstrate whether the utilization of maternal health services is associated with contraceptive adoption in Pakistan. This study uses data from a large-scale survey conducted in Sindh province in 2013 to examine whether ANC utilization is a significant predictor of subsequent contraceptive use among women. In an analysis which controls for a range of variables known to be important for family planning adoption, the findings show that ANC is the strongest predictor of subsequent family planning use among women in Sindh. The antenatal visit represents an enormous opportunity to promote the adoption of family planning in Pakistan. The family planning programme should ensure that high-quality family planning counselling is provided to women during their ANC visits. This approach has the potential for contributing to substantial increases in contraceptive use in Pakistan.