Determinants of utilization of antenatal care services in developing countries

Abstract

PurposeThe purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.Design/methodology/approachThe paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.FindingsThe study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.Research limitations/implicationsThe GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.Practical implicationsThe fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.Originality/valueA new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

“…However, we found that they were more likely to have attended ANC at least four times if they had enrolled in the health insurance scheme. Consistent with those of earlier studies [4,36,42–49], the findings of the current study demonstrated the importance of health insurance in seeking and receiving healthcare. Implementation of the Ghanaian government policy for free medical care for pregnant women under the NHIS could have been a factor in increasing ANC attendance.…”

The relationship between perceived service quality of antenatal care and use among rural women in Ghana

“…This result of relatively easy access to ANC by the rural women is encouraging. A high level of accessibility to ANC has a positive influence on the level of utilisation, as found by previous studies in other African countries such as Ghana (Addai, 2000;Buor, 2004;Nketiah-Amponsah et al, 2013;Asundep et al, 2013), Ethiopia (Mekonnen and Mekonnen, 2003;Girma et al, 2011;Tsegay et al, 2013) and Nigeria (Dahiru and Oche, 2015). Increased utilisation results in positive health outcomes such as reduced maternal and infant morbidity and mortality resulting from of pregnancy and birth complications.…”

“…The WHO estimated Ghana's maternal mortality ratio at 376 per 100,000 live births in 2005, 325 per 100,000 in 2010, and 319 per 100,000 in 2015 (World Health Organization, 2015). Inadequate access, low quality and underutilisation of modern ANC services are key reasons for poor maternal and infant health outcomes in Ghana and other Sub-Saharan African countries (Nketiah-Amponsah et al, 2013;Escribano-Ferrer et al, 2016;Emelumadu et al, 2014).…”

“…Previous studies have reported on inconsistent ANC visits among pregnant women in Ghana (Nketiah-Amponsah et al, 2013;Gudu and Addo, 2017;Ameyaw et al, 2017;Bonfrer et al, 2016;Asundep et al, 2013Asundep et al, , 2014. However, no study has assessed the quality of ANC services from the perspective of users, and the impact of the perceived quality on ANC utilisation.…”

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

“…Communities were not randomly assigned to intervention or comparison areas. There were differences between the intervention and comparison areas at baseline in terms of ethnicity, which studies have shown to be associated with uptake of ANC services (Abor et al 2011;Nketiah-Amponsah, Senadza, and Arthur 2013;Pell et al 2013). Additionally, this study did not follow a cohort of mothers, but rather selected separate pre-post samples at baseline and follow-up in both programme areas.…”