Household wealth and maternal health: evidence from Ghana

Abstract

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.

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age

“…We noted that maternal education has significant positive impacts on both ≥ 4 ANC and the newly recommended ≥ 8 antenatal contacts. Our finding of a significant positive association between maternal education and ≥ 4 and the recommended ≥ 8 antenatal contacts conforms to past studies, both for Nigeria and elsewhere ( 7 , 17 , 20 , 28 – 30 ). However, this finding contradicts the reports made by some other studies conducted in Nigeria and elsewhere ( 2 , 31 ).…”

“…We further observed that access to media showed increased odds for undertaking ≥ 4 and ≥ 8 ANC contacts, which conform to studies in Benin Republic (7), a Ghanaian study (17), an Ethiopian study (30,33), India study (34), Bangladesh (35), and rural Malawi (36). The reason for this could be that frequently listening to the radio and watching television will increase the literacy of a person, which has been noted as a key determinant of maternal care utilization (17). According to Afu-Mensah et al (37) information education through media influences the use of health services (17).…”

“…We found out that the coverage of ≥ 4 and ≥ 8 ANC contacts were respectively 31.4 and 2.2%. The prevalent rate of ≥ 8 ANC contacts is far below the rates reported by a Nigerian study (4, 7), a Ghanaian study (17), and a study in the Benin Republic (28). Intervention programmes should be implemented in the study area that will expand the coverage rate of ANC, particularly the newly recommended guidelines of WHO of eight contacts.…”

“…The reason for this could be that frequently listening to the radio and watching television will increase the literacy of a person, which has been noted as a key determinant of maternal care utilization ( 17 ). According to Afu-Mensah et al ( 37 ) information education through media influences the use of health services ( 17 ).…”

“…To reduce the number of preventable maternal deaths and to ensure that the Sustainable Development Goals target of reducing maternal mortality to <70 per 100,000 live births by the year 2030 is met, the WHO in 2016 came up with new guidelines for ANC ( 4 , 7 , 17 ). As part of the recommendations, the minimum number of ANC contacts should increase from four to eight or more.…”