Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys

Abstract

Background Delivery in unsafe and unsupervised conditions is common in developing countries including Ghana. Over the years, the Government of Ghana has attempted to improve maternal and child healthcare services including the reduction of home deliveries through programs such as fee waiver for delivery in 2003, abolishment of delivery care cost in 2005, and the introduction of the National Health Insurance Scheme in 2005. Though these efforts have yielded some results, home delivery is still an issue of great concern in Ghana. Therefore, the aim of the present study was to identify the risk factors that are consistently associated with home deliveries in Ghana between 2006 and 2017–18. Methods The study relied on datasets from three waves (2006, 2011, and 2017–18) of the Ghana Multiple Indicator Cluster surveys (GMICS). Summary statistics were used to describe the sample. The survey design of the GMICS was accounted for using the ‘svyset’ command in STATA-14 before the association tests. Robust Poisson regression was used to estimate the relationship between sociodemographic factors and home deliveries in Ghana in both bivariate and multivariable models. Results The proportion of women who give birth at home during the period under consideration has decreased. The proportion of home deliveries has reduced from 50.56% in 2006 to 21.37% in 2017–18. In the multivariable model, women who had less than eight antenatal care visits, as well as those who dwelt in households with decreasing wealth, rural areas of residence, were consistently at risk of delivering in the home throughout the three data waves. Residing in the Upper East region was associated with a lower likelihood of delivering at home. Conclusion Policies should target the at-risk-women to achieve complete reduction in home deliveries. Access to facility-based deliveries should be expanded to ensure that the expansion measures are pro-poor, pro-rural, and pro-uneducated. Innovative measures such as mobile antenatal care programs should be organized in every community in the population segments that were consistently choosing home deliveries over facility-based deliveries.

Mother and newborn skin-to-skin contact in sub-Saharan Africa: prevalence and predictors

“…This is consistent with evidence from The Gambia,13 Ethiopia29 and Nigeria,24 that found higher odds of mother and newborn skin-to-skin contact among women who delivered at a health facility as compared with those who delivered at home. It is noteworthy that, delivery in a health facility significantly rests on the availability of skilled birth attendants (SBAs) who have been trained to ensure that mothers comply with best maternal and neonatal practices 30 31. Thus, it is highly plausible that at the health facility, women who deliver are more likely to be educated about the relevance of skin-to-skin contact to both the mother and the survival of the newborn and supported to practice skin-to-skin contact compared with those who deliver at home without assistance from an SBA.…”

Continuum of care for maternal, newborn, and child health in 17 sub-Saharan African countries

“…For instance, Aboagye et al [6] assessed timely ANC attendance in SSA. Other studies conducted in SSA have also examined the factors associated with skilled birth attendance [12], home deliveries [13], PNC utilisation [14], breastfeeding [15], and vaccination [16]. However, there is a dearth of empirical evidence on the factors associated with the CoC for maternal, newborn, and child health (MNCH) in SSA.…”

Trends and inequalities in children aged 6–59 months who received Vitamin A supplementation: evidence from the 2003, 2008 and 2014 Ghana Demographic and Health Survey

“…However, in 2014, the widest inequality in Vitamin A supplementation favored children born to rural dwelling women. Perhaps, the changing dynamics in the uptake of Vitamin A supplementation in Ghana could be a reflection of the outcome of several pro-rural maternal and child health policies or interventions, such as the Community-Based Health Planning and Services (CHPS), free maternal healthcare policy and NHIS [ 20 , 21 ]. The findings imply that inasmuch as pro-rural interventions are critical to the uptake of Vitamin A supplementation, there is a need to focus on children born to urban dwelling women.…”