Household wealth and maternal health: evidence from Ghana

  • International Journal of Social Economics, Volume 48, No. 1, Year 2021

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Study Justification:
– The World Health Organization (WHO) revised the recommended contacts for antenatal care (ANC) by expectant mothers from four to eight.
– Ghana has not yet adopted the new recommendation, but some women choose to adhere to it due to the health benefits.
– The study aims to examine the influence of household wealth on ANC visits and modern contraceptive use.
– It also explores the effect of paternal characteristics on maternal health service utilization.
Highlights:
– Household wealth has a significant positive effect on ANC visits for women who attended at least eight visits.
– Wealth has an insignificant relationship with modern contraceptive use.
– Education, age, birth order, media exposure, and geographical locations influence both ANC visits and modern contraceptive use.
– Women in rural areas with partners who have attained secondary education are more likely to attend 4-7 ANC visits.
Recommendations:
– Strengthen interventions that improve livelihoods to increase ANC attendance, especially in rural areas.
– Implement holistic health education programs that involve husbands/partners in rural areas.
– Consider adopting the revised WHO recommendation of eight ANC visits for expectant mothers.
Key Role Players:
– Government health agencies
– NGOs working in maternal health
– Community health workers
– Health educators
– Researchers and academics
Cost Items for Planning Recommendations:
– Training and capacity building for health workers and educators
– Development and implementation of health education programs
– Outreach and awareness campaigns in rural areas
– Monitoring and evaluation of interventions
– Research and data collection for evidence-based decision making

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study used data from the most recent Ghana Demographic and Health Survey, which provides a solid foundation for the analysis. The bivariate and multivariate analyses were appropriate methods for investigating the effects of household wealth on antenatal visits and modern contraceptive use. The findings show a positive and significant effect of household wealth on ANC visits for women who attended at least eight visits, but the relationship was insignificant for poorer and middle quintiles attending four to seven visits. However, the abstract does not provide specific details about the sample size, sampling methodology, or statistical significance of the findings. Including these details would strengthen the evidence. Additionally, the abstract could benefit from a clearer explanation of the study’s limitations and implications for future research. To improve the evidence, the authors should consider providing more specific information about the sample size, sampling methodology, and statistical significance. They should also discuss the limitations of the study and suggest areas for further research.

Purpose: In 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/approach: The 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. Findings: The 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/value: Health 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.

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Based on the description provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or text messaging services to provide pregnant women with important information about antenatal care, family planning, and maternal health services. This can help overcome barriers such as limited access to healthcare facilities or lack of awareness.

2. Telemedicine: Establish telemedicine services to enable remote consultations between pregnant women and healthcare providers. This can be particularly beneficial for women in rural or underserved areas who may have limited access to healthcare facilities.

3. Community Health Workers: Train and deploy community health workers to provide education, counseling, and support to pregnant women in their communities. These workers can help increase awareness about the importance of antenatal care, family planning, and maternal health services, and provide guidance on accessing these services.

4. Financial Incentives: Introduce financial incentives, such as cash transfers or subsidies, to encourage pregnant women to attend the recommended number of antenatal visits and utilize modern contraceptives. This can help address financial barriers that may prevent women from accessing these services.

5. Public-Private Partnerships: Foster collaborations between the government, private sector, and non-profit organizations to improve access to maternal health services. This can involve initiatives such as setting up mobile clinics in underserved areas or providing free or subsidized healthcare services to pregnant women.

6. Maternal Health Education Programs: Develop and implement comprehensive maternal health education programs that target not only pregnant women but also their partners, families, and communities. These programs can focus on raising awareness about the importance of antenatal care, family planning, and maternal health services, and address cultural or social barriers that may hinder access.

7. Strengthening Health Systems: Invest in improving healthcare infrastructure, staffing, and supply chain management to ensure that maternal health services are readily available and of high quality. This can involve upgrading healthcare facilities, training healthcare providers, and ensuring the availability of essential medicines and equipment.

It is important to note that the specific recommendations for improving access to maternal health may vary depending on the context, resources, and priorities of the particular country or region.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health is to implement a holistic health education program that includes husbands/partners in rural areas and strengthens interventions to improve livelihoods. This recommendation is based on the findings that household wealth has a significant influence on antenatal care (ANC) visits for women who attend at least eight visits, but not for those who attend four to seven visits. Additionally, the study reveals that women in rural areas whose partners/husbands have attained a minimum of secondary education are more likely to attend ANC visits compared to those whose partners are without education. Therefore, by involving husbands/partners in the rural areas and providing education on maternal health, the access to ANC visits can be improved. Furthermore, interventions that improve livelihoods can also contribute to better access to maternal health services.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for innovations to improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or SMS-based systems to provide pregnant women with information, reminders, and support for antenatal care visits and family planning services. These technologies can help overcome barriers such as lack of awareness, transportation, and distance to healthcare facilities.

2. Telemedicine Services: Establish telemedicine platforms that allow pregnant women in remote or underserved areas to consult with healthcare providers remotely. This can help address the shortage of healthcare professionals in certain regions and improve access to timely and quality maternal healthcare.

3. Community Health Workers (CHWs): Train and deploy CHWs to provide maternal health education, counseling, and basic healthcare services in communities. CHWs can play a crucial role in reaching pregnant women who may face cultural, social, or economic barriers to accessing formal healthcare facilities.

4. Financial Incentives: Implement financial incentives, such as conditional cash transfers or vouchers, to encourage pregnant women to attend antenatal care visits and utilize family planning services. These incentives can help offset the costs associated with seeking maternal healthcare and improve access for women from low-income households.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the target population: Identify the specific group of pregnant women or communities that would benefit from the innovations. Consider factors such as geographic location, socioeconomic status, and cultural context.

2. Collect baseline data: Gather data on the current access to maternal health services, including antenatal care visits and modern contraceptive use, in the target population. This can be done through surveys, interviews, or existing data sources such as health records or demographic surveys.

3. Develop a simulation model: Create a mathematical or computational model that simulates the impact of the recommended innovations on access to maternal health. The model should consider factors such as the reach and effectiveness of the innovations, the characteristics of the target population, and any potential barriers or limitations.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to estimate the potential impact of the innovations on improving access to maternal health. Vary the parameters of the model to explore different scenarios and assess the sensitivity of the results.

5. Analyze and interpret results: Analyze the simulation results to determine the potential changes in access to maternal health services. Assess the magnitude of the impact, identify any disparities or variations across different subgroups, and evaluate the cost-effectiveness of the recommended innovations.

6. Communicate findings and make recommendations: Present the findings of the simulation study in a clear and concise manner. Highlight the potential benefits and limitations of the recommended innovations, and provide evidence-based recommendations for policymakers, healthcare providers, and other stakeholders to improve access to maternal health.


Statistics:
Citations: 3
Identifiers:
DOI: 10.1108/IJSE-03-2020-0153
ISSN: 03068293
Research Areas:
Community Interventions, Disparities, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ghana
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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