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Background: To achieve the Sustainable Development Goal target 3.1, the World Health Organisation recommends that all pregnant women receive antenatal care (ANC) from skilled providers, utilise the services of a skilled birth attendant at birth and receive their first postnatal care (PNC) within the first 24 h after birth. In this paper, we examined the maternal characteristics that determine utilisation of skilled ANC, skilled birth attendance (SBA), and PNC within the first 24 h after delivery in Ghana. Methods: We used data from the 2014 Ghana Demographic and Health Survey. Women aged 15-49 with birth history not exceeding five before the survey were included in the study. A total of 2839 women were included. Binary logistic regression was employed at a 95% level of significance to determine the association between maternal factors and maternal healthcare (MCH) utilisation. Bivariate and multivariate regression was subsequently used to assess the drivers. Results: High proportion of women had ANC (93.2%) with skilled providers compared to the proportion that had SBA (76.9%) and PNC within the first 24 h after delivery (25.8%). Only 21.2% utilised all three components of MCH. Women who were covered by national health insurance scheme (NHIS) had a higher likelihood (AOR = 1.31, CI = 1.04 – 1.64) of utilising all three components of MCH as compared to those who were not covered by NHIS. Women with poorer wealth status (AOR = 0.72, CI = 0.53 – 0.97) and those living with partners (AOR = 0.65, CI = 0.49 – 0.86) were less likely to utilise all three MCH components compared to women with poorest wealth status and the married respectively. Conclusion: The realisation that poorer women, those unsubscribed to NHIS and women living with partners have a lower likelihood of utilising the WHO recommended MCH strongly suggest that it is crucial for the Ministry of Health and the Ghana Health Service to take pragmatic steps to increase education about the importance of having ANC with a skilled provider, SBA, and benefits of having the first 24 h recommended PNC.
The Ghana Demographic and Health Survey (GDHS) used a standard DHS model questionnaire developed by the Measure DHS programme [22]. This study used the most recent DHS data and a descriptive cross-sectional study design. The DHS are national surveys carried out every 5 years in low- and middle-income countries globally [23]. The surveys concentrate on maternal and child health, physical activity, sexually transmitted infections, fertility, health insurance, tobacco use, and alcohol consumption. They mainly provide data to monitor the demographic and health profiles of the respective countries [23]. For the purpose of the study, women with birth history who had given birth up to 5 years before the survey were included. A sample of 2839 women with complete data required for our analysis participatedble in this study. Permission to use the data set was given by the MEASURE DHS following the assessment of our concept note. The DHS program permitted us to use the dataset after evaluation of our concept note. The datasets are freely available to the public at www.measuredhs.com. Outcomes of interest were skilled providers of antenatal care (ANC), skilled birth attendance, and postnatal care utilisation within 24 h. Skilled provider of ANC and skilled birth attendance were derived from the question “did you see anyone for antenatal care for this pregnancy? If YES: whom did you see?” and “who assisted with the delivery?” respectively. Responses were categorized under Health Personnel and Other Person. Health personnel included doctor, nurse, nurse/midwife, an auxiliary midwife; Other persons also consisted of the traditional birth attendant (TBA), traditional health volunteer, community/village health volunteer, neighbours/ friends/relatives, other. For the purpose of the study, skilled birth attendance referred to births assisted by a doctor, nurse, auxiliary midwife, nurse/midwife [21, 24–26]. Postnatal utilisation within 24 h was derived from the question “How many hours, days, or weeks after the birth of (NAME) did the first check take place?” The response was recoded as within 24 h (coded as 1) and after 24 h (coded as 0). Twelve explanatory variables were used for the study. These include age, place of residence, level of education, covered by health insurance, frequency of listening to radio, frequency of watching television, wealth status, antenatal care visits, marital status, getting medical help for self: getting permission to go, getting medical help for self: getting money needed for treatment, getting medical help for self: distance to health facility. The study employed both inferential and descriptive analysis. The inferential analysis was a multivariate binary logistic analysis of the predictors of the outcome variables. Four models were employed. Model 1 was based on the background characteristics and skilled ANC provider. Model 2 and 3 were constructed on background characteristics and skilled birth attendance and postnatal care respectively. Model 4 is a combination of all the outcome variables and background characteristics. Descriptive analysis was computed by having a bivariate analysis of the 12 explanatory variables and the outcome variables. All analyses were done using STATA version 14 and all results were weighted. The presence of multicollinearity between the independent variables was checked before fitting the models. The variance inflation factor (VIF) test revealed the absence of high multicollinearity between the variables with mean VIF = 3.68 among explanatory variables. Categories with the highest frequencies were used as the reference groups throughout the analysis. This study benefited from publicly available data from DHS. Permission to access the data was granted by the Measure DHS Program. Pre-approval was obtained from all participants prior to the survey. The DHS Program adheres to ethical standards to protect respondents’ privacy. Inner-City Fund (ICF) International also ensures that the surveys are in line with the ethical requirements of the US Department of Health and Human Services. No additional ethical approval is required because the data is secondary and publicly available. Details of the ethical standards are available on http://goo.gl/ny8T6X.
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