Factors Influencing Choice of Place of Delivery Among Pregnant Women in the Ashanti Bekwai Municipality

Abstract

Background: Despite global and national commitments to reducing maternal mortality, a substantial proportion of pregnant women in Ghana continue to deliver outside of health facilities. In the Ashanti Bekwai Municipality, while antenatal registrations have remained high, hospital based deliveries have not shown commensurate increases. This study sought to investigate the behavioural beliefs, normative influences, attitudes, and subjective norms influencing pregnant women's choices regarding delivery locations. Methods: A cross-sectional survey was conducted among pregnant women in the Bekwai Municipality. Data were collected through structured questionnaires and analysed using SPSS version 27. Principal Component Analysis was employed to generate composite scores for key theoretical constructs. Regression and causal mediation analysis were utilized to evaluate the relationships among beliefs, intentions, and delivery behaviour. Results: A total of 415 pregnant women participated in the study. Behavioural beliefs were found to be significant predictors of the intention to deliver at a health facility (Adjusted Odds Ratio [AOR] = 1.70; 95% Confidence Interval [CI]: 1.14–2.52; p = 0.009), while outcome evaluations did not demonstrate a significant effect (p = 0.890). In the adjusted model, both normative beliefs (β = 0.42; p < 0.001) and motivation to comply (β = 0.35; p < 0.001) were identified as strong predictors of intention. Furthermore, positive attitudes toward delivery at health facilities were significantly correlated with intention (β = 0.67; p < 0.001). However, only intention (AOR = 1.93; 95% CI: 1.26–2.97; p = 0.003) emerged as a significant predictor of delivery behaviour, while attitude did not. Subjective norms (direct norms [β = 0.26] and normative beliefs [β = 0.50; p < 0.001]) exhibited a significant influence on intention. Mediation analysis indicated that behavioural intention significantly mediated the relationships between both attitude (80%) and subjective norms (88%) with the actual place of delivery. Conclusion: The study concludes that maternal education, attendance at antenatal care, affordability of transportation, and spousal support significantly influence the choice of delivery location. Enhancing male involvement, improving community health education, and increasing access to health facilities may contribute to a rise in institutional deliveries within the Ashanti Bekwai Municipality.