Influence of Married Women’s Autonomy on the Choice of Place of Delivery in Ghana: An Analysis of the 2014 Ghana Demographic and Health Survey
Date
2019-06
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Publisher
University of Ghana
Abstract
Background: Sub-Saharan Africa has the highest record of maternal mortality. The World Health Organization defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. In Ghana, maternal mortality rate stands at 319 deaths per 100,000 live births. Trends from the last five Ghana Demographic and Health Surveys show a steady increase in the percentage of deliveries in health institutions, however there is still a large gap between the prenatal coverage and actual deliveries in hospitals/clinics. A woman’s choice in place of delivery is a key factor that influences maternal or child health. This study seeks to understand how married women’s autonomy in the household influences her choice of place of delivery.
Methods: This study used data from the Ghana Demographic and Health Survey 2014, which is the most recent Demographic and Health Study to access the characteristics of the sample. The sample comprised of 2801 married women aged between 15-49 years who had delivered a child in the last five years at the time of the study. Descriptive statistics was used to examine the distribution of the sample and logistic regression to examine the relationship between married women’s autonomy and choice of place of delivery. Data analysis was done using STATA 15.
Results: Married Women aged 35-39 years and those with spouses aged 35-39 years were observed to be more autonomous (76.7% and 74.5% respectively) than other women in the study. It was also observed that women with tertiary education, Christian women, women who had had four or more ANC visits were more autonomous than other groups. Occupation of mother and spouse was also observed to be significantly associated with autonomy Mothers aged 35-39 years and mothers aged 40-44 years with spouses had the most institutional deliveries. Mothers with tertiary education and those whose spouses received tertiary education, urban dwellers, Christians, women from wealthy households and mother’s covered by insurance had the most institutional deliveries. Greater Accra region recorded the highest institutional births and the attendance of 4+ Antenatal visits was significantly associated with institutional delivery.
An increase in autonomy led to an equal increase in the odds of institutional delivery though after adjusting for other socio-demographic/economic factors, the level of influence fluctuated. Region, increase in education, type of residence, wealth and occupation were found to influence the odds of a mother having institutional delivery.
Conclusion: Education, religion, wealth, ANC visits and occupation influenced both autonomy and place of delivery. Female education was observed to increase autonomy and give rise to the number of institutional deliveries. However, some of the influential variables cannot be manipulated such as age of respondents but others such as education can be used as a tool to promote institutional delivery through civic education. The government should also focus on developing the health network (e.g. hospitals, road networks and utilities) in the rural areas.
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MPH.
Keywords
Married Women’s Autonomy, 2014 Ghana Demographic, Health Survey