Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Pregnancy Childbirth
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 eforts 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 decreas‑
ing 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.
Description
Research Article
Keywords
Prenatal care, Antenatal care, Pregnancy, Skilled birth attendance