Socioeconomic Inequalities and Maternal Health Outcomes in Ghana

Abstract

Maternal health outcomes are among the most diverse human indicators of development as well as critical global indicators of socioeconomic standing of a country. While many studies have over the years identified risk factors associated with the occurrence of adverse maternal health outcomes, such studies have tended to be relatively proximal and individually-based. Using the Ghana Maternal Health Survey data in a multilevel modelling design, this study examined the relationship between the socioeconomic status of the area within which women live and the occurrence of maternal mortality, stillbirth, miscarriage and abortion as prime indicators of maternal health. The aim is to understand how, independent of individual level factors, maternal health is affected by the characteristics of the areas within which women live and work. The study used the 2000 Population and Housing Census data to construct a composite index of multiple deprivation to reflect the socioeconomic structure of women’s immediate environment. The quantitative analysis was triangulated with qualitative interviews to contextualise the discussions. The results showed that women living in deprived areas have higher odds of maternal death compared to women living in less deprived areas. The level of deprivation further suppresses the expected positive effect of educational attainment measured at the individual level, indicating that individual level educational qualification is not protective of maternal mortality in a deprived area. The effect of the deprivation status however reduces in areas where the aggregate proportion of females educated up to Senior High School level or higher s high. This means that policies that will provide and ensure educational attainment up to the Senior High School level for women will be crucial in reducing the risk of maternal mortality. The incidence rate of maternal mortality is also lower in neighbourhoods where coverage of supervised deliveries is higher. Women who live in less deprived neighbourhoods however have a higher likelihood of seeking abortion compared with women in deprived neighbourhoods. Less deprived neighbourhoods are also associated with high odds of suffering miscarriage but lower odds of stillbirth. Controlling for a variety of individual characteristics the results further showed that it is women of middle or wealthy households living in less deprived neighbourhoods who are mostly likely to seek abortion, whilst women of poor households living in less deprived neighbourhood have higher probabilities of reporting miscarriages. These results setup two important agendas that concern development policy and research. The resulting policy recommendation from the work is that, an expansion of educational opportunities that enable more women to obtain school education up to the Senior High School level and higher will be significant in reducing maternal mortality in Ghana. In terms of research agenda, the findings strengthen the need to broaden the scope of maternal health research to include an understanding of the community within which women live and work. Results from such research agendas will show the need to be more careful in targeting interventions in communities since in many situations the poor living in affluent neighbourhoods are often clouded up by the affluence of the wealthy and kept largely unnoticed for intervention programmes yet they do not enjoy the advantages of being in such neighbourhoods.