Inequalities in antenatal care in Ghana, 1998–2014

Seidu, Abdul-Aziz, Okyere, Joshua, Budu, Eugene, Duah, Henry Ofori, and Ahinkorah, Bright Opoku (2022) Inequalities in antenatal care in Ghana, 1998–2014. BMC Pregnancy and Childbirth, 22 (1). 478.

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Background: In order to effectively and efficiently reduce maternal mortality and ensure optimal outcomes of pregnancy, equity is required in availability and provision of antenatal care. Thus, analysis of trends of socio-economic, demographic, cultural and geographical inequities is imperative to provide a holistic explanation for differences in availability, quality and utilization of antenatal care. We, therefore, investigated the trends in inequalities in four or more antenatal care visits in Ghana, from 1998 to 2014.

Methods: We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software to analyse data from the 1998 to 2014 Ghana Demographic and Health Surveys. We disaggregated four or more antenatal care visits by four equality stratifiers: economic status, level of education, place of residence, and sub-national region. We measured inequality through summary measures: Difference, Population Attributable Risk (PAR), Ratio, and Population Attributable Fraction (PAF). A 95% uncertainty interval (UI) was constructed for point estimates to measure statistical significance.

Results: The Difference measure of 21.7% (95% UI; 15.2–28.2) and the PAF measure of 12.4% (95% UI 9.6–15.2) indicated significant absolute and relative economic-related disparities in four or more antenatal care visits favouring women in the highest wealth quintile. In the 2014 survey, the Difference measure of 13.1% (95% UI 8.2–19.1) and PAF of 6.5% (95% UI 4.2–8.7) indicate wide disparities in four or more antenatal care visits across education subgroups disfavouring non-educated women. The Difference measure of 9.3% (95% UI 5.8–12.9) and PAF of 5.8% (95% UI 4.7–6.8) suggest considerable relative and absolute urban–rural disparities in four or more antenatal care visits disfavouring rural women. The Difference measure of 20.6% (95% UI 8.8–32.2) and PAF of 7.1% (95% UI 2.9–11.4) in the 2014 survey show significant absolute and relative regional inequality in four or more antenatal care visits, with significantly higher coverage among regions like Ashanti, compared to the Northern region.

Conclusions: We found a disproportionately lower uptake of four or more antenatal care visits among women who were poor, uneducated and living in rural areas and the Northern region. There is a need for policymakers to design interventions that will enable disadvantaged subpopulations to benefit from four or more antenatal care visits to meet the Sustainable Development Goal 3.1 that aims to reduce the maternal mortality ratio (MMR) to less than 70/100, 000 live births by 2030. Further studies are essential to understand the underlying factors for the inequalities in antenatal care visits.

Item ID: 76370
Item Type: Article (Research - C1)
ISSN: 1471-2393
Keywords: Antenatal care, Demographic and Health Surveys, Ghana, Global health, Inequality
Copyright Information: © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Date Deposited: 15 Mar 2023 03:50
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 50%
42 HEALTH SCIENCES > 4206 Public health > 420606 Social determinants of health @ 50%
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