Trends in antenatal care visits and associated factors in Ghana from 2006 to 2018

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Abstract

Introduction

Given that maternal mortality is a major global health concern, multiple measures including antenatal care visits have been promoted by the global community. However, most pregnant women in Ghana and other sub-Saharan African countries do not attain the recommended timelines, in addition to a slower progress towards meeting the required minimum of eight visits stipulated by the World Health Organization. Therefore, this study explored the trends in antenatal care visits and the associated factors in Ghana from 2006 to 2018 using the Multiple Indicator Cluster Surveys.

Methods

The study used women datasets ( N = 7795) aged 15 to 49 years from three waves (2006, 2011, and 2017-2018) of the Ghana Multiple Indicator Cluster Surveys (GMICS). STATA version 14 was used for data analyses. Univariable analyses, bivariable analyses with chi-square test of independence, and multivariable analyses with robust multinomial logistic regression models were fitted.

Results

The study found a consistent increase in the proportion of women having adequate and optimal antenatal attendance from 2006 to 2018 across the women’s sociodemographic segments. For instance, the proportion of mothers achieving adequate antenatal care (4 to 7 antenatal care visits) increased from 49.3% in 2006 to 49.98% in 2011 to 58.61% in 2017-2018. In the multivariable model, women with upward attainment of formal education, health insurance coverage, increasing household wealth, and residing in the Upper East Region were consistently associated with a higher likelihood of adequate and/or optimal antenatal care attendance from 2006 to 2018.

Conclusion

Women who are less likely to achieve optimal antenatal care visits should be targeted by policies towards reducing maternal mortalities and other birth complications. Poverty-reduction policies, promoting maternal and girl-child education, improving general livelihood in rural settings, expanding health insurance coverage and infrastructural access, harnessing community-level structures, and innovative measures such as telehealth and telemedicine are required to increase antenatal care utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04404-9.

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Most cited references 51

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Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi

Christopher Pell, Arantza Meñaca, Florence Were … (2013)

Background Antenatal care (ANC) is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi) with varying levels of ANC attendance. Methods Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. Results Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care – checking the foetus’ position or monitoring its progress – motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women’s timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures – in spite of policies of free ANC – combined with ideas about the compulsory nature of follow-up appointments. Conclusion In these socially and culturally diverse sites, the findings suggest that ‘supply’ side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation.

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Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013

Ann-Beth Moller, Max Petzold, Doris Chou … (2017)

Summary Background The timing of the first antenatal care visit is paramount for ensuring optimal health outcomes for women and children, and it is recommended that all pregnant women initiate antenatal care in the first trimester of pregnancy (early antenatal care visit). Systematic global analysis of early antenatal care visits has not been done previously. This study reports on regional and global estimates of the coverage of early antenatal care visits from 1990 to 2013. Methods Data were obtained from nationally representative surveys and national health information systems. Estimates of coverage of early antenatal care visits were generated with linear regression analysis and based on 516 logit-transformed observations from 132 countries. The model accounted for differences by data sources in reporting the cutoff for the early antenatal care visit. Findings The estimated worldwide coverage of early antenatal care visits increased from 40·9% (95% uncertainty interval [UI] 34·6–46·7) in 1990 to 58·6% (52·1–64·3) in 2013, corresponding to a 43·3% increase. Overall coverage in the developing regions was 48·1% (95% UI 43·4–52·4) in 2013 compared with 84·8% (81·6–87·7) in the developed regions. In 2013, the estimated coverage of early antenatal care visits was 24·0% (95% UI 21·7–26·5) in low-income countries compared with 81·9% (76·5–87·1) in high-income countries. Interpretation Progress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation. Funding Department of Reproductive Health and Research, WHO and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

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Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

Maureen Porter, Padam Simkhada, Bibha Simkhada … (2008)

This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.

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Author and article information

Contributors

Jerry John Nutor: Jerry.Nutor@ucsf.edu

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 22 January 2022

Publication date PMC-release: 22 January 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 59

Affiliations

[1 ]GRID grid.15751.37, ISNI 0000 0001 0719 6059, Department of Nursing and Midwifery, School of Human and Health Sciences, , University of Huddersfield, ; Queensgate, Huddersfield, England UK

[2 ]GRID grid.16890.36, ISNI 0000 0004 1764 6123, School of Nursing, , The Hong Kong Polytechnic University, ; Kowloon, Hong Kong

[3 ]GRID grid.415450.1, ISNI 0000 0004 0466 0719, Child Health Directorate, , Komfo Anokye Teaching Hospital, ; Post Office Box 1934, Adum -, Kumasi, Ghana

[4 ]GRID grid.15276.37, ISNI 0000 0004 1936 8091, Department of Epidemiology, College of Public Health & Health Professions, College of Medicine, , University of Florida, ; Gainesville, USA

[5 ]GRID grid.411382.d, ISNI 0000 0004 1770 0716, Department of Sociology and Social Policy, , Lingnan University, ; 8 Castle Peak Road, Tuen Mun, Hong Kong

[6 ]GRID grid.9829.a, ISNI 0000000109466120, Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, , Kwame Nkrumah University of Science and Technology, ; Kumasi, Ghana

[7 ]GRID grid.8652.9, ISNI 0000 0004 1937 1485, Department of Psychology, , University of Ghana, ; P.O. Box LG 84, Legon, Ghana

[8 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Family Health Care Nursing, School of Nursing, , University of California San Francisco, ; San Francisco, California, USA

Article

Publisher ID: 4404

DOI: 10.1186/s12884-022-04404-9

PMC ID: 8783507

PubMed ID: 35062909

SO-VID: 2f22c44f-1326-4c30-b304-a79cc86ef722

License:

Open AccessThis 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 http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 April 2021

Date accepted : 12 January 2022

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: prenatal care,maternal and child health,sub-saharan africa,child morality,maternal mortality

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: prenatal care, maternal and child health, sub-saharan africa, child morality, maternal mortality

Trends in antenatal care visits and associated factors in Ghana from 2006 to 2018

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Abstract

Introduction

Methods

Results

Conclusion

Supplementary Information

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SDG 3: Good Health and Well-Being

Most cited references 51

Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi

Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013

Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

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