The social determinants of health facility delivery in Ghana
Abstract Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods...
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doaj-b9e91bb0e70b438a8ae87f254010ea282020-11-25T03:52:13ZengBMCReproductive Health1742-47552019-07-0116111010.1186/s12978-019-0753-2The social determinants of health facility delivery in GhanaEmmanuel Dankwah0Wu Zeng1Cindy Feng2Shelley Kirychuk3Marwa Farag4School of Public Health, University of SaskatchewanThe Heller School for Social Policy and Management, Brandeis UniversitySchool of Public Health, University of SaskatchewanCollege of Medicine, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of SaskatchewanSchool of Public Health, University of SaskatchewanAbstract Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen’s health care utilization model was used as the conceptual framework guiding this study.. Results Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions First, in spite of Ghana’s free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access.http://link.springer.com/article/10.1186/s12978-019-0753-2Health facilityDeliveryReproductive aged women,Social determinantsBirth |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emmanuel Dankwah Wu Zeng Cindy Feng Shelley Kirychuk Marwa Farag |
spellingShingle |
Emmanuel Dankwah Wu Zeng Cindy Feng Shelley Kirychuk Marwa Farag The social determinants of health facility delivery in Ghana Reproductive Health Health facility Delivery Reproductive aged women, Social determinants Birth |
author_facet |
Emmanuel Dankwah Wu Zeng Cindy Feng Shelley Kirychuk Marwa Farag |
author_sort |
Emmanuel Dankwah |
title |
The social determinants of health facility delivery in Ghana |
title_short |
The social determinants of health facility delivery in Ghana |
title_full |
The social determinants of health facility delivery in Ghana |
title_fullStr |
The social determinants of health facility delivery in Ghana |
title_full_unstemmed |
The social determinants of health facility delivery in Ghana |
title_sort |
social determinants of health facility delivery in ghana |
publisher |
BMC |
series |
Reproductive Health |
issn |
1742-4755 |
publishDate |
2019-07-01 |
description |
Abstract Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen’s health care utilization model was used as the conceptual framework guiding this study.. Results Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions First, in spite of Ghana’s free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access. |
topic |
Health facility Delivery Reproductive aged women, Social determinants Birth |
url |
http://link.springer.com/article/10.1186/s12978-019-0753-2 |
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