Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018 : insights from the multiple indicator cluster surveys

Veronica Millicent DZOMEKU, Precious Adade DUODU, Joshua OKYERE, Livingstone ADUSE-POKU, Nutifafa Eugene Yaw DEY, Adwoa Bemah BOAMAH MENSAH, Emmanuel Kweku NAKUA, Pascal AGBADI, Jerry John NUTOR*

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

1 Citation (Scopus)

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 efforts 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 decreasing 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.

Original languageEnglish
Article number518
Number of pages12
JournalBMC Pregnancy and Childbirth
Volume21
Issue number1
Early online date21 Jul 2021
DOIs
Publication statusPublished - Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
This research was funded by University of California, San Francisco Population Health and Health Equity Fellowship program.

Funding Information:
The current study used datasets collected in three waves by the Ghana Multiple Indicator Cluster Survey (GMICS) in 2006, 2011, and 2017/2018. The GMICS is a cross-sectional survey conducted by Ghana Statistical Service (GSS) in collaboration with the Ghana Health Service (GHS), Ministry of Health (MOH), and the Ministry of Education []. The survey received funding and technical support from the United Nations International Children's Emergency Fund (UNICEF) and other international donors []. The primary goal of the MICS surveys is to analyze key indicators that assist countries to produce data for use in national development plans, policies, and programmes. On top of that, the GMICS is intended to assess progress towards SDGs and other agreements signed internationally [].

Publisher Copyright:
© 2021, The Author(s).

© 2021. The Author(s).

Keywords

  • Antenatal care
  • Pregnancy
  • Prenatal care
  • Skilled birth attendance

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