Ethnic disparities in utilisation of maternal health care services in Ghana: evidence from the 2007 Ghana Maternal Health Survey

Abstract

Objective. Disparities in utilisation of maternal health care remain a challenge to attainment of the maternal health-related Millennium Development Goals. The objective of this descriptive study was to examine disparities in utilisation of maternal health care among ethnic groups in Ghana.

Design. Data from the 2007 Ghana Maternal Health Survey were analysed for disparities in antenatal care (ANC) visit, utilisation of tetanus toxoid immunisation and iron tablets/syrup intake during pregnancy, place of delivery, skilled birth attendance, caesarean section (CS) and post-natal care (PNC) among different ethnic groups.

Results. Findings show that the proportion of women who received any form of skilled antenatal, delivery and PNC in the five years (2003–2007) preceding the survey was 96%, 55% and 55%, respectively. Despite the incremental progress Ghana made in improving access to skilled maternal health care services, large gradients of disparities exist. The ethnic difference in utilisation of institutional prenatal care was small; however, fewer births to women from majority ethnic groups such as the Akan (21%) took place at home compared with births to women from minority ethnic groups such as the Ewe (58.8%), Guan (42.7%), Grusi (53.4%), Mole-Dagbani (74.7%) and Gruma (58.8%). The rate of consultation of a skilled health care provider for delivery among the different ethnic groups also ranged from a low of 27% for births to Mole-Dagbani women to a high of 68.8% among births to Akan women.

Conclusion. Minority ethnic groups reported lower utilisation levels for most of the components of skilled maternity care in Ghana. However, ethnic disparities in utilisation of all the components of ANC in Ghana were less compared to delivery in health facilities, skilled attendance at birth, use of CS and PNC. Therefore, efforts to promote universal access to skilled maternity care not only should target those sub-populations with significantly low utilisation levels but also must focus on those components of maternal health care such as skilled attendance at delivery that demonstrate the greatest disparities. There is also the need to further explore who continues to remain excluded from receiving needed care, and how to encourage such women, especially minority women, to seek skilled care.

Keywords:

• ethnicity
• maternal health care
• utilisation
• ethnic disparities
• ethnic minorities
• Ghana

Acknowledgement

The author also acknowledges the support of the Ghana Statistical Service, which generously granted access to the data used in this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Key messages

1. Ethnic disparities in utilisation of maternal healthcare services remain a challenge to attainment of the maternal health-related Millennium Development Goals in Ghana.

2. Efforts to promote universal access to skilled maternity care should target ethnic groups with significantly low utilisation levels.

3. Interventions should especially focus on incentivising and encouraging minority women to seek skilled care during pregnancy and childbirth.

Additional information

Funding

This research was funded by a Wellcome Trust Doctoral Studentship as part of a Wellcome Trust Enhancement Award [Number 087285] to the Ethox Centre, Nuffield Department of Population Health, University of Oxford. The work of the Ethox Centre in Global Health Bioethics is supported by a Wellcome Trust Strategic Award [096527].