Social determinants of antenatal care utilization: an analysis of 2022 Ghana demographic and health survey
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Background
Despite Ghana’s free maternal health services policy, antenatal care (ANC) utilization remains suboptimal. This study examines the predisposing, enabling, and need factors associated with ANC use among women in Ghana.
Methods
Using the 2022 Ghana Demographic and Health Survey (GDHS), this study examined 5,302 women aged 15–49 to identify key determinants of ANC use. Antenatal care utilization was defined as completing at least four visits. Guided by the Andersen’s healthcare utilization model, predictors were categorized into predisposing (age, education, marital status, religion), enabling (household income, residence, health insurance), and need factors (self-rated health, pregnancy loss). Descriptive statistics and chi-square tests were used to assess differences in ANC utilization. A modified Poisson regression was applied to estimate adjusted prevalence ratio (aPR) for the association between predisposing, enabling, and need factors and ANC utilization.
Results
Overall, 88.1% of women utilized ANC. Women aged 25–34 were more likely to use ANC compared to those aged 15–24 ( aPR = 1.04; 95% CI: 1.00-1.07). Women with secondary ( aPR = 1.09; 95% CI: 1.05–1.14) and higher education ( aPR = 1.10; 95% CI: 1.04–1.15) were associated with greater ANC use. Married women ( aPR = 1.07; 95% CI: 1.03–1.10) and Muslim women ( aPR = 1.04; 95% CI: 1.01–1.07) were more likely to use ANC, whereas women practicing traditional/other religions were less likely to use ANC ( aPR = 0.83; 95% CI: 0.75–0.92). Women from rich households ( aPR = 1.08; 95% CI: 1.04–1.12) and those with health insurance ( aPR = 1.29; 95% CI: 1.14–1.46) were more likely to use ANC. Residence, self-rated health, and pregnancy loss were not significant predictors.
Conclusions
Key determinants of ANC utilization included age, education, marital status, religion, household income, and health insurance coverage. This suggests that reducing socioeconomic and cultural obstacles is essential for improving maternal health coverage. Future research is needed to understand the indirect barriers that continue to discourage women from seeking ANC in Ghana.
