Trends and inequalities in distance-related barriers to healthcare access among women of reproductive age in Ghana, 2003–2022

Background Geographic access to healthcare is a key determinant of women’s reproductive health outcomes. In Ghana, distance to health facilities remains a commonly reported barrier to care, yet evidence on long term trends and socioeconomic, residential, and regional inequalities is limited. This study examined trends and inequalities in distance related barriers to healthcare access among women aged 15–49 years in Ghana between 2003 and 2022. Methods We analysed four rounds of the Ghana Demographic and Health Surveys (2003, 2008, 2014, and 2022). The outcome was self-reported distance to a health facility as a major barrier to seeking care. Inequalities were assessed across wealth quintile, place of residence, and subnational region using the WHO Health Equity Assessment Toolkit. Summary measures included difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF), with 95% confidence intervals (CIs), accounting for the complex survey design. Results Nationally, the prevalence of women reporting distance as a major barrier declined over the study period. However, inequalities persisted across all dimensions. Rural women consistently reported higher prevalence than urban women, although the rural–urban gap narrowed over time (D: 30.9 percentage points in 2003 to 17.3 in 2022). Wealth-related inequalities were substantial: after narrowing between 2003 and 2014, absolute inequality widened again by 2022 (D = 38.4), with relative inequality remaining high (R = 4.7). The wealth-related PAF remained large across survey years (− 58.5% in 2003; −53.0% in 2022). Regional disparities were pronounced but declined over time, with the highest prevalence shifting from Upper East in 2003 to Northern region in 2022. Conclusions Although distance-related barriers declined nationally, national improvements in reported access may mask persistent and substantial subpopulation disadvantage. The findings provide policy relevant evidence supporting equity focused and geographically targeted health infrastructure and service delivery strategies to reduce distance related barriers to reproductive healthcare.