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The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.

Probit and ordered probit models are employed in this study.

The results generally indicate that most women in Ghana undertake the required visits for antenatal services and also take both doses of the tetanus toxoid vaccine as required by World Health Organization. However, the results show low levels of usage in terms of the other maternal health care services (i.e. prenatal care, delivery at a health facility, and postnatal care). There is clearly an urgent need to develop innovative strategies that will help upscale intervention especially for improvement in the use of these services by women in Ghana. The regression results reveal that utilization of maternal health services and intensity of use of antenatal services are influenced by age of mother, type of birth, education of mother, ethnicity, economic status, geographic location, residence, and religious affiliation. Obviously, this suggests that more than medical factors are responsible for the differences in the use of maternal health services by women in Ghana as well as the decision on the number of visits to undertake with respect to antenatal visits.

The findings of this study have important implications for health policy formulation targeted at improving maternal health care service utilization.

The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the causes of inequalities in maternal healthcare utilization in Ghana.

Data are drawn from three rounds of the Ghana Demographic and Health Survey collected in 2003, 2008 and 2014, respectively. The authors employ two alternative measures of socioeconomic inequalities in health – the Wagstaff and Erreygers indices – to examine the trends of socioeconomic inequalities in maternal healthcare utilization. The authors proceed to decompose the causes of inequalities in maternal healthcare by applying a recently developed generalized decomposition technique based on recentered influence function regressions.

The study finds substantial pro-rich inequalities in maternal healthcare utilization in Ghana. The degree of inequalities has been decreasing since 2003. The elimination of user fees for maternal healthcare has contributed to achieving equity and inclusion in utilization. The decomposition analysis reveals significant contributions of individual, household and locational characteristics to inequalities in maternal healthcare. The authors find that educational attainment, urban residence and challenges with physical access to healthcare facilities increase the socioeconomic gap in maternal healthcare utilization.

There is a need to target vulnerable women who are unlikely to utilize maternal healthcare services. In addition to the elimination of user fees, there is a need to reduce inequalities in the distribution and quality of maternal health services to achieve universal coverage in Ghana.

Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.

Using a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.

The results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).

Rwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the effect of Information and Communication Technologies (ICTs) on the use of maternal health services in Ghana.

Study used data from the 2008 Ghana Demographic and Health Surveys and binary response regression models to examine the effect of women's access to ICTs on maternal healthcare utilization in Ghana. Three variables on maternal healthcare utilization were employed: use of contraception, antenatal care and place of delivery.

Results from the study show that the effect of the use of technology is both positive and significant. In particular, among the other ICTs (i.e. landline phone, listening to radio, watch television, color television in household, computer in household), the coefficients of mobile phone ownership tends to be consistently significant across all four reproductive health services. Therefore, ICTs have a good capacity to influence women's demand of health information. This needs to be taken into account when designing maternal health policies and interventions.

This is one of the few papers examining the effect of ICTs on utilization of maternal health services from the demand side compared to the popular supply side argument often found in the literature.

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.

The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.

The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.

The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.

A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

This was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.

The results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.

This is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.

This research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.

Underutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

In 2016, the World Health Organization (WHO) revised upwards the recommended contacts for antenatal care (ANC) by expectant mothers with a health provider from a minimum of four to eight over the pregnancy period. Although Ghana is yet to adopt the new recommendation, some women choose to adhere to the new protocol because of its enormous health benefits to the expecting mother and the unborn child. As part of ANC, family planning services are also provided to ensure child spacing and birth control. To reduce health costs, government introduced the free maternal health policy, Community-based Health Planning Services, Livelihood Empowerment Against Poverty and established the Northern Development Authority to increase access to healthcare and also create wealth. Given these interventions, the study hypothesizes that household wealth would not have a significant influence on antenatal visits and modern contraceptive use. Therefore, this paper aims to examine whether household wealth would play any significant role on the new minimum contacts proxied by antenatal visits and also on the use of modern contraceptives as a family planning counselling tool during ANC visits. The study further examines a possible heterogeneity effect of paternal characteristic on maternal health service utilization.

The study used data from the most recent Ghana Demographic and Health Survey (GDHS, 2014). Both bivariate and multivariate analyses were used to investigate the effects of household wealth on the number of antenatal visits and modern contraceptive use. The bivariate analysis employed the use of chi-square test whiles, the multivariate analysis involved estimations using logistic regressions.

The findings show that household wealth would play a critical role given the revised WHO minimum ANC contacts by expectant mothers. Household wealth exerts a positive and significant effect on ANC for all wealth quintiles for women who attended at least eight ANC visits, but was insignificant for the poorer and middle quintiles of those who attended four to seven visits. Wealth, however, had an insignificant relationship with modern contraceptive use. Generally, education, age, birth order, media exposure as well as geographical locations had a significant influence on both ANC visits and modern contraceptive use. The study further revealed a heterogeneous effect on ANC attendance. In particular, despite the relatively poor conditions, women in rural areas whose partners/husbands have attained a minimum of secondary education are about twice more likely to attend 4–7 antenatal visits compared to their counterparts whose husbands/partners are without education. Hence, a holistic health education, which includes husbands/partners in the rural areas as well as strengthening interventions that improve livelihoods, is crucial.

Health guidelines are constantly reviewed, and government policies must adapt accordingly. This paper looks at the significant role household wealth still plays on modern contraceptive use and ANC visits, given the revised WHO minimum ANC contacts and uniquely underscores the influence of paternal characteristics on the utilization of these maternal health services.

The purpose of this paper was to examine rural women’s perceived quality of antenatal care (ANC) and its influence on the extent of ANC in the Amansie Central District in the Ashanti Region of Ghana.

A quantitative cross-sectional study was conducted with 120 women attending postnatal care at selected public health facilities. Structured interviews were used to obtain data. Crude odds ratio with 95% confidence interval (CI) was generated to determine the odds of women’s utilisation of ANC with their perceived service quality. The association between women’s background characteristics and ANC use was determined and assessed using Pearson’s χ² (2) test.

Majority of the women (58.3 percent) utilised ANC for at least four times during pregnancy. Women’s education (p=0.027), religious affiliation (p=0.006), source of income (p=0.012) and insurance status (p=0.023) all had a positive relationship with ANC use. Women who perceived ANC quality as good were three times more likely to have four or more ANC visits than those who perceived quality as poor (OR= 3.042, 95% CI=0.181–0.647, p=0.001).

Ghana has had numerous policy interventions that address the accessibility and quality of ANC service. However, little is known about the extent to which they are observed and about the quality of service from users’ perspective. Most existing literature on ANC use in Ghana focusses on socio-economic factors that influence utilisation. This paper will be the first to examine the perceived quality of ANC provided, and its influence on the extent of ANC visits among rural women in Ghana.

This paper aims to explore the determinants of maternal healthcare services (MHS) utilisation in Ghana.

In this paper, logit and negative binomial regressions were used to model data from a recent nationally representative survey (the 2017 Ghana Maternal Health Survey). The analysis is observational, without causal implications. The authors measure MHS utilisation by four indicators: antenatal care (ANC) use, the number of ANC clinic visits, choice of health facility delivery and postnatal care (PNC) use.

Age, parity, education, marital status, wealth, residence and health facilities concentration proved to be significant predictors of MHS use in Ghana. Specifically, older, married and educated women; women of lower parity; those living in urban areas and women from wealthier households were more likely to use MHS. The authors also find that health facilities and personnel predicted higher MHS use. Lastly, women with frequent stillbirths had higher MHS use.

The results for health facilities and personnel suggest that increasing the supply of health centres and workers may enhance MHS use. The authors conclude that women of lower socio-economic status have worse MHS use, meaning empowering such women might increase such women's MHS use.

Existing data suggest falling MHS use in Ghana. Yet, the extant works are based on relatively old data or lack external validity (besides using limited MHS indicators). This paper provides recent and generalisable evidence for public health policies. Additionally, this paper tests the statistical significance of some supply-side factors that have yet to be emphasised in the literature.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2022-0199.

One of the targets of sustainable development goal (SDG) 2030 is to reduce maternal mortality ratio to 70 per 100,000 live births and ensure pregnant women attend at least four antenatal visits. In urban Pakistan, it is expected that more women utilize antenatal care (ANC) because urban areas have more resources, higher education and wealthier people. Despite these facilities, the lack of utilization of antenatal care among pregnant women is abysmal—the latest estimate by Pakistan Demographic and Health Survey (PDHS) places the figure at 63%. Therefore, the paper attempts to identify the factors that affect the utilization of ANC in urban areas by using the PDHS 2017–2018.

The study used cross-tabs to determine the socioeconomic characteristics of women, and used the marginal effects from the probit model to evaluate the significance and relationship between socioeconomic determinants and antenatal visits. Finally, the study used Adam Wagstaff's decomposition analysis to identify the magnitude and main determinants of inequality.

The marginal effects show that socioeconomic variables such as education, province of residence, birth of a first child, age, education and consulting a doctor predicted the probability of 4+ antenatal visits. The decomposition analysis shows that women who consulted a doctor, belonged to non-poor class, were more educated and older contributed significantly to the inequality of antenatal care utilization in urban areas.

The study calls for increasing the number of doctors, promoting education, increasing awareness related to pregnancy complications and reducing wealth inequality. Moreover, the study also calls for increasing global intervention by implementing programs similar to ending preventable maternal mortality (EPPM) to increase antenatal coverage.

The distinctiveness of the study can be found in the fact that no study has been conducted that analyses the inequality related to the usage of ANC in urban areas of Pakistan.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-06-2022-0390