Trends and inequalities in health facility deliveries among women of reproductive age in Ghana, 1993–2022

Résumé

Background: Health facility delivery is a critical intervention to reduce maternal and neonatal mortality. Ghana has achieved substantial gains in facility deliveries over the past three decades, yet disparities persist across socioeconomic and demographic dimensions. This study describes trends and inequalities in health facility deliveries among women of reproductive age in Ghana from 1993 to 2022 across wealth, education, place of residence, age, and region. Methods: Data were extracted from the WHO Health Equity Assessment Toolkit (HEAT), which provides weighted, age-standardised estimates from Ghana Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) for the years 1993, 1998, 2003, 2006, 2008, 2011, 2014, 2017, and 2022. The outcome was the percentage of live births occurring in a health facility (WHO HEAT indicator code: MNCH7). Inequality was measured using the absolute difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) for each dimension, with 95% confidence intervals. Results: National health facility delivery prevalence increased from 42.3% (95% CI: 39.5-45.1) in 1993 to 85.4% (95% CI: 84.1-86.7) in 2022. In 2022, marked disparities remained: richest vs. poorest quintile (97.1% vs. 71.1%; D = 25.7 percentage points); higher education vs. no education (98.0% vs. 72.3%; D = 25.7 percentage points); urban vs. rural (93.7% vs. 77.9%; D = 15.8 percentage points); and Upper East vs. Northern region (97.7% vs. 69.0%; D = 28.7 percentage points). Absolute economic inequality (D) declined from 60.6 percentage points in 1993 to 25.7 in 2022; educational inequality fell from 53.6 to 17.8; and rural-urban inequality declined from 35.8 to 9.7. Age-related inequality was negligible throughout. Conclusion: While Ghana has achieved substantial gains in health facility deliveries, marked inequalities by wealth, education, place of residence, and region persist. These patterns coincide temporally with policy reforms including the Free Maternal Health Policy and the National Health Insurance Scheme; however, this descriptive analysis cannot establish causality. Targeted interventions for women in poorer, less educated, and rural settings are needed to achieve equitable maternal healthcare.

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