TY - JOUR
T1 - Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey
AU - Moyer, Cheryl A.
AU - McLaren, Zoë M.
AU - Adanu, Richard M.
AU - Lantz, Paula M.
PY - 2013/9
Y1 - 2013/9
N2 - Objective To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Methods Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. Results In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Conclusion Affordability was an important determinant of facility delivery in Ghana - even among women with health insurance - but social access variables had a mediating role.
AB - Objective To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Methods Data relating to the "5 As of Access" framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. Results In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Conclusion Affordability was an important determinant of facility delivery in Ghana - even among women with health insurance - but social access variables had a mediating role.
KW - Access to care
KW - Africa
KW - Facility-based delivery
KW - Ghana Low-income countries
KW - Healthcare utilization
KW - Maternal and child health
UR - http://www.scopus.com/inward/record.url?scp=84880924496&partnerID=8YFLogxK
U2 - 10.1016/j.ijgo.2013.04.005
DO - 10.1016/j.ijgo.2013.04.005
M3 - Article
C2 - 23800716
AN - SCOPUS:84880924496
SN - 0020-7292
VL - 122
SP - 224
EP - 229
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -