Factors associated with the utilisation of maternal health services in Western, Western North and Central Regions of Ghana, 2025

Abstract

Introduction: Maternal health services (MHS), essential for the health of women and newborns, are underutilized in countries like Ghana, leading to preventable maternal and neonatal morbidity and mortality. This study identifies factors affecting the use of antenatal care (ANC), skilled delivery, and postnatal care (PNC) in Ghana’s Central, Western, and Western North Regions. Methods: This was a retrospective cohort study involving women who registered for ANC in January 2025 across 15 selected health facilities. Data on ANC (4+attendance), skilled delivery, and postnatal care (PNC within 48hrs) were extracted from records. Descriptive statistics provided frequencies and means, while significant variables from bivariate analysis were analyzed using multivariable logistic regression with Epi Info 7. Fifteen in-depth interviews were conducted with purposively selected women from each facility, and transcripts thematically coded with quotes supporting quantitative findings. Results: In total, 1,730 women were included with a representation of 63.9%(1105/1730) ANC attendance, 45.1%(781/1730) delivery and 51.6%(407/788) PNC utilization. After adjustment, predictors of ANC were women aged 26–35 years (aRR = 1.21, 95% CI: 1.04–1.41), traders (aRR = 1.18, 95% CI: 1.02–1.38; ), and those booking in the first trimester (aRR = 1.36, 95% CI: 1.19–1.55). The predictors of PNC were women with secondary or higher education (aRR = 1.29, 95% CI: 1.08–1.55) and those who completed ANC visits (aRR = 1.42, 95% CI: 1.25–1.62). In-depth interview showed that family support, short travel distance, and good staff attitude influence MHS. Conclusion: MHS dropped along the cascade, with the lowest utilisation at delivery. Early entry into care, age, occupation and education supported complete services across ANC, delivery, and postnatal care continuum. Social support and good client experience also shaped women maternal health seeking behaviour. Respectful maternal care should be strengthened by care givers as this influence’s women using MHS.