Who gets to deliver in a health facility? An investigation of wealth-based inequities in institutional delivery in Ghana

Abstract

OBJECTIVES: Institutional delivery under skilled care is essential for reducing maternal mortality. Ghana has expanded maternal health services through policies such as the National Health Insurance Scheme and the free maternal healthcare policy. Inequalities in access to facility-based delivery, however, remain across socioeconomic groups. This study examined wealth-based inequities in institutional delivery and identified maternal and socioeconomic factors associated with facility delivery in Ghana. DESIGN: A cross-sectional analysis of nationally representative survey data. SETTING: Ghana. PARTICIPANTS: Data were drawn from the 2022 Ghana Demographic and Health Survey. The analysis included 5855 women aged 15-49 years who had at least one live birth in the 5 years preceding the survey. METHODS: Descriptive statistics were used to summarise participant characteristics, and weighted logistic regression models were applied to identify factors associated with institutional delivery. RESULTS: 84.3% of women delivered in a health facility. Wealth showed a strong gradient effect. Women in the richest wealth quintile had significantly higher odds of institutional delivery compared with those in the poorest quintile (odds ratio (OR) 2.71, p<0.001). Higher education, increased antenatal care visits and health insurance coverage were also associated with higher odds of facility delivery. Rural residence was associated with lower odds of institutional delivery (OR 0.52, p<0.001). CONCLUSION: Socioeconomic and geographic disparities in institutional delivery remain evident in Ghana. Wealth, education, antenatal care attendance and health insurance coverage influence access to facility-based childbirth. Targeted interventions are needed to improve equitable access to skilled delivery services.