Socioeconomic Inequalities in Quality Antenatal Care Utilization and Childhood Birth Weight in Ghana

Abstract

Background: Child health and development in sub-Saharan Africa (SSA) are critical issues. Despite the attainment of universal antenatal care (ANC) coverage in Ghana, the utilization of high-quality ANC remains challenging for pregnant women regardless of their socioeconomic status. This inequality in utilizing quality ANC leads to adverse birth outcomes. To address this issue, this study examined socioeconomic inequalities in the utilization of ANC and its impact on childhood birth weight in Ghana. Methods: Data were obtained from the 2007 and 2017 Ghana Maternal Health Surveys (GMHS). The pregnant woman's visits to the antenatal clinic and the content of care she received were used as measures of quality ANC. Concentration Curve (CC), Concentration Index (CI) and Erreygers’ Index (EI) were constructed to measure the magnitude and trends of socioeconomic inequalities. The Total Differential Approach was used to decompose the contributions of various factors of inequalities. Finally, the Karlson–Holm–Breen (KHB) rescaling method was used to examine the relative impact of socioeconomic variables mediating the total effect of ANC utilization on birth weight. Results: This study revealed minimal pro-poor socioeconomic inequalities in the utilization of quality ANC in Ghana. The Total Differential Approach showed how protective effect of pregnant women’s literacy status, exposure to mass media, and residential status is a potential tool in addressing the presence of socioeconomic inequalities in pregnant women utilizing quality ANC in Ghana. Furthermore, the study showed that underutilization of quality ANC increased the odds of delivering low birth weight babies, with socioeconomic factors mediating 27.2% of this effect. Conclusion: Ensuring more equitable policies and programs targeted at promoting health literacy in pregnant women can further prevent vulnerable pregnant women from persistently falling through the ANC inequality crack and help minimize the incidence of low birth weight in Ghana.