Ghana district study finds antenatal care access differs by household factors

A cross-sectional study of 310 women in Ghana’s Twifo Hemang Lower Denkyira District found that antenatal care attendance was high, but access and the timing of the first visit were associated with different household and socioeconomic factors. Among women aged 15–49 years with children younger than 12 months, 93.9% reported attending at least one antenatal care visit and 69.1% began care early. The study defined early initiation as a first visit at 0–12 weeks of gestation and late initiation as a first visit at 13 weeks or later.

Researchers collected data through structured interviews and used univariate and multivariate logistic regression analyses in Stata 17, reporting adjusted odds ratios and 95% confidence intervals. The results identified distinct patterns for attendance and timing. Unmarried women had lower odds of attending at least one antenatal care visit than married women, with an adjusted odds ratio of 0.125 (95% confidence interval, 0.012–0.926; p = 0.047). Women who delivered at home also had lower odds of attending antenatal care, with an adjusted odds ratio of 0.013 (95% confidence interval, 0.001–0.176; p = 0.001). These were adjusted associations in the surveyed population, not experimentally established effects.

Several factors were associated with late initiation rather than attendance itself. Women living in households with 11 or more members had higher odds of beginning antenatal care late than women in smaller households, with an adjusted odds ratio of 3.848 (95% confidence interval, 1.914–6.211; p = 0.046). Women reporting fewer than four antenatal care contacts also had higher odds of late initiation, with an adjusted odds ratio of 6.332 (95% confidence interval, 2.049–9.571; p = 0.001). A home visit by Community-Based Health Planning and Services, or CHPS, staff was also associated with late initiation, with an adjusted odds ratio of 1.813 (95% confidence interval, 1.014–3.243; p = 0.045). In the opposite direction, higher monthly income was associated with lower odds of late initiation, with an adjusted odds ratio of 0.123 (95% confidence interval, 0.024–0.630; p = 0.012).

Not every measured characteristic showed a statistically significant association after adjustment. Antenatal care and pregnancy knowledge, receiving care in a CHPS zone, and distance to a CHPS zone were not significantly associated with antenatal care attendance or initiation timing in the reported models. The study therefore points to differing correlates for two related but separate outcomes: whether women attended antenatal care at all and when they began it. Its findings concern access within the Central Region district and do not show that any single factor caused the observed differences.

The cross-sectional design limits the conclusions that can be drawn about causation and change over time. The sample was restricted to women aged 15–49 years with children less than 12 months old, and the single-district setting limits generalization beyond the study area. Even with high reported attendance and early initiation overall, the analysis identified groups with lower odds of attending care or greater odds of starting late. The authors concluded that strengthening community-based and multisectoral interventions may improve timely antenatal care use and maternal health outcomes, while the present study itself did not test those outcomes or establish that the measured factors produced them.

Subject of Research: Antenatal care attendance and initiation timing in a Ghanaian district

Article Title: A cross-sectional study to evaluate access to antenatal care services in Twifo Hemang Lower Denkyira district of Ghana

Article References: Hammond, J., Adjei-Gyamfi, S., Brew Daniels, D., Sarpong, G. K., Aiga, H., & Aoki, T. (2026). A cross-sectional study to evaluate access to antenatal care services in Twifo Hemang Lower Denkyira district of Ghana. PLOS One, 21(10), e0359892. https://doi.org/10.1371/journal.pone.0359892

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0359892

Keywords: antenatal care, Ghana, maternal health, cross-sectional study, health access, household factors, CHPS, pregnancy care, health equity, cross-sectional, evaluate, access