Interplay of sociodemographic factors and antenatal care attendance with free maternal care policy: a case study of Ghana

IntroductionThe Free Maternal Care Policy (FMCP) was introduced in Ghana around 2008 as part of the government’s efforts to improve maternal and child health outcomes in the country. The policy was aimed at increasing access to antenatal care (ANC) services and reducing financial barriers to antenatal healthcare utilisation. Despite the expected success of the FMCP, there is limited evidence regarding its impact on the frequency of ANC visits across different sociodemographic groups of women in Ghana. This study examined associations between sociodemographic and health-related factors and the frequency of ANC attendance while considering the implementation period of the FMCP in Ghana as a fundamental reference point.MethodsThis quantitative study used Ghana’s Demographic and Health Survey datasets on pregnant women’s ANC visits for 2003, 2008 and 2014 (N=15 408). Logistic regression and descriptive analyses were conducted using Stata/SE V.14.ResultsFindings showed a slight fluctuation in the level of ANC visits before and after the introduction of the FMCP in Ghana. This fluctuation may indicate that ANC service cost as a barrier to ANC visits may not be the only factor affecting ANC utilisation among pregnant women in Ghana. Our results showed that women’s lack of autonomy to make health-related decisions affected their ANC service utilisation, particularly in 2008. In addition, we found that educational attainment, being wealthy and urban residency were also significantly associated with ANC service utilisation among pregnant women in Ghana, particularly, in 2003. Women’s anaemic levels were significantly associated with their likelihood of attending ANC services in 2003 and 2014.ConclusionsOur findings suggest that the FMCP may have had a discernible effect on the utilisation of ANC services in Ghana. However, other significant confounding factors may be influencing the ongoing use of ANC services in this setting.