The relationship between antenatal provider type and maternal care in rural Ghana: A cross-sectional study

Objectives: To investigate the influence of antenatal provider type on maternity care in rural Ghana. Methods: An analysis of maternal care by antenatal provider type using the 2008 Ghana Demographic and Health Survey. Study population included rural Ghanaian women aged 15-49 years with report of a live birth between 2003 and 2008. Bivariate chi-square analysis was performed to examine differences in maternal report of WHO Maternal Health Interventions. Multivariate linear and logistic regression were performed to assess differences in antenatal care (ANC) scales and maternal care packages. Results: Thousand and three hundred and sixty-seven rural women reported a live birth. Provider distribution was: doctor, 15.6%; midwife, 70%; community health officer (CHO), 9.1%; no provider, 5.3%. Women from lower socio-demographic categories were more likely to report midwife or CHO. Report of CHO vs. no provider was positively associated with maternal services (P < 0.01). Report of doctor or midwife vs. CHO was significantly associated with maternal services (P < 0.01). Conclusion: There is a positive association between antenatal provider length of training and maternal specialization and report of maternal services. Community-based providers are associated with markedly increased report of maternal services compared with no provider. Structural factors appear to underlie some differences in service provision.