Online Program

High antenatal care but low skilled attendance at birth: What are underlying the health system factors?

Monday, November 2, 2015 : 9:00 a.m. - 9:10 a.m.

Patience A. Afulani, MBChB, MPH, Department of Community Health Sciences, UCLA Fielding School of Public Health, los Angeles, CA
Background: Like many countries in sub-Saharan Africa, over 95 percent of pregnant women in Ghana go for at least one antenatal care (ANC) visit. Yet, only about half deliver with a skilled birth attendant (SBA)—a critical intervention to reduce maternal mortality. Why do some women go for ANC but do not deliver with a SBA? Access plays a role; but other health system factors may be contributing to the coverage gap between ANC and skilled attendance at delivery. There are also wide disparities in use of SBAs by socioeconomic status (SES) and rural/urban residence—less so for ANC attendance. Prior studies have shown disparities in ANC quality by SES, rural/urban residence, and type of antenatal facility. These disparities in ANC quality may be contributing to the disparities in use of SBAs.

Aim: This study examines factors associated with use of SBAs among women who attend ANC in Ghana, focusing on the mediating role of ANC quality.

Methods: Data are from the Ghana Maternal Health Survey (N=4,868). Quality of antenatal care is measured by an index based on receipt (or otherwise) of nine essential antenatal services during the last pregnancy. Analytic techniques include multilevel linear regression with mediation analysis to examine intervening effects.

Results: Among women who go for an ANC visit, those who receive higher quality ANC are more likely to deliver with a SBA than those who receive lower quality ANC. Urban residence, higher SES, frequent ANC visits, and receiving ANC in a higher-level or private health facility increases the odds of delivering with a SBA. ANC quality partially mediates the effects of these factors on use of SBAs.

Implications: Targeted policies and programs to increase ANC quality, especially in the lower-level health facilities and among low SES women, will help improve coverage and reduce disparities in use of SBAs.

Learning Areas:

Program planning
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Identify the factors associated with use of skilled birth attendants among women who receive some antenatal care Analyze if quality of antenatal care is associated with use of skilled birth attendants net of other factors Evaluate if disparities in quality of antenatal care explain some of the socioeconomic and rural/urban disparities in use of skilled birth attendants

Keyword(s): International MCH, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a PhD Candidate in the Department of Community Health Sciences at UCLA School of Public Health. I am also from Ghana where I was trained as a medical doctor. My area of specialty is maternal and child health. I conceived the study, conducted the analyses, and wrote up the content of this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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