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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Spatial variation in the use of reproductive health services over time: a decomposition analysis

Author: Gordon Abekah-Nkrumah

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

The paper argues that several Sub-Saharan African countries have recorded marked improvements in the use of reproductive health services. However, the literature has hardly highlighted such progress and the factors responsible for them. The current study uses Ghana as a case to examine progress in the consumption of reproductive health services over the last two decades and the factors responsible for such progress.

Methods

The study uses two rounds (1998 and 2014) of Demographic and Health Survey data from Ghana. Standard frequencies, a logit model and decomposition of the coefficients of the logit model (i.e. Oaxaca-type decomposition) was employed to examine changes in the use of reproductive health services (4+ antenatal visits and skilled attendance at birth) at national and sub-national levels (i.e the four ecological zones of Ghana) between 1998 and 2014 as well as factors explaining observed spatial changes between the two periods.

Results

Descriptive results suggest that the highest level of improvement occurred in resource-poor zones (i.e. northern belt followed by the southern belt) compared to the middle belt and Greater Accra, where access to resources and infrastructure is relatively better. Results from Oaxaca-type decomposition also suggest that women and partner’s education, household wealth and availability and accessibility to health facilities are the key factors explaining spatial variation in reproductive health service consumption over the two periods. Most importantly, the marginal efficiency of investment in women and partner’s education and access to health services were highest in the two resource poor zones.

Conclusion

There is the need to target resource poor settings with existing or new pro-poor reproductive health interventions. Specifically, the northern and southern zones where the key drivers of education and availability of health facilities are the lowest, will be key to further improvements in the consumption of reproductive health services in Ghana.
Appendix
Available only for authorised users
Footnotes
1
CHPS are lower level health facilities put up and operated by the staff of the Ministry of Health and normally found in the rural areas. The basic idea behind CHPS is enable rural dwellers to have easy access to health facilities and more importantly, reproductive health services for pregnant mothers.
 
Literature
1.
WHO. Trends in maternal mortality: 1990 to 2013 estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations population division. Geneva: World Health Organisation. p. 2014.
2.
Unicef. Improving child nutrition: the achievable imperative for global progress. New York: UNICEF; 2013.
3.
Save the Children. Surviving the first day. In: State of the world’s mothers 2013. Westport Connecticut: Save the Children; 2013.
4.
Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF International. The 2014 Ghana demographic and health survey (DHS) key findings. Rockville: GSS, GHS, and ICF International; 2015.
5.
Ministry of Health. Independent annual review of the health sector Programme of works for 2007. Accra: Ministry of Health, Ghana; 2008.
6.
Celik Y, Hotchkiss DR. The socio-economic determinants of maternal health care utilization in Turkey. Soc Sci Med. 2000;50(12):1797–806.CrossRefPubMed
7.
Overbosch GB, Nsowah-Nuamah NNN, van den Boom GJM, Damnyag L. Determinants of antenatal care use in Ghana. J Afr Econ. 2004;13(2):277–301.CrossRef
8.
Abor PA, Abekah-Nkrumah G, Sakyi K, Adjasi CKD, Abor J. The socio-economic determinants of maternal health care utilization in Ghana. Int J Soc Econ. 2011;38(7):628–48.CrossRef
9.
Abekah-Nkrumah G, Guerriero M, Purohit P. ICTs and maternal healthcare utilization. Evidence from Ghana. Int J Soc Econ. 2014;41(7):518–41.CrossRef
10.
Abekah-Nkrumah G, Abor PA. Socioeconomic determinants of use of reproductive health services in Ghana. Heal Econ Rev. 2016;6(1):1.CrossRef
11.
Bosomprah S, Aryeetey GC, Nonvignon J, Adanu RM. A decomposition analysis of change in skilled birth attendants, 2003 to 2008, Ghana demographic and health surveys. BMC Pregnancy Childbirth. 2014;14(1):1.CrossRef
12.
13.
Pariyo GW, Ekirapa-Kiracho E, Okui O, Rahman MH, Peterson S, Bishai DM, Lucas H, Peters DH. Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor? Int J Equity Health. 2009;8(1):39.CrossRefPubMedPubMedCentral
14.
WHO: Antenatal care: report of a technical working group,. In. Geneva, 31 October-4 November: World Health Organization; 1994.
15.
WHO. Mother baby-Pakage: implementing safe motherhood in Counries - practical guide. In: Geneva: maternal health and safe motherhood Programme division of family health World health organisation; 1994.
16.
Addai I. Determinants of use of maternal and child health Services in Rural Ghana. J Biosoc Sci. 2000;32(01):1–15.PubMed
17.
Lavy V, Strauss J, Thomas D, de Vreyer P. Quality of health care, survival and health outcomes in Ghana. J Health Econ. 1996;15(3):333–57.CrossRefPubMed
18.
Sahn DE. The contribution of income to improved nutrition in cote d'Ivoire. J Afr Econ. 1994;3(1):29–61.CrossRef
19.
Sahn DE, Stifel DC. Parental preferences for nutrition of boys and girls: evidence from Africa. J Dev Stud. 2002;39(1):21–45.CrossRef
20.
Kabubo-Mariara J, Ndenge GK, Mwabu DK. Determinants of Children's nutritional status in Kenya: evidence from demographic and health surveys. J Afr Econ. 2009;18(3):363–87.CrossRef
21.
Christiaensen L, Alderman H. Child malnutrition in Ethiopia: can maternal knowledge augment the role of income? Econ Dev Cult Chang. 2004;52(2):287–312.CrossRef
22.
Blinder AS. Wage discrimination: reduced form and structural estimates. J Hum Resour. 1973;8(4):436–55.CrossRef
23.
Oaxaca R. Male-female wage differentials in urban labor markets. Int Econ Rev. 1973;14(3):693–709.
24.
Fairlie RW. The absence of the African-American owned business: an analysis of the dynamics of self-employment. J Labor Econ. 1999;17(1):80–108.CrossRef
25.
26.
Fairlie RW. An extension of the blinder-Oaxaca decomposition technique to logit and probit models. J Econ Soc Meas. 2005;30(4):305–16.
27.
Kabeer N. Resources, agency, achievements: reflections on the measurement of Women's empowerment. Dev Chang. 1999;30(3):435–64.CrossRef
28.
Kabeer N. Gender equality and Women's empowerment: a critical analysis of the third millennium development goal. Gend Dev. 2005;13(1):13–24.CrossRef
29.
30.
Burgard S. Race and pregnancy-related care in Brazil and South Africa. Soc Sci Med. 2004;59(6):1127–46.CrossRefPubMed
31.
Furuta M, Salway S. Women’s position within the household as a determinant of maternal health care use in Nepal. Int Fam Plan Perspect. 2006;32(1):17–27.CrossRefPubMed
32.
Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH. Determinants of the use of maternal health services in rural Bangladesh. Health Promot Int. 2003;18(4):327–37.CrossRefPubMed
33.
Gebreselassie A. Factors affecting maternal health care seeking behavior in Rwanda. Macro International Inc: Calverton; 2008.
34.
Raghupathy S. Education and the use of maternal health care in Thailand. Soc Sci Med. 1996;43(4):459–71.CrossRefPubMed
35.
Matsumura M, Gubhaju B. Women’s status, household structure and the utilization of maternal health Services in Nepal. Asia-Pac Popul J. 2001;16(1):23-44.
36.
Ekman B, Axelson H, Ha DA, Nguyen LT: Use of maternal health care services and ethnicity: a cross-sectional analysis of Vietnam. 2007. Available at SSRN 993713.
Metadata
Title
Spatial variation in the use of reproductive health services over time: a decomposition analysis
Author
Gordon Abekah-Nkrumah
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1695-3

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