Spatial inequalities in pregnancy planning and delivery care uptake in Ghana : multilevel and small area analysis

In this study the 1998 and 2003 Ghana Demographic and Health Survey (GDHS) and the 2000 Ghana Population and Housing Census (GPHC) have been used to quantify the spatial inequalities in pregnancy planning and the use of delivery care and investigates the contextual factors that mitigate the spatial inequalities after controlling for individual and household level predictors using multinomial multilevel logit models. The results show that there is considerable exposure to mistimed pregnancies within rural communities and the Savannah Zone, while urbanised communities and the Coastal and Forest Zones have high exposure to unwanted pregnancies. The inequalities, associated with exposure to unintended pregnancies, were significantly high between rural communities and the Savannah and Forest zones of Ghana. Inequalities between urban communities and the Coastal Zone have declined and become less important. The results show that more urbanised communities and zones have lesser inequalities in exposures to unintended pregnancies than less urbanised communities and zones. Considering uptake of care at birth, the results show that home deliveries under the supervision of unskilled attendants were more pronounced within rural communities and the Savannah Zone of Ghana. Unlike exposures to unintended pregnancies, the results of the analysis on delivery care uptake show high and increasing inequalities between urban communities and the Forest and Coastal Zones, while rural inequalities, irrespective of zonal differences remains relatively high. The results suggest that urbanisation plays an important role in uptake of delivery care. However, unlike contraceptives which are relatively cheap and more accessible to urban dwellers, obstetric care is quite expensive, and there is an indication that the urban poor cannot afford such services.