Family structure and antenatal health care in Ghana.


Clifford Semabiah, Memorial University

Adequate and timely antenatal care is critical factor minimizing adverse pregnancy outcomes. The World Health Organization (WHO) now recommends eight visits to monitor high-risk pregnancies. Despite this, many countries in sub-Saharan Africa including Ghana continue to grapple with high maternal mortality rates. This persistent issue is often attributed to delayed initiation of antenatal care and insufficient frequency of visits. Previous research has identified socio-demographic, health facility level and geographical factors as contributors, including education, income, age, marital status, quality of care, and proximity. Given prior research, however, there is reason to suspect that marriage type such as polygyny beyond marital status could be a crucial factor. Polygynous marriages entail intricate family dynamics, including jealousy over the husband’s affection and resources among co-wives, which can affect maternal health care outcomes. The study employs data from the 2022 Ghana Demographic and Health Survey, focusing on 5,422 women in marital unions. We use Andersen and Newman’s (1973) Health Services Utilization framework to show that marriage type is a strong predisposing factor to antenatal care access among Ghanaian women. A series of binary logit models were utilized to examine the frequency and timing of antenatal care visits within this framework. The findings indicate that there are significant differences in antenatal care outcomes among different marriage types. Polygynous women are less likely to initiate early antenatal care and attend the recommended number of visits compared to their monogamous counterparts. However, this difference vanished after controlling for women’s socio-economic and demographic characteristics. This means polygynous women’s lack of access can be linked to their selective individual socio-demographic characteristics, including lack of education, low income, and limited decision-making within the household. The study underscores the importance of considering the vulnerabilities of polygynous women’s access to antenatal health care in Ghana. The findings emphasize the need for targeted interventions that address the unique challenges faced by polygynous women, including educating them about the importance of antenatal care. Moreover, it emphasizes the need to expand free maternal healthcare access to overcome barriers and enhance accessibility for all women. Community nurses who offer health education should also target polygynous women in the community to ensure equity in access to basic health services. By understanding and addressing the complexities of family dynamics within polygynous marriages, policymakers and healthcare providers can take strides toward reducing maternal mortality rates and improving overall maternal health outcomes in the region. This study is highly relevant to the overarching theme of Social Problems, Development, and Policy in Africa. In the context of Ghana, where polygynous marriages are prevalent, understanding the impact of such family structures on antenatal healthcare access is crucial. This topic aligns with the sessions focus on addressing social issues, promoting human development, and exploring policy implications. By examining how polygyny influences antenatal care accessibility, the discussion contributes valuable insights to the broader discourse on social progress, health, and effective policy interventions, thereby enhancing the overall quality of life in African communities. The study also contributes to the existing body of knowledge on maternal healthcare in developing countries and provides a foundation for further research and policy development in the field.

Non-presenting author: Eric Tenkorang, Memorial University

This paper will be presented at the following session: