Publications

Authors

Sandy Adu, Nana Owusu Ahenkan, Jochebed Afua, Anita Apau, MD, Kelvin Akoto Gyamera, MD, Sophia Ansong, MD, Ansumana Bockarie, MD^*, Yaw Ansong Snr, MD, PhD^*

Abstract

Ghana's maternal mortality ratio stands at approximately 308 per 100,000 live births (WHO, 2023), with inadequate utilization of antenatal care (ANC) and skilled delivery identified as key drivers. However, preliminary data we have gathered reveal a paradox in community health settings in Southern Ghana where pregnant women consistently demonstrate high awareness of maternal healthcare importance and express strong intentions to access formal services, yet actual utilization, particularly completion of the full ANC schedule, facility delivery, and postnatal follow-up, falls persistently short of those intentions. This divergence constitutes the intention-utilization gap, which remains under-theorized in the Ghanaian context (Boah et al., 2018). Existing research has also examined barriers to ANC or facility delivery in isolation, without a unifying framework that explains why intention and utilization systematically diverge (Ganle et al., 2014; Kassim et al., 2023). Critically, the simultaneous roles of facility-level resource adequacy and community support as determinants of this gap have not been examined exhaustively through primary patient-voice data in Southern Ghana. This study addresses that gap directly by drawing on primary data already collected from 106 women across community health facilities in Greater Accra and the Central Region. It documents, analyses, and theorizes the intention-utilization gap as lived and experienced by pregnant women. It further challenges the dominant policy assumption that maternal health education campaigns are the primary lever for improving utilization, an assumption the data does not support. When awareness is near-universal, and intention is strong, the missing ingredient is not knowledge. Rather, it could be the structural conditions that either enable or obstruct the translation of intention into action.