Publications

Authors

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

Abstract

Maternal health service utilization remains a critical strategy for reducing maternal and neonatal mortality, yet gaps persist across antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) in Ghana, particularly among rural women. While mass media and digital access have been linked to improved utilization of maternal health services in Sub-Saharan Africa, evidence specific to Ghana remains limited. This study assessed the association between media exposure (radio, television, newspaper) and digital access (phone ownership, internet use) with four maternal health service utilization outcomes: ANC use (4+ visits), adequate ANC (8+ visits), SBA, and PNC among women in Ghana, stratified by place of residence. We analyzed data from 4,982 women in the 2022 Ghana Demographic and Health Survey using multilevel logistic regression, adjusting for sociodemographic and healthcare-access covariates. Utilization was high for ANC4+ (88.5%), SBA (86.7%), and PNC (86.3%), but substantially lower for ANC8+ (38.7%), with rural women underperforming urban women across all outcomes. After adjustment, mobile phone ownership emerged as the most consistent correlate of service utilization. Basic phone ownership was associated with higher odds of ANC use, SBA, and PNC, while smartphone ownership was associated with higher odds of ANC use and SBA. Weekly radio listening was associated with higher odds of adequate ANC in the total sample, but no other media exposure variable or regular internet use was independently associated with any outcome. These findings suggest that mobile phone ownership is more consistently associated with maternal healthcare use in Ghana than traditional mass media exposure or internet use. Health policy and implementation research is therefore needed to examine how mobile phone-based approaches, differentiated by phone type and tailored to urban and rural contexts, may support efforts to reduce persistent disparities in maternal health service utilization in Ghana.

Authors

Sandy Adu, Nana Owusu Ahenkan, Jochebed Afua, Sophia Ansong, MD^*, Yaw Ansong Snr, MD, PhD^*

Abstract

Maternal mortality remains a major public health challenge in Ghana, with inadequate utilization of antenatal care, skilled birth attendance, and postnatal care contributing to preventable maternal deaths. Access to health information is a modifiable determinant of maternal health service use, and digital technologies and mass media may provide scalable channels for improving care-seeking behavior. While evidence from low- and middle-income countries suggests that mobile phones, internet use, television, and radio exposure are associated with maternal health service utilization, Ghana-specific evidence remains limited and often focuses on single media channels or isolated outcomes such as facility delivery. This study uses the 2022 Ghana Demographic and Health Survey to examine the association between digital access, traditional media exposure, and maternal health service utilization among women aged 15-49 years with a recent birth. Digital access is assessed through mobile phone ownership and internet use, while traditional media exposure is assessed through television and radio exposure. Maternal health service utilization is examined across the continuum of antenatal care, delivery care, and postnatal care. By integrating multiple forms of information access within a single analytical framework, this study aims to generate evidence to inform maternal health communication strategies, digital health policy, and efforts to advance Sustainable Development Goal 3.1 in Ghana.

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.