Skip to main content

Utilization of antenatal care among adolescent and young mothers in Ghana; analysis of the 2017/2018 multiple indicator cluster survey

Abstract

Background

Complications during pregnancy and childbirth are the leading cause of death among adolescent girls. In Ghana, the prevalence of adolescent pregnancy remains high. Yet, little is known about ANC utilization among adolescent and young mothers. This study aimed to assess the prevalence of obtaining 4 or more ANC visits and associated factors among adolescent and young mothers.

Methods

We analysed secondary data from the sixth round of the Ghana Multiple Indicator Cluster Survey. A total of 947 adolescent and young mothers were included in this study. Data were analysed using STATA/SE, version 16, employing descriptive statistics and Binary Logistic Regression.

Results

It was found that majority of the participants were aged 20-24 years (70%), married/in union (61%) and non-insured (64%). The prevalence of obtaining 4 or more ANC visits was 84%. Adolescent and young mothers with junior high school education, in the second wealth quintile, exposed to the internet, and resided in the Upper East region had a higher likelihood of obtaining 4 or more ANC visits (p < 0.05).

Conclusions

This study demonstrated that optimal ANC utilization among adolescent and young mothers were determined by socio-economic factors. Going forward, maternal healthcare interventions must prioritize adolescent and young mothers from poor socio-economic backgrounds.

Peer Review reports

Background

Although much progress has been made in the last two decades from maternal healthcare interventions across the world, the maternal mortality ratio is still high. Globally, 295,000 women died of pregnancy and childbirth-related complications in 2017 [1]. The majority (94%) of these deaths occurred in low-resource settings [1]. Therefore, Target 3.1 of the Sustainable Development Goals seeks to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 [2, 3]. Adolescent pregnancy is a risk factor for maternal mortality. Adolescent girls face a higher risk of complications, such as eclampsia, puerperal endometritis, systemic infections and death [1, 4]. Complications during pregnancy and childbirth are the leading cause of death among adolescent girls aged 15-19 years globally [5]. About 99% of maternal deaths worldwide occur in developing countries with the majority occurring in sub-Saharan Africa [6].

Antenatal care (ANC) services present a golden opportunity to help reduce maternal mortality. Although many maternal complications are difficult to detect during ANC visits, some, such as hypertensive disorders can be identified and proactively managed through antenatal care visits [4]. Pregnant women have access to skilled healthcare and early detection of danger signs in pregnancy during ANC visits. There is a positive relationship between ANC utilization and positive pregnancy outcomes [7]. Also, ANC enables expectant mothers to learn about signs of obstetric complications and the essence of accessing skilled delivery services [7]. ANC can help reduce perinatal and new-born morbidity and mortality [8,9,10,11].

Despite the benefits associated with ANC services, utilization remains low worldwide [1], especially among young mothers (15-24 years) [12,13,14,15]. Evidence shows that adolescent mothers (15-19 years) are three times less likely to utilize ANC compared to adult mothers [15]. The uptake of ANC is influenced by socio-demographic and behavioural factors. Prior studies have reported that the uptake of ANC was associated with proximity to health facilities, maternal educational status, partner’s educational status, geographical region, access to health information and socioeconomic status [13, 14]. Though the World Health Organization recently recommended 8 or more ANC visits, adolescent and young mothers in Low- and Middle-Income Countries still do not obtain the previous recommendation of 4 or more ANC visits [16].

In Ghana, the maternal mortality ratio decreased from 398 deaths per 100,000 live births in 2003 to 308 deaths per 100,000 live births in 2017 [1]. This ratio is still high and above the Sustainable Development Goal 3 target. Adolescent pregnancy remains a public health concern in Ghana. For instance, about 109,888 adolescent pregnancies were recorded in 2020. Thus, 301 adolescent girls were impregnated every day or 13 adolescent girls were impregnated every hour [17]. The utilization of ANC among adolescent and young mothers in Ghana is below expectation. In addition, existing studies on ANC utilization focused on all pregnant women [18, 19], with little attention on adolescent and young mothers (10-24 years) who are at a higher risk of pregnancy-related complications. This is the maiden study to investigate the utilization of ANC among adolescent and young mothers in Ghana, using nationally representative data. Findings from this study would help inform maternal health policy and programming. Therefore, this study aimed to assess the prevalence of obtaining 4 or more ANC visits, and associated factors among adolescent and young mothers in Ghana, analyzing data from the 2017/18 Multiple Indicator Cluster Survey (MICS) [20].

Methods

Data source and study design

We analysed data from the sixth Multiple Indicator Cluster Survey in Ghana. The survey collected data on socio-demographic and health indicators at the national level. The target population for the survey were persons between the ages of 15-49 years, both males and females. A two-stage stratified sampling technique was employed to recruit participants into MICS. Participants were recruited across the former ten regions of Ghana using the 2010 Population and Housing Census as the sampling frame. In the first stage of the sampling, enumeration areas were selected from both rural and urban areas proportional to size. In the second stage, a systematic sampling technique was employed to select households within the enumeration areas. Regarding the women survey, data were collected from participants using Computer Assisted Personal Interviewing (CAPI).

The unweighted total sample size for the women survey (15-49 years) was 14,374 women. However, this study focused on mothers aged 15-24 years. Therefore, women aged 25-49 years (8538), women who did not utilize ANC services in the last 2 years to the survey (4707) and those who responded ‘do not know’ (7) were dropped/deleted before the analysis. The remaining sample for women aged 15-24 years was (unweighted) 1122 women. After adjusting for the sample weight, the sample size was reduced to (weighted) 947 women aged 15-24 years. Participation in MICS was voluntary and informed consent was obtained from adult participants (18-24 years) and caregivers of minors (15-17 years). Assent was obtained from minors. The 2017/18 MICS was approved by the Ghana Health Service Ethics Review Committee. Details about the 2017/18 MICS are provided elsewhere [20].

Measurement

The main outcome of this study was ANC visits. This was a single continuous variable (i.e how many times you received antenatal care during this pregnancy?). During the analysis, the outcome was recoded into a dichotomous variable (1-3 ANC visits = 0 and 4 or more ANC visits = 1). The categorization was based on WHO’s previous recommendation of 4 or more ANC visits during pregnancy [13, 14]. Between 2002 and 2016, WHO advocated for a four-visit model of focused antenatal care, which prioritised the delivery of evidence-based interventions at each visit. The 2017/18 MICS was conducted barely a year after the WHO latest recommendation of 8 or more ANC visits. Hence, the implementation of the new policy was commencing in Ghana.

The following exposures were identified in the literature: mother’s age, mother’s educational status, marital status, household wealth index, area of residence, region [13, 16, 21] and health insurance membership [22,23,24]. Exposure to the media, including frequency of reading newspaper/magazine, frequency of listening to the radio and frequency of watching television, was also identified in the literature [25,26,27]. We also assessed the effect of mobile phone ownership and internet use on ANC utilization. Maternal age was coded as (15-19 years = 1 and 20-24 years = 2). Marital status was coded as (currently married/in union = 1, formerly married/in union = 2, and never married/in union = 3). Educational status was coded as (pre-primary or none = 0, primary = 1, junior high = 2, secondary = 3 and higher = 4). Household wealth index was coded as (poorest = 1, second = 2, middle = 3, fourth = 4 and richest = 5). In addition, area of residence was coded as (urban = 1 and rural = 2), while region was coded as (Western = 1, Central = 2, Greater Accra = 3, Volta = 4, Eastern = 5, Ashanti = 6, Brong- Ahafo = 7, Northern = 8, Upper East = 9 and Upper West =10). Items that measured exposure to the media included frequency of listening to the radio, watching television and reading newspaper/magazine, which were coded as (not at all = 0, less than once a week = 1, at least once a week = 2 and almost every day = 3). Mobile phone ownership was coded as (Yes = 1 and No = 2) and internet use was coded as (Yes = 1 and No = 2).

Statistical analysis

Data were analysed with Stata/SE version 16 (StataCorp, College Station, Texas, USA). We employed both univariate and multivariable analyses. Descriptive statistics, including frequency, percentage and graphs, were computed at the univariate level. At the multivariable level, we computed Binary Logistic Regression. In the crude analysis, we assessed the effect of each exposure variable on the outcome variable. In the adjusted analysis, we assessed the combined effect of all the exposures on the outcome. To offset challenges associated with oversampling, we reported the weighted results. The adjusted model fitted reasonably well (p > 0.05) [28]. All statistical analyses were reported at the 0.05 significance level.

Results

Descriptive statistics

It was found that the majority (70%) of the participants were aged 20-24 years. About half (49%) of the participants had junior high school education and 61% were currently married/in a union. Exactly 9% of the participants were in the richest wealth quintile, while 26% were in the poorest wealth quintile. The majority of the participants resided in rural areas (65%) and 36% of them had enrolled on the National Health Insurance Scheme. Regarding exposure to the mass media, nine in ten participants did not read newspapers, 26% listen to the radio every day and 45% watched television every day. Also, more than half (90%) of the participants had never used the internet and more than five in ten participants owned a mobile phone. Details are provided in Table 1. Concerning ANC visits, the majority (84%) of the participants obtained 4 or more visits, while 16% obtained 1-3 ANC visits.

Table 1 Participants’ characteristics

Predictors of 4 or more ANC visits among adolescents and young mothers in Ghana

At the crude analysis level, it was found that mothers aged 20-24 years were 1.5 times (COR = 1.55; 95% CI: 1.00-2.38) more likely to obtain 4 or more ANC visits compared with those aged 15-19 years (reference category). Participants with senior high school education were 3 times (COR = 3.07; 95% CI: 1.13-8.33) more likely to obtain 4 or more ANC visits compared with those with pre-primary or no education (reference category). In addition, participants in the fourth wealth quintile (COR = 3.04; 95% CI: 1.39-6.66) had a higher likelihood of obtaining 4 or more ANC visits compared with those in the poorest wealth quintile (reference category). Participants residing in rural areas had decreased odds (COR = 0.51; 95% CI: 0.29-0.88) of obtaining 4 or more ANC visits compared with those residing in urban areas (reference category). Further, adolescents and young mothers who have ever used the internet were 6 times (COR = 6.72; 95% CI: 2.22-20.36) more likely to obtain 4 or more ANC visits compared with those who have never used the internet (reference category).

At the adjusted analysis level, the likelihood of obtaining 4 or more ANC visits was associated with higher educational status, socio-economic status, geographical region and exposure to the internet. For instance, adolescents and young mothers with junior high school education were 2 times (AOR = 2.19; 95% CI: 1.03-4.66) more likely to obtain 4 or more ANC visits compared with those with pre-primary or no education (reference category). Also, participants in the second wealth quintile were 2 times (AOR = 2.23; 95% CI: 1.20-4.16) more likely to obtain 4 or more ANC visits compared with those in the poorest wealth quintile (reference category). Further, adolescent and young mothers residing in the Upper East region were 6 times (AOR = 6.30; 95% CI: 1.03-38.74) more likely to obtain 4 or more ANC visits compared with those in the Greater Accra region (reference category). Adolescents and young mothers who had ever used the internet were 4 times (AOR = 4.38; 95% CI: 1.09-17.64) more likely to obtain 4 or more ANC visits compared with those who had never used (reference category) Table 2.

Table 2 Regression analysis of ANC visits among adolescent and young mothers in Ghana

Discussion

It was revealed that the majority (84%) of the mothers obtained the recommended ANC visits. This national-level prevalence is similar to findings at the district level. For instance, a study in the Yendi Municipality found a prevalence of 83.9% among adolescent mothers [14]. However, the prevalence in this study is higher than findings in Nigeria (35.1%) [29], Bangladesh (30%) [30] and India (22.9%) [31]. The differences in findings can be attributed to the implementation of the Free Maternal Health Care Policy (FMHCP) by the government of Ghana in 2008. With this policy, pregnant women who enrol on the National Health Insurance Scheme (NHIS) have access to free maternal healthcare services, including ANC services.

On the other hand, a substantial proportion (16%) of adolescent and young mothers did not obtain the recommended ANC visits. This is likely to derail efforts towards achieving SDG 3 since optimal ANC utilization is crucial for reducing maternal mortality [4]. The prevalence of underutilization of ANC (16%) is higher than findings in developed countries (5%) [7]. This may be attributed to differences in contextual factors, such as socio-cultural norms and health system factors. For instance, adolescents may delay in accessing ANC services due to fear of stigma or being expelled from school [32]. Also, negative attitudes of health providers towards adolescent mothers coupled with distance to health facilities might have accounted for the differences in the findings [14, 33].

The salient factors associated with obtaining the recommended ANC visits were higher educational status, higher socio-economic status, exposure to the internet, and geographical region. It was revealed that adolescent and young mothers who had junior high school education were more likely to obtain 4 or more ANC visits. This finding is consistent with prior studies in low-and middle-income countries [16, 29]. For instance, a study revealed that Indonesian adolescent mothers with higher education were more likely to utilize ANC services compared with those with lower education [34]. Also, a systematic review of studies from sub-Saharan Africa showed that women with higher education were more likely to obtain the recommended ANC visits [35]. Educated mothers have more access to health information, appreciate the causes of adverse pregnancy outcomes and the importance of ANC to the wellbeing of the mother and the unborn baby [36]. In addition, educated mothers have greater autonomy to make decisions and financial access to quality healthcare [37].

In addition, it was revealed that adolescent and young mothers in the second wealth quintile were more likely to obtain the recommended ANC visits. This finding is consistent with previous studies in developing countries where economic inequities were observed in maternal healthcare service utilization [34]. Evidence shows that socio-economic status significantly affects ANC utilization among adolescent mothers [15, 16, 21, 29, 32]. This finding is understandable because young mothers from poor households are less likely to have financial access to maternal healthcare compared with those from wealthy households [31]. A previous study reported that pregnant women in Ghana still pay for some maternal health services such as drugs, urine and blood tests and ultrasound scans despite the Free Maternal Healthcare Policy [38].

Internet use was also associated with optimal ANC utilization. This finding is consistent with previous studies in Malawi where women who received family planning messages through the internet had higher odds of antenatal care utilisation [39]. Evidence shows that women access pregnancy-related information on the internet, which has the potential to influence their health-seeking behaviours [40]. The geographical region was another salient factor associated with ANC utilization [16]. Adolescent and young mothers in the Upper East region were more likely to obtain the recommended ANC visits. The Upper East region has the highest ANC coverage in Ghana [41], hence this finding is understandable.

Implications and recommendations of findings

The findings of this study provide relevant information for maternal health policy and programming. For instance, a substantial proportion of adolescent and young mothers did not obtain the recommended ANC visits. These young mothers are at a higher risk of pregnancy and childbirth complications as well as negative birth outcomes. This may delay the achieving of Sustainable Development Goals 3, which aims to ensure healthy lives and promote wellbeing at all ages, including adolescent and young mothers. It is, therefore, necessary for stakeholders, including the Ministry of Health and Ghana Health Services, to invest resources that will help increase ANC coverage among young mothers. Stakeholders can leverage existing youth-friendly initiatives such as the Adolescent Health and Development (ADHD) programme. Currently, the ADHD programme does not cover ANC services, hence, stakeholders should consider incorporating these services. Also, the Ghana Health Service should consider separating young mothers from adult mothers during ANC visits to help encourage ANC utilization among adolescent mothers. Owolabi and colleagues [4] revealed that adult mothers stigmatize pregnant adolescent girls. Moreover, stakeholders should strengthen efforts towards providing Focused Antenatal Care. This may help increase ANC utilization among adolescent and young mothers in Ghana.

Further, adolescent and young mothers from poor households, those with lower education and no internet exposure were less likely to obtain optimal ANC visits. This suggests that poor mothers still face financial barriers to accessing ANC services despite the Free Maternal Health Care Policy. This has the potential to delay progress towards improving maternal and child health outcomes as well as achieving SDGs 3. Therefore, the National Health Insurance Authority needs to liaise with health service providers to eliminate all forms of unapproved charges (fees for medication, ultrasound scan, urine and blood test) on maternal healthcare services as reported by Ziblim and colleagues [14] in Northern Ghana. In addition, stakeholders must invest resources in promoting girl child education. Hence, Ghana’s free basic and secondary education policy is commendable. The internet may provide a golden opportunity for stakeholders to increase ANC coverage among young mothers. With the rapid increase in internet penetration in the country, stakeholders can leverage the internet to raise awareness and educate adolescent and young mothers about the importance of ANC and danger signs in pregnancy and childbirth.

Strength and limitations

This is the maiden study in Ghana to estimate the prevalence of ANC visits among adolescent and young mothers using national representative data. Although this study provides invaluable information for maternal health policy, it is not devoid of limitations. This study focused on socio-demographic factors and ANC utilization; hence the interpretation of the findings must be done with caution. Another limitation of this study is the small sample size. Also, quantitative surveys are unable to expose the many intricate views of participants regarding a subject matter. Future studies should, therefore, consider adopting qualitative designs as well as assessing more exposures. For instance, the 2017/18 MICS did not collect data on some potential exposures of ANC utilization among adolescent and young mothers. These exposures include school attendance, pregnancy history and violence against women, hence they should be included in future surveys.

Conclusion

This study showed high utilization of ANC services among adolescent and young mothers. Optimal utilization of ANC was influenced by higher educational status, socio-economic status, exposure to the internet and residing in the Upper East region. Efforts to increase ANC coverage among adolescent and young mothers should focus on promoting girl child education and removing financial barriers to accessing healthcare. Going forward, stakeholders must focus on addressing socio-economic inequalities as part of efforts to improve maternal and child health indicators.

Availability of data and materials

The data used in this study is owned by UNICEF, therefore, the authors cannot share the data. The datasets generated and/or analysed during the current study are available in the UNICEF repository. Interested persons can contact UNICEF for the data via accra@unicef.org. The authors confirm they did not have any special access or privileges to the data that other researchers would not have.

References

  1. WHO. Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division, vol. 2019. Geneva: World Health Organization; 2019.

    Google Scholar 

  2. Desa UN. Transforming our world: the 2030 agenda for sustainable development; 2016.

    Google Scholar 

  3. GMHS: 2017 Ghana Maternal Health Survey: Fact Sheet. 2017.

    Google Scholar 

  4. Owolabi OO, Wong KL, Dennis ML, Radovich E, Cavallaro FL, Lynch CA, et al. Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of West Africa: a cross-sectional analysis of demographic and health surveys. Lancet Child Adolescent Health. 2017;1(3):203–12.

    PubMed  Article  Google Scholar 

  5. WHO: Global Maternal mortality; Fact Sheets. 2021.

    Google Scholar 

  6. Apanga PA, Awoonor-Williams JK. Maternal death in rural Ghana: a case study in the upper east region of Ghana. Front Public Health. 2018;6:101.

    PubMed  PubMed Central  Article  Google Scholar 

  7. WHO: WHO recommendations on antenatal care for a positive pregnancy experience: World Health Organization; 2016.

    Google Scholar 

  8. Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122.

    PubMed  PubMed Central  Article  Google Scholar 

  9. Nimi T, Fraga S, Costa D, Campos P, Barros H. Prenatal care and pregnancy outcomes: a cross-sectional study in Luanda, Angola. Int J Gynecol Obstet. 2016;135:S72–8.

    Article  Google Scholar 

  10. Afulani PA. Determinants of stillbirths in Ghana: does quality of antenatal care matter? BMC Pregnancy Childbirth. 2016;16(1):1–17.

    Article  Google Scholar 

  11. Ebu NI, Gross J. Factors influencing access to antenatal services and delivery care in sub-Saharan Africa. African J Midwifery Women’s Health. 2015;9(2):58–65.

    Article  Google Scholar 

  12. WHO: Reproductive health indicators: guidelines for their generation, interpretation and analysis for global monitoring: World Health Organization; 2006.

    Google Scholar 

  13. Abor PA, Abekah-Nkrumah G, Sakyi K, Adjasi CK, Abor J. The socioeconomic determinants of maternal health care utilization in Ghana. Int J Soc Econ. 2011;38(7):628–48. https://doi.org/10.1108/03068291111139258.

  14. Ziblim S-D, Yidana A, Mohammed A-R. Determinants of antenatal care utilization among adolescent mothers in the Yendi municipality of northern region, Ghana. Ghana J Geography. 2018;10(1):78–97.

    Google Scholar 

  15. Mweteni W, Kabirigi J, Matovelo D, Laisser R, Yohani V, Shabani G, et al. Implications of power imbalance in antenatal care seeking among pregnant adolescents in rural Tanzania: a qualitative study. PLoS One. 2021;16(6):e0250646.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):1–14.

    Article  Google Scholar 

  17. GHS: Ghana health service teenage pregnancy update 2021. 2021.

    Google Scholar 

  18. Sakeah E, Okawa S, Rexford Oduro A, Shibanuma A, Ansah E, Kikuchi K, et al. Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey. Glob Health Action. 2017;10(1):1291879.

    PubMed  PubMed Central  Article  Google Scholar 

  19. Ekholuenetale M, Nzoputam CI, Barrow A. Prevalence and socioeconomic inequalities in eight or more antenatal care contacts in Ghana: findings from 2019 population-based data. Int J Women’s Health. 2021;13:349.

    Article  Google Scholar 

  20. Ghana Statistical Service. Multiple Indicator cluster survey (MICS2017/18), survey findings report. Accra: Ghana Statistical Service; 2018.

    Google Scholar 

  21. Ali A, Dero AA, Ali S, Ali G. Factors affecting the utilization of antenatal care among pregnant women: a literature review. Preg Neonatal Med. 2018;2(2):41–5.

  22. Agbanyo R. Ghana's national health insurance, free maternal healthcare and facility-based delivery services. Afr Dev Rev. 2020;32(1):27–41.

    Article  Google Scholar 

  23. Brugiavini A, Pace N. Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care. Health Econ Rev. 2016;6(1):1–10.

    Article  Google Scholar 

  24. Wang W, Temsah G, Mallick L. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda. Health Policy Plan. 2017;32(3):366–75.

    PubMed  Google Scholar 

  25. Dickson KS, Ameyaw EK, Darteh EKM. Understanding the endorsement of wife beating in Ghana: evidence of the 2014 Ghana demographic and health survey. BMC Womens Health. 2020;20(1):25.

    PubMed  PubMed Central  Article  Google Scholar 

  26. Oyediran KA. Explaining trends and patterns in attitudes towards wife-beating among women in Nigeria: analysis of 2003, 2008, and 2013 demographic and health survey data. Genus. 2016;72(1):11.

    Article  Google Scholar 

  27. Doku DT, Asante KO. Women’s approval of domestic physical violence against wives: analysis of the Ghana demographic and health survey. BMC Womens Health. 2015;15(1):120.

    PubMed  PubMed Central  Article  Google Scholar 

  28. Meyers LS, Gamst GC, Guarino A. Performing data analysis using IBM SPSS. Hoboken: Wiley; 2013.

  29. Rai RK, Singh PK, Singh L. Utilization of maternal health care services among married adolescent women: insights from the Nigeria demographic and health survey, 2008. Womens Health Issues. 2012;22(4):e407–14.

    PubMed  Article  Google Scholar 

  30. Ali N, Sultana M, Sheikh N, Akram R, Mahumud RA, Asaduzzaman M, et al. Predictors of optimal antenatal care service utilization among adolescents and adult women in Bangladesh. Health Serv Res Manag Epidemiol. 2018;5:2333392818781729.

    PubMed  PubMed Central  Google Scholar 

  31. Singh A, Kumar A, Pranjali P. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3. PeerJ. 2014;2:e592.

    PubMed  PubMed Central  Article  Google Scholar 

  32. Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, et al. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One. 2013;8(1):e53747.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  33. Abuosi AA, Anaba EA. Barriers on access to and use of adolescent health services in Ghana. J Health Res. 2019;33(3):197–207.

    Article  Google Scholar 

  34. Efendi F, Chen C-M, Kurniati A, Berliana SM. Determinants of utilization of antenatal care services among adolescent girls and young women in Indonesia. Women Health. 2017;57(5):614–29.

    PubMed  Article  Google Scholar 

  35. Simkhada B, van Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–60.

    PubMed  Article  Google Scholar 

  36. Antai D. Inequalities in under-5 mortality in Nigeria: do ethnicity and socioeconomic position matter? J Epidemiol. 2011;21(1):13–20.

    PubMed  PubMed Central  Article  Google Scholar 

  37. Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, et al. Use pattern of maternal health services and determinants of skilled care during delivery in southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007;7(1):1–7.

    Article  Google Scholar 

  38. Dalinjong PA, Wang AY, Homer CS. Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in northern Ghana. PLoS One. 2018;13(2):e0184830.

    PubMed  PubMed Central  Article  Google Scholar 

  39. Wang Y, Etowa J, Ghose B, Tang S, Ji L, Huang R. Association between mass media use and maternal healthcare service utilisation in Malawi. J Multidiscip Healthc. 2021;14:1159.

    PubMed  PubMed Central  Article  Google Scholar 

  40. Gao L-l, Larsson M, Luo S-y. Internet use by Chinese women seeking pregnancy-related information. Midwifery. 2013;29(7):730–5.

    PubMed  Article  Google Scholar 

  41. GSS G, ICF. Ghana maternal health survey 2017. Accra: Ghana Statistical Service (GSS), Ghana Health Service (GHS) and Macro ICF; 2018.

    Google Scholar 

Download references

Acknowledgements

We thank UNICEF for making data available and accessible for the study.

Funding

No funding was received for the study.

Author information

Authors and Affiliations

Authors

Contributions

EAA conceptualised the study and conducted the formal analysis. SKA drafted the introduction and methods and CDB drafted the discussion of the results. All the authors proofread, edited and accepted the final manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Stanley Kofi Alor.

Ethics declarations

Ethics approval and consent to participate

Informed consent was obtained from all participants and, for participants aged 15–17 years, informed consent was obtained from their parents or legal guardians. The MICS 2017/2018 had the approval of the Ghana Health Service Ethics Review Committee (GHS-ERC). All methods of this study were performed in accordance with the BMC journal guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Anaba, E.A., Alor, S.K. & Badzi, C.D. Utilization of antenatal care among adolescent and young mothers in Ghana; analysis of the 2017/2018 multiple indicator cluster survey. BMC Pregnancy Childbirth 22, 544 (2022). https://doi.org/10.1186/s12884-022-04872-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12884-022-04872-z

Keywords

  • Adolescent and young mothers
  • Antenatal care
  • Utilization
  • Ghana
  • Multiple Indicator cluster survey