Determinants of Antenatal Care Use in Ghana

2 We investigate the determinants of antenatal care use in Ghana using a large-scale living standard survey. Most previous studies on the subject have used surveys that focus on demography and fertility, and have used approximate indicators of economic variables such as income and cost of consultation. This leads to an overestimation of effects when explanatory factors pick up the effect of underlying economic conditions. We describe antenatal care demand as a three level nested multinomial logit model that includes more appropriate economic explanatory variables. The estimation results show that indeed income, cost of consultation and in particular travel distance to the health care facility are significantly associated with the demand for antenatal care. Use of sufficient antenatal care can thus be promoted effectively by extending the supply of antenatal care services in the rural area. In addition, education of the mother is positively The paper has been prepared in the context of the project 'Human Resource Development for Poverty Reduction and Household Food Security' of the foundation 'Sécurité Alimentaire Durable en Afrique de l'Ouest Central' (SADAOC, Ouagadougou, Burkina Faso). The authors gratefully acknowledge the Ghana Statistical Service and the Ministry of Health for kindly making the data available, and the foundation SADAOC for its support and for the useful comments and recommendations of its Advisory Council. Abstract 3 associated to choice for sufficient antenatal care, while women having more pregnancy experience tend to underutilize antenatal care. This suggests that campaigns to promote sufficient antenatal care should pay special attention to education and to women who already gave birth. The results further indicate that, in contrast to findings elsewhere, a special targeting of antenatal care according to religion seems unwarranted. Expectant mothers who obtain sufficient antenatal care generally have better pregnancy outcomes than those who lack such care, both in terms of their own health condition and that of their babies. In turn, better maternal health has a favorable impact on household food security. Not only will a better maternal health increase babies' access to breastfeeding, it will also increase the access to nutritious food of household members in general, due to the predominant role of (expectant) mothers in the production, marketing and preparation of food. These immediate and indirect consequences of antenatal care for food security are particularly relevant in sub-Sahara Africa, where fertility rates are high and women often bare the sole responsibility for food security. For this …