Background
Methods
Study design
Data source
Exposure variable
Dependent variable
Independent covariate
Statistical analysis
Variable | Antenatal Care Uptake | Facility Delivery Utilization | ||||
---|---|---|---|---|---|---|
uOR | CI: (95%) | P-value | uOR | CI: 95% | P-value | |
No_FMHCP | 1 | 1 | ||||
FMHCP | 2.69 | (2.25–3.21) | 0.001*** | 2.37 | (2.03–2.77) | 0.001*** |
Age | 1.01 | (1.00-1.03) | 0.006* | 1.00 | (0.99-1.00) | 0.996 |
Parity | 0.87 | (0.84–0.90) | 0.001*** | 0.81 | (0.78–0.83) | 0.001*** |
History of abortion | ||||||
No history of abortion | 1 | 1 | ||||
History of abortion | 1.59 | (1.26–2.01) | 0.001*** | 1.93 | (1.62–2.31) | 0.001*** |
delivery place | 1 | |||||
Home delivery | 1 | 6.03 | (4.89–7.44) | 0.001*** | ||
Facility delivery | 1.16 | (1.14–1.19) | 0.001*** | |||
Area of residence | ||||||
Urban | 1 | 1 | ||||
Rural | 0.34 | (0.27–0.44) | 0.001*** | 0.14 | (0.11–0.18) | 0.001*** |
Employment | ||||||
Unemployed | 1 | 1 | ||||
Employed | 1.25 | (1.01–1.55) | 0.035* | 0.74 | (0.60–0.91) | 0.005* |
Education | ||||||
No education | 1 | 1 | ||||
Primary Secondary Tertiary | 1.18 3.24 26.2 | (0.92–1.51) (2.50–4.21) (4.59-150.16) | 0.185 0.001*** 0.001*** | 2.01 5.69 51.6 | (1.63–2.49) (4.56–7.09) (12.89–207.4) | 0.001*** 0.001*** 0.001*** |
Marital status | ||||||
Unmarried | 1 | 1 | ||||
Married Liv. tog. Widowed Divorced Not liv. tog. | 1.28 0.92 0.85 1.06 1.07 | (0.94–1.75) (0.66–1.28) (0.46–1.60) (0.47–2.36) (0.68–1.68) | 0.107 0.624 0.632 0.876 0.767 | 0.64 0.65 0.39 1.21 0.75 | (0.46–0.87) (0.47–0.89) (0.22–0.69) (0.58–2.53) (0.48–1.19) | 0.005* 0.009* 0.001** 0.598 0.228 |
Wealth Index | ||||||
Poorest | 1 | 1 | ||||
Poorer Middle Richer Richest | 1.44 2.01 5.14 15.0 | (1.11–1.88) (1.49–2.71) (3.50–7.54) (8.34–27.2) | 0.006* 0.001*** 0.001*** 0.001*** | 2.14 4.18 13.13 39.65 | (1.71–2.69) (3.21–5.43) (9.60-17.97) (25.70-61.18) | 0.001*** 0.001*** 0.001*** 0.001*** |
Region | ||||||
Western | 1 | 1 | ||||
Central G. Accra Volta Eastern Ashanti Brong-Ahafo Northern Upper East Upper West | 0.91 1.56 0.44 0.44 1.43 0.96 0.35 1.13 1.15 | (0.55–1.51) (0.96–2.52) (0.28–0.71) (0.29–0.67) (0.90–2.26) (0.58–1.58) (0.21–0.58) (0.67–1.93) (0.69–1.91) | 0.740 0.071 0.001** 0.001*** 0.124 0.880 0.001*** 0.629 0.570 | 0.82 4.30 0.70 0.83 1.82 1.23 0.20 1.00 0.59 | (0.57–1.18) (2.73–6.77) (0.47–1.07) (0.58–1.20) (1.26–2.64) (0.81–1.86) (0.13–0.33) (0.65–1.56) (0.37–0.96) | 0.286 0.001*** 0.101 0.336 0.001** 0.321 0.001*** 0.966 0.035* |
Sensitivity analysis
Results
Descriptive statistics
Variable | Observation | 2008 | 2014 | ||
---|---|---|---|---|---|
n | mean | N | Mean | ||
Maternal Age | 8,876 | 2,992 | 30 | 5,884 | 31 |
Antenatal Care | 6,360 | 2,088 | 6 | 4,272 | 6 |
Parity | 8,876 | 2,992 | 4 | 5,884 | 4 |
Associated factors of antenatal care uptake and facility delivery utilization
Variable | Multiple logistic regression with linearized std. error | Poisson regression with linearized std. error | Negative binomial regression With linearized std. error | ||||||
---|---|---|---|---|---|---|---|---|---|
aOR | (CI: 95%) | P-Value | aPR | (CI: 95%) | P-Value | aPR | (CI: 95%) | P-value | |
No_FMHCP | Ref. | Ref. | Ref. | ||||||
FMHCP | 1.97 | (1.61–2.41) | 0.001*** | 0.09 | (0.06–0.11) | 0.001*** | 0.09 | (0.07–0.11) | 0.001*** |
Age | 1.05 | (1.03–1.07) | 0.001*** | 0.01 | (0.003–0.01) | 0.001*** | 0.01 | (0.004–0.01) | 0.001*** |
Parity | 0.84 | (0.79–0.90) | 0.001*** | -0.02 | (-0.02-0.01) | 0.001*** | -0.02 | (-0.03 -0.01) | 0.001*** |
Abortion | |||||||||
No history of abortion | Ref. | Ref. | Ref. | ||||||
History of abortion | 1.13 | (0.88–1.46) | 0.312 | 0.01 | (-0.01-0.03) | 0.305 | 0.02 | (-0.003–0.04) | 0.094 |
Delivery place | |||||||||
Home delivery | Ref. | Ref. | Ref. | ||||||
Facility delivery | 3.20 | (2.61–3.92) | 0.001*** | 0.22 | (0.18–0.26) | 0.001*** | 0.22 | (0.18–0.25) | 0.001*** |
Area of residence | |||||||||
Urban | Ref. | Ref. | Ref. | ||||||
Rural | 1.03 | (0.79–1.35) | 0.774 | 0.01 | (-0.02-0.04) | 0.706 | -0.002 | (-0.02–0.023) | 0.881 |
Employment | |||||||||
Unemployed | Ref. | Ref. | Ref. | ||||||
Employed | 1.46 | (1.16–1.84) | 0.001*** | 0.04 | (0.007–0.07) | 0.016* | 0.03 | (0.005 − 0.06) | 0.023* |
Education | |||||||||
No education | Ref. | Ref. | Ref. | ||||||
Primary | 1.02 | (0.80–1.28) | 0.867 | -0.003 | (-0.04-0.04) | 0.868 | 0.002 | (-0.03–0.03) | 0.925 |
Secondary | 1.59 | (1.23–2.06) | 0.001*** | 0.047 | (0.01–0.08) | 0.010* | 0.04 | (0.01–0.06) | 0.013* |
Tertiary | 3.69 | (0.63–21.3) | 0.144 | 0.038 | (-0.002-0.07) | 0.065 | 0.03 | (-0.01- 0.06) | 0.061 |
Marital status | |||||||||
Not married | Ref. | Ref. | Ref. | ||||||
Married | 1.38 | (0.96–1.97) | 0.077 | 0.027 | (-0.02-0.07) | 0.249 | 0.05 | (0.01–0.09) | 0.028* |
Liv. together | 1.07 | (0.73–1.56) | 0.723 | -0.001 | (-0.05-0.05) | 0.977 | 0.01 | (-0.03–0.06) | 0.624 |
Widowed | 1.02 | (0.53–1.97) | 0.936 | -0.001 | (-0.10-0.09) | 0.978 | 0.01 | (-0.08–0.10) | 0.847 |
Divorced | 1.14 | (0.50–2.59) | 0.748 | 0.01 | (-0.10-0.12) | 0.880 | 0.01 | (-0.08–0.09) | 0.857 |
Not liv. together | 1.25 | (0.78–1.99) | 0.343 | 0.02 | (-0.04-0.08) | 0.563 | 0.01 | (-0.05–0.08) | 0.668 |
Wealth index | |||||||||
Poorest | Ref. | Ref. | Ref. | ||||||
Poorer | 1.19 | (0.92–1.53) | 0.164 | 0.05 | (-0.004-0.10) | 0.067 | 0.04 | (-0.001- 0.07) | 0.056* |
Middle | 1.25 | (0.92–1.71) | 0.150 | 0.06 | (0.01–0.12) | 0.029* | 0.06 | (0.01–0.09) | 0.006* |
Richer | 2.23 | (1.42–3.49) | 0.001*** | 0.09 | (0.04–0.15) | 0.001** | 0.09 | (0.05–0.13) | 0.001*** |
Richest | 4.72 | (2.33–9.56) | 0.001*** | 0.10 | (0.04–0.16) | 0.001** | 0.08 | (0.03–0.12) | 0.001** |
Region | |||||||||
Western | Ref. | Ref. | Ref. | ||||||
Central | 1.16 | (0.72–1.84) | 0.532 | 0.02 | (-0.03- 0.07) | 0.500 | 0.02 | (-0.02–0.05) | 0.398 |
G. Accra | 0.54 | (0.31–0.93) | 0.028* | -0.04 | (-0.08–0.01) | 0.098 | -0.02 | (-0.05–0.02) | 0.361 |
Volta | 0.52 | (0.32–0.83) | 0.007* | -0.10 | (-0.17- -0.02) | 0.006 | -0.09 | (-0.15 - -0.04) | 0.001*** |
Eastern | 0.44 | (0.29–0.68) | 0.001*** | -0.12 | (-0.17- -0.06) | 0.001*** | -0.11 | (-0.16 - -0.06) | 0.001*** |
Ashanti | 1.10 | (0.67–1.79) | 0.701 | 0.01 | (-0.04- -0.05) | 0.757 | 0.01 | (-0.02–0.05) | 0.506 |
Brong-Ahafo | 1.03 | (0.63–1.69) | 0.892 | 0.004 | (-0.05- -0.05) | 0.877 | 0.01 | (-0.02–0.05) | 0.529 |
Northern | 0.75 | (0.47–1.21) | 0.249 | -0.05 | (-0.13- -0.04) | 0.253 | -0.07 | (-0.13 - -0.02) | 0.003 |
Upper East | 1.41 | (0.80–2.49) | 0.232 | 0.65 | (0.002–0.13) | 0.045* | 0.06 | (0.01–0.10) | 0.013* |
Upper West | 1.67 | (0.97–2.88) | 0.062 | 0.08 | (0.02–0.14) | 0.011* | 0.07 | (0.02- 0.11) | 0.005* |
Variable | Multiple logistic regression with linearized std. error | Poisson regression with linearized std. error | Negative binomial regression with robust std. error | ||||||
---|---|---|---|---|---|---|---|---|---|
aOR | (CI: 95%) | P-Value | aPR | (CI: 95%) | P-Value | aPR | (CI: 95%) | P-value | |
No_FMHCP | Ref. | Ref. | Ref. | ||||||
FMHCP | 1.87 | (1.57–2.23) | 0.001*** | 0.14 | (0.10–0.18) | 0.001*** | 0.18 | (0.14–0.21) | 0.001*** |
Age | 1.03 | (1.01–1.05) | 0.001*** | 0.01 | (0.003–0.01) | 0.001*** | 0.01 | (0.004–0.01) | 0.001*** |
Parity | 0.87 | (0.82–0.93) | 0.001*** | -0.03 | (-0.04- -0.01) | 0.001*** | -0.04 | (-0.05 - -0.02) | 0.001*** |
Abortion | |||||||||
No history of abortion | Ref. | Ref. | Ref. | ||||||
History of abortion | 1.31 | (1.07–1.60) | 0.009* | 0.05 | (0.01–0.08) | 0.007* | 0.03 | (-0.005–0.06) | 0.103 |
Antenatal care | |||||||||
0–3 attendance | Ref. | Ref. | Ref. | ||||||
4 + attendance | 3.20 | (2.61–3.92) | 0.001*** | 0.50 | (0.39–0.61) | 0.001*** | 0.52 | (0.44–0.60) | 0.001*** |
Area of residence | |||||||||
Urban | Ref. | Ref. | Ref. | ||||||
Rural | 0.44 | (0.34–0.56) | 0.001*** | -0.17 | (-0.22- -0.15) | 0.001*** | -0.19 | (-0.23- 0.15) | 0.001*** |
Employment | |||||||||
Unemployed | Ref. | Ref. | Ref. | ||||||
Employed | 0.88 | (0.70–1.09) | 0.260 | -0.04 | (-0.07-0.01) | 0.094 | -0.03 | (-0.06 − 0.004) | 0.085 |
Education | |||||||||
No education | Ref. | Ref. | Ref. | ||||||
Primary | 1.19 | (0.94–1.52) | 0.142 | 0.08 | (0.01–0.15) | 0.046 | 0.11 | (0.05–0.16) | 0.001*** |
Secondary | 1.78 | (1.40–2.26) | 0.001*** | 0.14 | (0.07–0.20) | 0.001*** | 0.17 | (0.12–0.22) | 0.001*** |
Tertiary | 3.44 | (0.76–15.5) | 0.108 | 0.14 | (0.6 − 0.21) | 0.001*** | 0.16 | (0.10–0.21) | 0.001*** |
Marital status | |||||||||
Not married | Ref. | Ref. | Ref. | ||||||
Married | 0.79 | (0.56–1.12) | 0.197 | -0.05 | (-0.11-0.01) | 0.099 | -0.07 | (-0.13- -0.24) | 0.005* |
Liv. together | 0.79 | (0.56–1.14) | 0.205 | -0.04 | (-0.10-0.02) | 0.202 | -0.07 | (-0.12- -0.01) | 0.016* |
Widowed | 0.41 | (0.19–0.83) | 0.014* | -0.22 | (-0.40- -0.04) | 0.016 | -0.17 | (-0.32- -0.02) | 0.024* |
Divorced | 1.87 | (0.83–4.24) | 0.129 | 0.10 | (-0.03-0.24) | 0.133 | 0.03 | (-0.08- 0.14) | 0.565 |
Not liv. together | 0.79 | (0.46–1.36) | 0.407 | -0.05 | (-0.16-0.43) | 0.260 | -0.12 | (-0.21- 0.02) | 0.014* |
Wealth index | |||||||||
Poorest | Ref. | Ref. | Ref. | ||||||
Poorer | 1.64 | (1.34–2.01) | 0.001*** | 0.26 | (0.16–0.35) | 0.001*** | 0.20 | (0.14–0.27) | 0.001*** |
Middle | 2.08 | (1.60–2.71) | 0.001*** | 0.35 | (0.25–0.46) | 0.001*** | 0.29 | (0.22–0.36) | 0.001*** |
Richer | 4.20 | (2.85–6.17) | 0.001*** | 0.43 | (0.33–0.54) | 0.001*** | 0.34 | (0.27–0.41) | 0.001*** |
Richest | 6.11 | (3.59–10.3) | 0.001*** | 0.39 | (0.28–0.50) | 0.001*** | 0.31 | (0.24–0.38) | 0.001*** |
Region | |||||||||
Western | Ref. | Ref. | Ref. | ||||||
Central | 0.87 | (0.55–1.37) | 0.556 | -0.03 | (-0.13- 0.06) | 0.501 | 0.03 | (-0.04- 0.09) | 0.469 |
G. Accra | 1.55 | (0.92–2.63) | 0.098 | 0.07 | (-0.01-0.15) | 0.067 | 0.08 | (0.03–0.14) | 0.002* |
Volta | 1.21 | (0.75–1.96) | 0.418 | 0.04 | (-0.06-0.16) | 0.420 | 0.04 | (-0.02- -0.12) | 0.198 |
Eastern | 1.08 | (0.70–1.66) | 0.707 | 0.02 | (-0.07-0.12) | 0.634 | 0.05 | (-0.01- -0.12) | 0.110 |
Ashanti | 1.54 | (0.99–2.38) | 0.052 | 0.08 | (-0.001-0.16) | 0.053 | 0.11 | (0.05–0.17) | 0.001*** |
Brong-Ahafo | 1.60 | (1.00-2.56) | 0.049* | 0.09 | (-0.001-0.19) | 0.053 | 0.13 | (0.07–0.19) | 0.001*** |
Northern | 0.62 | (0.38-1.00) | 0.054 | -0.25 | (-0.43- -0.07) | 0.006 | -0.21 | (-0.03- -0.12) | 0.001*** |
Upper East | 2.96 | (1.75–4.98) | 0.001*** | 0.34 | (0.21–0.46) | 0.001*** | 0.32 | (0.24–0.39) | 0.001*** |
Upper West | 1.45 | (0.86–2.45) | 0.165 | 0.11 | (-0.03-0.26) | 0.135 | 0.11 | (0.03–0.19) | 0.006* |
Percentage points impact of the ‘free’ policy on antenatal care uptake and facility-level delivery utilization
Variable | Bootstrapping standard error | |||||
---|---|---|---|---|---|---|
Antenatal care uptake | Facility delivery utilization | |||||
ATE | (CI: 95%) | P-value | ATE | (CI: 95%) | P-value | |
No_FMHCP | 1 | 1 | ||||
FMHCP | 0.08 | (0.06–0.10) | 0.001*** | 0.13 | (0.11–0.15) | 0.001*** |
Age | 0.003 | (-0.002-0.008) | 0.231 | 0.004 | (0.0001–0.008) | 0.043* |
Abortion | ||||||
No | 1 | 1 | ||||
Yes | 0.12 | (0.04–0.20) | 0.004* | 0.13 | (0.06–0.20) | 0.001*** |
Area of residence | ||||||
Urban | 1 | 1 | ||||
Rural | -0.06 | (-0.15-0.02) | 0.176 | -0.09 | (-0.17- -0.01) | 0.021* |
Employment | ||||||
No | 1 | 1 | ||||
Yes | -0.12 | (-0.21-0.03) | 0.008 | -0.13 | (-0.20 - -06) | 0.001*** |
Education | ||||||
No education | 1 | 1 | ||||
Primary | 0.03 | (-0.06-0.13) | 0.486 | 0.06 | (0.21 − 0.13) | 0.151 |
Secondary | 0.39 | (0.29–0.48) | 0.001*** | 0.41 | (0.32–0.48) | 0.001*** |
Tertiary | 0.67 | (0.44–0.90) | 0.001*** | 0.68 | (0.47–0.87) | 0.001*** |
Marital status | ||||||
Not married | 1 | 1 | ||||
Married | 0.33 | (-0.20-0.47) | 0.001) *** | 0.36 | (0.24–0.49) | 0.001*** |
Liv. together | 0.15 | (o.01-0.29) | 0.035* | 0.21 | (0.08–0.33) | 0.001** |
Widowed | 0.21 | (-0.07- -0.49) | 0.148 | 0.22 | (-0.04-0.47) | 0.103 |
Divorced | -0.16 | (-0.44-0.12) | 0.265 | -0.16 | (-0.42- 0.09) | 0.210 |
Not liv. together | -0.09 | (-0.11-0.31) | 0.367 | 0.10 | (-0.08- 0.29) | 0.290 |
Wealth index | ||||||
Poorest | 1 | 1 | ||||
Poorer | 0.16 | (0.06–0.26) | 0.002* | 0.16 | (0.07–0.24) | 0.001*** |
Middle | 0.32 | 0.20–0.43) | 0.001*** | 0.31 | (0.20–0.41) | 0.001*** |
Richer | 0.43 | (0.29–0.57) | 0.001*** | 0.42 | (0.29–0.54) | 0.001*** |
Richest | 0.61 | (0.44–0.78) | 0.001*** | 0.61 | (0.45–0.75) | 0.001*** |
Region | ||||||
Western | 1 | 1 | ||||
Central | -0.35 | (-0.49- -0.20) | 0.001*** | -0.40 | (-0.53- -0.28) | 0.001*** |
G. Accra | -0.49 | (-0.65- -0.33) | 0.001*** | -0.45 | (-0.58- -0.30) | 0.001*** |
Volta | 0.16 | (-0.009-0.31) | 0.038* | 0.15 | (0.01–0.28) | 0.025* |
Eastern | 0.13 | (-0.01-0.28) | 0.082 | 0.11 | (-0.02- 0.23) | 0.104 |
Ashanti | -0.31 | (-0.45- -0.17) | 0.001*** | -0.32 | (-0.44- -0.20) | 0.001*** |
Brong-Ahafo | 0.48 | (0.33–0.62) | 0.001*** | 0.44 | (0.31–0.56) | 0.001*** |
Northern | 0.34 | (0.19–0.49) | 0.001*** | 0.28 | (0.15- -0.40) | 0.001*** |
Upper East | 0.61 | (0.44–0.77) | 0.001*** | 0.59 | (0.44–0.72) | 0.001*** |
Upper West | 0.82 | (0.65–0.99) | 0.001*** | 0.77 | (0.62–0.91) | 0.001*** |