Poverty and maternal health in Ghana: a spatial analysis of exclusion from care

Zoe Matthews, University of Southampton
Angela Baschieri, London School of Hygiene and Tropical Medicine (LSHTM)
Philomena E. Nyarko, University of Ghana
Faustina Frempong-Aiguah, University of Ghana
Peter Gething, University of Southampton
Fiifi Amoako-Johnson, University of Southampton
Peter Atkinson, University of Southampton
Francis Nii-Amoo Dodoo, Pennsylvania State University
Jane C. Falkingham, University of Southampton

Ghana has a high level of maternal mortality and is scaling up the provision of maternal health services. This paper explores the relationship between aspects of deprivation within communities and use of maternal health services after controlling for other factors such as physical access and characteristics of women. The analysis brings together a range of existing data including the 2005 Ghana Living Standards Survey, the Core Welfare Indicators Cluster Survey 2003, area level socio-economic data from the 2000 Census of Ghana, small area level poverty estimates, and maps of transportation, land use and terrain. We derive a range of contextual information including measures of key dimensions of community segregation of the poor, distance to health facilities and area levels of socio-economic development. The paper highlights pathways through which poverty and community inequality affect the use of maternal health services and excludes women from accessing care.