title: Empowerment and use of antenatal care among women in Ghana: a cross-sectional study.
abstract: BACKGROUND
  Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana.
  
  
  METHODS
  We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education.
  
  
  RESULTS
  Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001).
  
  
  CONCLUSIONS
  Results suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women.
authors.affiliation: Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA. sipsmah@uic.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.affiliation: Department of Psychiatry, University of Ghana Medical School, Accra, Ghana. Angela.oforiatta@yahoo.com.
authors.forename: Angela
authors.initials: A
authors.lastname: Ofori-Atta
authors.affiliation: Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA. Maureen.canavan@yale.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: Canavan
authors.affiliation: Department of Economics, Yale University, New Haven, Connecticut, USA. Christopher.udry@yale.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Udry
authors.affiliation: Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA. Elizabeth.bradley@yale.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bradley
mesh_terms: D000328:Adult; D018585:Battered Women / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005869:Ghana; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011209:Power, Psychological; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D013179:Spouse Abuse / Q000523:psychology / Q000706:statistics & numerical data*