title: A geospatial analysis of the impacts of maternity care fee payment policies on the uptake of skilled birth care in Ghana.
abstract: BACKGROUND
  Many low and middle income countries have initiated maternity fee exemption and removal policies to promote use of skilled maternity care. After two and a half decades of these policies, uptake of skilled birth care remains low and inequalities continue to exist in many low and middle income countries. This study uses 2 decades of birth histories data to examine four maternity fee paying policies enacted in Ghana over the past 3 decades and their geospatial impacts on uptake of skilled delivery care.
  
  
  METHODS
  Bayesian Geoadditive Semiparametric regression techniques were applied on four conservative rounds of Demographic and Health Surveys in Ghana to examine the extent of geospatial dependence in skilled birth care use at the district level and their associative relationships with maternity fee paying policies focusing on the temporal trends when the policies were functional.
  
  
  RESULTS
  The results show that at the country-level, the policies had a positive influence on use of skilled delivery care; however their impacts on reducing between-district inequalities were trivial.
  
  
  CONCLUSIONS
  The findings suggest that targeted interventions at the district level are essential to strengthen maternal health programmes in Ghana.
authors.affiliation: Department of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK. faj100@soton.ac.uk.
authors.forename: Fiifi
authors.initials: F
authors.lastname: Amoako Johnson
mesh_terms: D001499:Bayes Theorem; D005249:Fees and Charges; D005260:Female; D005869:Ghana; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008880:Midwifery / Q000191:economics / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012959:Socioeconomic Factors