title: Focused maternity care in Ghana: results of a cluster analysis.
abstract: Ghana missed out in attaining Millennium Development Goal 5 in 2015. The provision of adequate prenatal and postnatal care remains problematic, with poor evidence on women's views on met and unmet maternity care needs across all regions in Ghana. This paper examines maternal care utilization in Ghana by applying WHO indicators for focused maternal care utilization.
  
  
  
  Two-step cluster analysis segregated women into groups based on the components of the maternity care used. Using cluster membership variables as dependent variables, we applied multinomial and binary regression to examine associations of care use with individual, household and regional characteristics.
  
  
  
  We identified three patterns of care use: adequate, less and least adquate care. The presence of a female and skilled provider is an indicator of adequate care. Women in Volta, Upper West, Northern and Western regions received less adequate care compared with other regions. Supply-related factors (drugs availability, distance/transport, health insurance ownership, rural residence) were associated with adequacy of care. The lack of female autonomy, widowed/divorced women, age and parity were associated with less adequate care. Care patterns were distinctively associated with the quality of health care support (skilled and female attendant) instead of with the number of visits made to the facility. Across regions and within rural settings, disparities exist, often compounded by supply-related factors.
  
  
  
  Efforts to address skilled workforce shortages, greater accountability for quality and equity, improving women motivation for care seeking and active participation are important for maternity care in Ghana.
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. m.ayanore@maastrichtuniversity.nl.|Centre for Health Policy, Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana. m.ayanore@maastrichtuniversity.nl.
authors.forename: Martin Amogre
authors.initials: MA
authors.lastname: Ayanore
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D005869:Ghana; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data; D012423:Rural Health / Q000592:standards; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Delivery care; Facility utilisation; Ghana; Medication care; Postnatal care; Prenatal care; Skilled delivery; WHO delivery care components