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COUNTRY PROFIL E

A N A L Y SI S O F D E M O GR A PH I C A N D H E A L T H SU R V EY S

Proportion of births occurring in urban and rural areas

Contiuum of care

Antenatal care

Number of antenatal care visits

Access to the contents of care

Skilled Birth Attendant at delivery

Utilization of servicesUtilization of services by subregion

Utilization of services by subregion (map)

Utilization of services by wealth quint ile

Place of delivery

Place of delivery

Place of delivery by wealth quintile

Problems in accessing t o health facilities

C-section

Utilization of services

Utilization of services by subregion

Utilization of services by subregion (map)

Utilization of services by wealth quint ile

Postnatal care visits and type of provider

Perinatal mortality rate

Total perinatal mortality rate

Perinatal mortality rate by subregion

Perinatal mortality rat e by wealth quintile

Neonatal and post neonatal mortality rate

Nutrition

Anaemia in pr egnancy

Low Birth Weight

Low Birth Weight

Tetanus toxoid vaccinationInitial breastfeeding

Malaria in pregnancy

Use of ITN

HIV in pregnancy

HIV counselling for pregnant women in ANC visits

Fertility

Total fertility rate

Teenage pregnancy

Teenage p regnancy

Teenage pregnancy by age

Teenage preg nancy by subregion

Family planningContr aceptive use

Contraceptive use by age

Contr aceptive use by subregion

For data from the Demographic and Health Surveys, years refer to t he years surveys were conducted. Estimates are based ondata referring to five years preceding the surveys.

Coverage of interventions (DHS Ghana, 1988 - 2008)

GhanaL i st of i nd icat or s

Pr opor t i on of bi r t hs occu r r i ng i n ur ban and r u r a l a r easAmong women who were interviewed,approximately 62% of births occurred in rur alareas.

Estimated total number of births (in thousands):765 (2008)

United Nations, Department of Economic and SocialAffairs, Populat ion Division, Wor ld PopulationProspects: The 2008 Revision, New York, 20 09(advanced Excel tables).

Urban

38%Rural

62%

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2C OU N TR Y PR OFILEGhana

Cont inuum o f car e

Number o f an t enata l car e (A NC) v i si t s

The survey in 2008 showed that approximately94% of women who with a live birth received ANC,and 95% did so from a skilled provider.

NB: Gap to 10 0% refers to the propor tion ofwomen who did not go to ANC.

% o

f w o m e n w

h o g a v e b i r t h

5.1 4 2.8

20.216.7

13.3

62.3 69.4 78.2

1.9 3.72.3

87.5

91.9 95.4

0

20

40

60

80

100

1998 2003 2008

ANC 1 visit ANC 2-3 visits ANC 4+ visits

DK/missing ANC by skilled provider

A ccess t o cont ent s of A NC

0

20

40

60

80

100

Informed signs of pregnancycomplication

Weighed

Blood pressure measuredUrine sample taken

Blood sample taken

Richest Poorest

The reported contents of ANC are an importantindicator of ANC services received. Effectivenessof ANC is determined not only by the type ofexamination but also from the counselling andinformation provided on danger signs associatedwith pregnancy and childbirth.

In Ghana, majority of women had received basictests; weighed, blood sample, urine sample, bloodpressure. However, taking blood sample and urinesample were less likelyto be performed amongpoorest women.

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Sk i l l ed B i r t h A t t en da n t (SB A ) a t bi r t h

Three quarters of all maternal deaths occurduring birth and the immediate post-partumperiod. One of the most critical interventionsfor safe motherhood is to ensure skilledcare provided by skilled professionals duringpregnancy and childbirth.

In Ghana, the latest survey in 2008 showedthat approximately 57% of births were assistedby SBA. While 62% of births were reported tooccur in rural areas, less than half of births wereassisted by SBA in rural areas. %

o f b i r t h s a s s i s t e d b y S B A

by w ea l t h q u in t i l e

Women’s wealth status is one of the deter minantsof receiving skilled care.

In 200 8, at national level, 57% of births receivedskilled assistance however bir ths to women in thepoorest quintile had approximately 3 times lessaccess to skilled care compared t o their r ichestcounterpar ts. Substential increase in the SBAcoverage was obsearved across all the wealthgroups in the two sur veys. However, coverage gapin accessing to skilled care by the poorest and therichest remained wide.

% o

f b i r t h s a s s i s t e d b y S B A

by r egion

% o

f b i r t h

s a s s i s t e d b y S B A

According to the latest survey in 2008, theutilization of SBA ranged from a high of 84%in the Capital city to a low of 27% in theNorthern areas.

% o

f b i r t h

s a s s i s t e d b y S B A

u i i za ion o r ange r om a ig oin the Capital city to a low of 27% in theNorthern areas.

Wof r

In 2skill

ooaccouovro

n arich

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Pl a ce of bi r t h

Proper medical attention and hygienic conditionsduring delivery can reduce the risk of complicationsand infections that may cause deaths or seriousillness to either the mother or the baby or both.According to the latest survey in 2008, 57% ofbirths took place in health facilities, and 42% weredelivered at own home or someone else’s home.

% o

f b i r t h s

22.1

41.753.5

68.8 71.5

1.4

7

8.6

11.3

21.2

75.7

50.236.5

19.66.6

0.2 1 0.7 0.3 0.30.6 0.1 0.7 0 0.3

0%

20%

40%

60%

80%

100%

Poorest Poorer Middle Richer Richest

Public health facility Private health facility Home Other Missing

% o

f b i r t h s

Approximately just more than half of births inGhana were delivered at health facility, mostly inthe public sector. Proportion of home birth waslikely to be r elated to women’s socioeconomicstatus. 76% of births to poorest womenoccurred at home as compared to7% of birthto their richest counterparts. Use of privatehealth facility was very low across all the

socioeconomic groups except the fact that 21%of richest women used private sector facilitiesfor giving births.

Pr obl ems in accessing heal t h f ac i l i t ies

Women’s decision to seek medical advice or

treatment can be influenced by various factors.Information on such factors is particularlyimportant in understanding and addressing thebarr iers women may face in seeking care duringpregnancy and at the t ime of bir th.

Women in Ghana repo r ted that the major pr oblemthey face in accessing health care for themselveswas getting money for treatment (45%) andconcerns that no drugs were available (45%),followed by concerns that no providers wereavailable (44%) and the distance to health facility(26%).

7

18.4

21.5

25

25.9

43.5

44.9

45.1

0 20 40 60 80 100

Getting permission to go for treatment

Not wanting to go alone

Concern no female provider available

Having to take transport

Distance to health facility

Concern no provider available

Concern no drugs available

Getting money for treatment

d

Abd


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by subr egion

At subregional level, data in 2008 indicated that the C-section rate ranged from a low of 1%in Upper East to a high of 11% in Ashanti. Data highlightssubstantial disparity across regions in accessing C-section.

% o

f b i r t h s d e l i v e r e d b y C - s e c t i o n

Caesar ean sect ion (C-sect ion)

At national level, the latest data in 2008 indicatedthat 7% of births were delivered with C-section.Substantial difference in accessing the C-sectionbetween urban and rural areas were observed.

% o


by weal t h qu in t i l e (2003)

By wealth quintile, a 8 -fold difference was obser vedbetween the women in the poorest and richestsocioeconomic gr oups.

% o


n ionalhat 7% f ubstantiale ween ur

-

% o


1511 10

17

48

24

50

65

82

95

0

10

20

30

40

50

60

70

80

90

100


2003 2008

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Post na ta l car e v i si t s f o r mot her s

It is critical for the postnatal check up totake place soon after the birth in order toscreen for conditions that may threatenan infant’s survival.

According to the survey in 2008, womendelivering in a health facility weremore than twice as likely to have had apostnatal check-up within the first twodays compared with women deliveringelsewhere.

% o

f w o m e n

30.140.9 52.8 56.7 57.6

4

89.7

17.218.611.1

1112.4

812.612.7

7.7 5.4 4.2 5.3

0%

20%

40%

60%

80%

100%


3-41 days 1-2 days 4-23 hours Less than 4 hours

Post nat a l car e v isi t s f or mot her s by t ype of pr ov ider

In Ghana, 58% of mothers obtainedpostnatal care from doctor/nurse/midwife, and the 80% of postnatalcare was provided in healthfacilities.

The likelihood o f women receivingpostnatal care from healthprofessionals declined withsocioeconomic status.

% o f

w o m e n

o f w

e n

46.5 56.240.1

61.3

24.3

10.915.7

7.7

15.4

4.2

10.910

11.5

10.9

11.1

7.3 49

4

12.3

0%

20%

40%

60%

80%

100%

Total Urban Rural Health facilities Elsewhere

3-41 days 1-2 days 4-23 hours Less than 4 hours

% o

f w o m e n

57.8

77.4

44.6

87.2

13.5

2.4

2.8

2.2

3.5

0.8

2.5

1.2

3.4

1.9

3.4

146.6

19.4

0.7

34.6

0%

20%

40%

60%

80%

100%

Total Urban Rural Health facilities Elsewhere

Others Community health officer Auxiliary midwife Doctor/nurse/midwife

Women in the richest wealth quintile wereabout t wice as likely to have had an earlypostnatal check-up as women in thepoorest wealth quintile.

by pl ace, by mode of bir t hs


by pl ace, by mode of bir t hs

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Per i na t a l mor t a l i t y r a t eTota l per ina ta l mor t a l i t y r a t e (2008)

Perinatal mortality rate consists of stillbirth rateand early neonatal mortality rate. The survey in200 8 repor ted that perinatal mortality rate was 39per 1000 pregnancies in total, showing a higherrate among women living in rural areas.

64

8

13

11

15

19

15

24

0

5

10

15

20

25

30

Total Urban Rural

ENMR SBR PMR

p e r 1 0 0 0 p r e

g n a n c i e s

27.4

46.7

61.276.1

90.11.6

3.7

2.4

2.5

1.7

6.4

2.2

1.70.6

0.7

23.9

15.511.2

8.8 2.6

0%

20%

40%

60%

80%

100%


Others Community health officer Auxiliary midwife Doctor/nurse/midwife

Women in the highest wealthquintile were more than twice aslikely to r eceive postnatal carefrom a health professional asthose in the lowest wealth quintile.

Neonat a l (NN) and post -neonat a l (PNN) mor t a l i t yThe survey in 2008 r eported that t he neonatalmort ality rate was 30 and the post neonatalmortality was 21 per 1000 live births. Thismeans that for every 1000 children born inGhana, 51 die before their first birthday; 30 ofsuch deaths occur within the first months of lifeand the other 21 , after the first months of lifebut before reaching the exact age of 1 year.

T

sa

30

35

30

2122

21

0

5

10

15

20

25

30

35

40

1994-1998 1999-2003 2004-2008

p e r 1 0 0 0 l i v

e

b i r t h s

NN PNN


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N u t r i t i o nA naemia i n pr egnancy (2008 )

According to the latest survey, 70% of pregnantwomen were reported to be anaemic. Of those whowere anaemic, the majority were reported to sufferfrom mild to moderate anaemia.

L ow B i r t h Weigh t

The survey in 2008 indicated that, of those whowere weighed, 10% were reported to weigh lessthan 2.5 kg at birth.

% o

f b a b i e s w e i g h i n g l e s s t h a n 2

. 5 k g

Tet anu s I mmunizat ion

Neonatal tetanus is a leading cause of neonataldeath in developing countries where a highproportion of deliveries were conducted at homeor unhygienic environment.

Tetanus toxoid immunization was given to pregnantwomen to prevent neonatal tetanus. According tothe survey in 200 8, more than half of women (56percent) in Ghana received two or more tetanusinjections during pregnancy and that 72 % of birthswere protected against neonatal tetanus.

% o

f w o m e n

11.1 6.714.1

31.531

31.8

56.2 61.252.8

1.2 1 1.3

0%

20%

40%

60%

80%

100%

Total Urban Rural

DK/missing Two doses or more One dose None

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% o

f w o m e n

Women in richest wealth quintile were morelikely to have received two or more tetanustoxoid injections than women in the poorstwealth quintile.

Wi

xoweal

17.7 13.9 11.7 7 2.4

31.332.8 36.1

26.6 31.1

49.8 51.4 51.465.7 65.4

1.2 1.9 0.7 0.8 1.2

0%

20%

40%

60%

80%

100%


DK/missing Two doses or more One dose None


I n i t i a l br east f eed ing

% o

f w o m e n

Early initiation of breastfeeding isencouraged for a number of reasons.It not only fosters bonding betweenmother and newborn but alsostimulates breast milk production andfacilitates the release of oxytocin,which helps the contraction of the

uterus and reduces post-partumblood loss.

For last-born children ever breastfed,52 percent star ted breastfeedingwithin 1h of birth and 8 2 percentstarted breastfeeding within the first24h after birth.

% o

f w o m e n

Initial breastfeeding had beenpracticed at t he same level across allthe wealth quintile (82-85%) exceptwomen in the poorer household group(75%).

by pl ace, by sex of chi l d, by mode of bir t hs


52.3 55.450.2 52.2 52.5 56 56

30.130.1

30.1 28.9 31.229.6 29.6

0

20

40

60

80

100

Total Urban Rural Male Female Medically trained Health faclity

Started 2-23 hours Started within 1 hour

51.245.6

52.657 57

30.7

30.1

30.329.4 28.3

0

20

40

60

80

100


Started 2-23 hours Started within 1 hour

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H I V in pr egnancyH IV counsel l ing and t est ing f or pr egnant women in A NC v isi t s (2003)

50% of pregnant women aged 15–49received HIV counselling during their ANCvisits. Of t hose women voluntarily testedfor HIV, 28% received results and 7% didnot receive result.

24% were counselled and tested for HIVand received their results.

F e r t i l i t yTot a l f er t i l i t y r a t e (T FR )

Total fertility rate consists of wanted total fertilityrate and unwanted total fertility rate. Accordingto the latest survey in 2008, the average womenin Ghana would have approximately 4 childrenby the end of her reproductive age. Of those,according to the survey in 2008, approximately4 were reported to be wanted fertility, reflectingsubstantial demand for having children.

T o t a l f e r t i l i t y r a t e p e r w o m a n

5.34.2

3.6 3.74

1.1

1

0.8 0.70.5

0

1

2

3

4

5

6

7

1988 1993 1998 2003 2008

Unwanted total fertility rate Wanted total fertility rate

M al a r i a in pr egnancy

Among pregnant women, 32% repor tedto have slept under a net and 20% sleptunder an ITN the night before the interview.In the same survey in 200 8, a total of 74%of pregnant women repor ted to have usedantimalarial drugs, and 41% received IPTduring ANC visit.

(2008)

73.8

40.9

31.7

19.9

0

20

40

60

80

100

% of last births in the five yearspreceding the survey for which the

mother took antimalarial drugs forprevention during the pregnancy

% of last births in the five yearspreceding the survey for which the

mother got intermittent preventivetreatment (IPT) during an antenatal

visit.

% of pregnant women age 15-49 whoslept under a mosquito net (treated or

untreated) the night before theinterview

% of pregnant women age 15-49 whoslept under insecticide-treated net

(ITN) the night before the interview

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Teenage pr egnancy by age

Because the absolute number in each category isvery small, it may be difficult to interpret trends.However, the latest survey in 2008 showed that7% of women at the age of 1 9 were pregnant withtheir first child.

% o

f w o m e n a g e

d 1

5 - 1

9 p r e g n a n

t w

i t h t h e

i r f i r s t c

h i l d

Teenage pr egnancy by subr egionAt subregional level, fluctuating trend wasobserved in western, central and other areas.According to the recent survey in 2008,approximately 7% of women at the age of 1 5-19 inthe Volta area were reported to be pregnant withtheir first child.

% o

f w o m e n a g e

d 1 5

- 1 9 p r e g n a n

t w

i t h t h e i r

f i r s t c

h i l d

% o

f w o m e n a g e

d 1

5 - 1

9 p r e g n a n

t w

i t h t h e

i r f i r s

t c

h i l d

heir irs child.

Teena ge pr egna ncyTeenage pr egna ncy

At national level, the recent survey showed 3.4%of women aged 15– 19 were currently pregnantwith their first child.

%

o f w o m e n a g e

d 1 5

- 1 9 p r e g n a n

t w

i t h t h e

i r f i r s t c

h i l d

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M oder n cont r acept ive use by age

According to the latest survey in 2008, thehighest use of modern contraceptive methods wasreported in women at the age of 20-24 (17%).

% o

f c u r r e n

t l y m a r r i e

d w o m e n u s

i n g m o

d e r n c o n

t r a c e p

t i v e s

M oder n cont r acept ive use by subr egions

% o

f c u r r e n

t l y m a r r i e

d w o m e n u s

i n g m o

d e r n c o n

t r a c e p

t i v e s

According to the latest survey in 2008, the use of modern contraceptives ranged from a high of 22% in the Capital city and in Brong-Ahafo to a low of 6% in the Northern areas.

Fami l y pl anningM oder n cont r acept ive use

At national level, according to the latestsurvey in 2008 , 17% of curr ently marriedwomen were using moder n contr aceptives.

%

o f c u r r e n

t l y m a r r i e

d w o m e n u s

i n g m o

d e r n c o n

t r a c e p

t i v e s

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Ref er encesGhana Statist ical Service (GSS), Ghana Health Service. Ghana Demogr aphic and Health Survey 2 00 8. Calverton, Mar yland: GSS, NMIMR, andORC Macro.

Ghana Statistical Service (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Macro. 2004. Ghana Demographic andHealth Survey 2003. Calverton, Maryland: GSS, NMIMR, and ORC Macro.

Ghana Statistical Service (GSS) and Macro Inter national Inc. (MI). 199 9. Ghana Demograp hic and Health Survey 19 98 . Calverton, Maryland:GSS and MI.

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