Determining factors of birthplace choice among women in Ghana: evidence from the 2022 nationally representative data

BACKGROUND: The availability and accessibility of high-quality maternal healthcare remain a significant challenge for health systems worldwide. Evidence demonstrates that health insurance positively influences the utilization of maternal healthcare services in Sub-Saharan Africa. But some subscribers of health insurance poorly utilize health facilities due to some persistent sociodemographic factors in Ghana. Low Facility-based delivery increases the risk of both maternal and child mortalities. Most of the recent studies conducted in Ghana have not determined the regional prevalence of Facility-based delivery and the health insurance subscription rates. This study estimated the prevalence of Facility-based delivery and assessed the associated factors that determine mothers' birthplace choice in Ghana. METHODS: The 2022 Ghana Demographic and Health Survey data were used in this cross-sectional study. Descriptive statistics for the variables were summarized using frequencies and percentages. The prevalence of facility-based delivery was determined by dividing all facility-based deliveries by total deliveries. Determinants of Facility-based delivery by women in Ghana were assessed in a multiple logistic regression model. RESULTS: Women with National Health Insurance were 93% more likely to have Facility-based delivery than those without National Health Insurance AOR = 1.93, 95% CI = 1.38-2.70. Women in rural areas were 55% less likely to have facility-based delivery AOR = 0.45, 95% CI = 0.32-0.62. Expectant mothers with secondary education were 91% more likely to give birth to their babies through a facility-based delivery compared to mothers with no formal education AOR = 1.91, 95% CI = 1.45-2.52. Women with a tertiary education had an increased odds of giving birth at health facilities compared to uneducated women AOR = 3.44, 95% CI = 1.13-10.76 Mothers who belong to other religions (traditionalists, etc.) were 72% AOR = 0.28, 95% CI = 0.17-0.46 less likely to be delivered in health facilities. Mothers from richer and richest families had an elevated odds of giving birth at health facilities compared to women from the poorest family AOR = 2.95, 95% CI = 1.61-5.42 and AOR = 2.96, 95% CI = 1.27-6.94 respectively. Mothers from the Southern zone of Ghana were less likely to give birth at health facilities AOR = 0.50, 95% CI = 0.31-0.79 compared to those from the Northern zone. Women who go for four or more ANC visits during pregnancy were 4.63 times more likely to give birth at a health facility compared to women who do not go for ANC visits during pregnancy AOR = 4.63, 95% CI = 2.45-8.76. CONCLUSION: The study revealed that facility-based delivery was influenced by health insurance, residence, education, religion, zone, wealth status and antenatal care visits. Health insurance should be further subsidized for rural and women from poorest families. ANC services should be extended to the doorsteps of rural women who are in communities far away from health facilities.