Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis

Samuel H. Masters, Roy Burstein, George Amofah, Patrick Abaogye, Santosh Kumar and Michael Hanlon
Authors registered in the RePEc Author Service: Santosh Kumar Gautam

Social Science & Medicine, 2013, vol. 93, issue C, 147-154

Abstract: Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions.

Keywords: Travel-time; Geographic information systems (GIS); Maternity care; Health service utilization; Ghana; In-facility delivery; Antenatal care; Access (search for similar items in EconPapers)
Date: 2013
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (13)

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DOI: 10.1016/j.socscimed.2013.06.012

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