Ghana COUNTRY PROFILE

List of indicators
Proportion of births occurring in urban and rural areas Perinatal mortality rate by wealth quintile
Contiuum of care Neonatal and post neonatal mortality rate
Antenatal care Nutrition
Number of antenatal care visits Anaemia in pregnancy
Access to the contents of care Low Birth Weight
Skilled Birth Attendant at delivery Low Birth Weight
Utilization of services Tetanus toxoid vaccination
Utilization of services by subregion Initial breastfeeding
Utilization of services by subregion (map) Malaria in pregnancy
Utilization of services by wealth quintile Use of ITN
Place of delivery HIV in pregnancy
Place of delivery HIV counselling for pregnant women in ANC visits
Place of delivery by wealth quintile Fertility
Problems in accessing to health facilities Total fertility rate
C-section Teenage pregnancy
Utilization of services Teenage pregnancy
Utilization of services by subregion Teenage pregnancy by age
Utilization of services by subregion (map) Teenage pregnancy by subregion
Utilization of services by wealth quintile Family planning
Postnatal care visits and type of provider Contraceptive use
Perinatal mortality rate Contraceptive use by age
Total perinatal mortality rate Contraceptive use by subregion
Perinatal mortality rate by subregion

ANALYSIS OF DEMOGRAPHIC AND HEALTH SURVEYS

For data from the Demographic and Health Surveys, years refer to the years surveys were conducted. Estimates are based on
data referring to five years preceding the surveys.
Coverage of interventions (DHS Ghana, 1988 - 2008)

Proportion of births occurring in urban and rural areas

Among women who were interviewed,
approximately 62% of births occurred in rural
areas.
Estimated total number of births (in thousands):
765 (2008)
Urban
Rural 38% United Nations, Department of Economic and Social
62%
Affairs, Population Division, World Population
Prospects: The 2008 Revision, New York, 2009
(advanced Excel tables).
 Continuum of care
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Number of antenatal care (ANC) visits

100 91.9 95.4
2.3
1.9 87.5 3.7 The survey in 2008 showed that approximately
80 94% of women who with a live birth received ANC,
g birth

and 95% did so from a skilled provider.

% of women who gave

60
62.3 69.4
NB: Gap to 100% refers to the proportion of
78.2
women who did not go to ANC.
40

20
20.2
16.7
13.3
0 5.1 4 2.8
1998 2003 2008

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

DK/missing ANC by skilled provider

Access to contents of ANC

Informed signs of pregnancy
complication The reported contents of ANC are an important
100 indicator of ANC services received. Effectiveness
of ANC is determined not only by the type of
80
examination but also from the counselling and
60 information provided on danger signs associated
40 with pregnancy and childbirth.
Blood sample taken Weighed
20 In Ghana, majority of women had received basic
tests; weighed, blood sample, urine sample, blood
0
pressure. However, taking blood sample and urine
sample were less likelyto be performed among
poorest women.

Urine sample taken Blood pressure measured

Richest Poorest

Ghana COUNTRY PROFILE 2

 Skilled Birth Attendant (SBA) at birth


Three quarters of all maternal deaths occur

during birth and the immediate post-partum
 

 

 
period. One of the most critical interventions
% of births assisted by SBA


for safe motherhood is to ensure skilled

care provided by skilled professionals during
 
pregnancy and childbirth.


 
 


In Ghana, the latest survey in 2008 showed

that approximately 57% of births were assisted
 
 
by SBA. While 62% of births were reported to
occur in rural areas, less than half of births were

assisted by SBA in rural areas.



 










by region
According to the latest survey in 2008, the
utilization of SBA ranged from a high of 84%

in the Capital city to a low of 27% in the
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Northern areas.
% of births assisted by SBA

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by wealth quintile



Wom

Women’s wealth status is one of the determinants
of receiving
r skilled care.



In 22008, at national level, 57% of births received
% of births assisted by SBA


skilled assistance however births to women in the

skill
poorest quintile had approximately 3 times less
poo





access to skilled care compared to their richest
acce
counterparts. Substential increase in the SBA
cou

coverage was obsearved across all the wealth
cove

groups in the two surveys. However, coverage gap
grou



in aaccessing to skilled care by the poorest and the


richest remained wide.
rich



 

 

 
  




Ghana COUNTRY PROFILE 3

 Place of birth


PProper medical attention and hygienic conditions
dduring delivery can reduce the risk of complications
"
and infections that may cause deaths or serious
an
ilillillness
l to either the mother or the baby or both.
!
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AAccording to the latest survey in 2008, 57% of




bbirths took place in health facilities, and 42% were
% of births


ddelivered
e at own home or someone else’s home.













 

  




 

  

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by wealth quintile

100% 0.6
0.2 0.1
1 0.7 0
0.3 0.3
6.6 Approximately just more than half of births in
19.6 Ghana were delivered at health facility, mostly in
80% 36.5 21.2 the public sector. Proportion of home birth was
50.2 11.3 likely to be related to women’s socioeconomic
status. 76% of births to poorest women
% of births

60% 75.7
8.6 occurred at home as compared to7% of birth
7 to their richest counterparts. Use of private
40%
71.5
health facility was very low across all the
68.8
53.5
socioeconomic groups except the fact that 21%
20%
1.4 41.7 of richest women used private sector facilities
22.1
for giving births.
0%
Poorest Poorer Middle Richer Richest

Public health facility Private health facility Home Other Missing

Problems in accessing health facilities

Getting money for treatment 45.1
Women’s decision to seek medical advice or
treatment can be influenced by various factors.
Concern no drugs available 44.9 Information on such factors is particularly
important in understanding and addressing the
barriers women may face in seeking care during
Concern no provider available 43.5
pregnancy and at the time of birth.
Women in Ghana reported that the major problem
Distance to health facility 25.9
they face in accessing health care for themselves
was getting money for treatment (45%) and
Having to take transport 25 concerns that no drugs were available (45%),
followed by concerns that no providers were
available (44%) and the distance to health facility
Concern no female provider available 21.5
(26%).

Not wanting to go alone 18.4

Getting permission to go for treatment 7

0 20 40 60 80 100

Ghana COUNTRY PROFILE 4

 Caesarean section (C-section)



At nnat
national
atio
iona
ion l level, the latest data in 2008 indicated
that
tha 77%
hat % of births were delivered with C-section.
e tion
b C-section

Substantial
Subs
Su tantial difference in accessing the C-section
sta
C-sec

 

between
betw
be urban and rural areas were observed.
tween urb

 

by

 

 

delivered
% of births delivered

 

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by subregion
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% of births delivered by C-section

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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 highlights
substantial disparity across regions in accessing C-section.

by wealth quintile (2003)

100 95 By wealth quintile, a 8-fold difference was observed

90 between the women in the poorest and richest
% of births delivered by C-section

82
socioeconomic groups.
80
70 65
60
50 48
50
40
30 24
15 17
20
11 10
10
0
Poorest Poorer Middle Richer Richest

2003 2008

Ghana COUNTRY PROFILE 5

 Postnatal care visits for mothers
by place, by mode of births
It is critical for the postnatal check up to
100%
take place soon after the birth in order to
7.3 4 4 screen for conditions that may threaten
9
10 10.9 12.3 an infant’s survival.
o en
% of women

10.9
wom

80% 11.5 According to the survey in 2008, women

15.7 15.4
10.9 delivering in a health facility were
7.7 11.1 more than twice as likely to have had a
60%
postnatal check-up within the first two
4.2 days compared with women delivering
40% elsewhere.
46.5 56.2 61.3
40.1
24.3
20%

0%
Total Urban Rural Health facilities Elsewhere

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

by wealth quintile

100% 4.2 5.3

5.4
7.7
8
Women in the richest wealth quintile were
12.7
12.4 12.6 about twice as likely to have had an early
80% 11
17.2 postnatal check-up as women in the
% of women

9.7
11.1 8
18.6 poorest wealth quintile.
60%
4

40%
40.9 52.8 56.7 57.6
30.1
20%

0%
Poorest Poorer Middle Richer Richest

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

Postnatal care visits for mothers by type of provider

by place, by mode of births
In Ghana, 58% of mothers obtained
postnatal care from doctor/nurse/
100% 0.7
6.6 1.9
3.5 midwife, and the 80% of postnatal
1.2
14 2.8
19.4
care was provided in health
% of women

80% 2.5 facilities.

2.4
3.4 The likelihood of women receiving
2.2 34.6
60%
postnatal care from health
professionals declined with
87.2 socioeconomic status.
77.4
40% 57.8
44.6 3.4
0.8
20%
13.5

0%
Total Urban Rural Health facilities Elsewhere

Others Community health officer Auxiliary midwife Doctor/nurse/midwife

Ghana COUNTRY PROFILE 6

 by wealth quintile

100% 2.6
0.7
Women in the highest wealth
1.7
11.2 8.8 quintile were more than twice as
15.5 0.6
1.7
2.5 likely to receive postnatal care
2.4
80% 23.9 from a health professional as
2.2
3.7 those in the lowest wealth quintile.
60%
6.4
1.6 90.1
76.1
40% 61.2
46.7

27.4
20%

0%
Poorest Poorer Middle Richer Richest

Others Community health officer Auxiliary midwife Doctor/nurse/midwife

Perinatal mortality rate

Total perinatal mortality rate (2008)

30 Perinatal mortality rate consists of stillbirth rate

and early neonatal mortality rate. The survey in
25 2008 reported that perinatal mortality rate was 39
24 per 1000 pregnancies in total, showing a higher
per 1000 pregnancies

20 rate among women living in rural areas.

19
15
15 15
13
10 11
5 8
6
4
0
Total Urban Rural

ENMR SBR PMR

Neonatal (NN) and post-neonatal (PNN) mortality

40
T survey in 2008 reported that the neonatal
The
35 35 mortality rate was 30 and the post neonatal
m
mortality was 21 per 1000 live births. This
m
30 30 30 means that for every 1000 children born in
m
per 1000 live births

GGhana, 51 die before their first birthday; 30 of

25
ssuch deaths occur within the first months of life
22
20 21 21 aand the other 21, after the first months of life
bbut before reaching the exact age of 1 year.
15

10

0
1994-1998 1999-2003 2004-2008

NN PNN

Ghana COUNTRY PROFILE 7

 Nutrition
Anaemia in pregnancy (2008 )
According to the latest survey, 70% of pregnant
women were reported to be anaemic. Of those who
were anaemic, the majority were reported to suffer
from mild to moderate anaemia.










 

 
 

Low Birth Weight

The survey in 2008 indicated that, of those who


were weighed, 10% were reported to weigh less

than 2.5 kg at birth.
% of babies weighing less than 2.5kg














Tetanus Immunization
Neonatal tetanus is a leading cause of neonatal
100% 1.2 1 1.3 death in developing countries where a high
proportion of deliveries were conducted at home
or unhygienic environment.
80%
% of women

56.2 52.8 Tetanus toxoid immunization was given to pregnant

61.2
women to prevent neonatal tetanus. According to
60% the survey in 2008, more than half of women (56
percent) in Ghana received two or more tetanus
40% injections during pregnancy and that 72% of births
were protected against neonatal tetanus.
31.8
31.5
20% 31

11.1 14.1
6.7
0%
Total Urban Rural

DK/missing Two doses or more One dose None

Ghana COUNTRY PROFILE 8

 by wealth quintile

100% 1.2 1.9 0.7 0.8 1.2 Woom

Women
W m in richest wealth quintile were more
likely
ely to have received two or more tetanus
lilike
kely
toxoid
toxo
to xo injections than women in the poorst
80% wwealth
eal quintile.
49.8 51.4 51.4
% of women

65.7 65.4
60%

40%
31.3 32.8 36.1
20% 26.6 31.1
17.7 13.9 11.7 7 2.4
0%
Poorest Poorer Middle Richer Richest

DK/missing Two doses or more One dose None

Initial breastfeeding
by place, by sex of child, by mode of births
Early initiation of breastfeeding is
100 encouraged for a number of reasons.
It not only fosters bonding between
mother and newborn but also
80 stimulates breast milk production and
% of women

30.1 31.2
29.6 29.6 facilitates the release of oxytocin,
30.1 28.9
30.1 which helps the contraction of the
60
uterus and reduces post-partum
blood loss.
40 For last-born children ever breastfed,
56 56
52 percent started breastfeeding
52.3 55.4 52.2 52.5
50.2 within 1h of birth and 82 percent
20
started breastfeeding within the first
24h after birth.
0
Total Urban Rural Male Female Medically trained Health faclity

Started 2-23 hours Started within 1 hour

by wealth quintile

100
Initial breastfeeding had been
practiced at the same level across all
the wealth quintile (82-85%) except
% of women

80
29.4 28.3 women in the poorer household group
30.3
30.7 (75%).
60 30.1

40

52.6 57 57
51.2
45.6
20

0
Poorest Poorer Middle Richer Richest

Started 2-23 hours Started within 1 hour

Ghana COUNTRY PROFILE 9

 Malaria in pregnancy
(2008)
100
Among pregnant women, 32% reported
to have slept under a net and 20% slept
80 73.8 under an ITN the night before the interview.
In the same survey in 2008, a total of 74%
of pregnant women reported to have used
60
antimalarial drugs, and 41% received IPT
40.9 during ANC visit.
40
31.7

19.9
20

0
% of last births in the five years
preceding the survey for which the
mother took antimalarial drugs for
prevention during the pregnancy
% of last births in the five years % of pregnant women age 15-49 who % of pregnant women age 15-49 who
preceding the survey for which the slept under a mosquito net (treated or slept under insecticide-treated net
mother got intermittent preventive untreated) the night before the (ITN) the night before the interview
treatment (IPT) during an antenatal interview
visit.

HIV in pregnancy
HIV counselling and testing for pregnant women in ANC visits (2003)


50% of pregnant women aged 15–49
received HIV counselling during their ANC
%
visits. Of those women voluntarily tested
for HIV, 28% received results and 7% did
not receive result.
#

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24% were counselled and tested for HIV
and received their results.
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Fertility
Total fertility rate (TFR)

Total fertility rate consists of wanted total fertility

7
rate and unwanted total fertility rate. According
6 to the latest survey in 2008, the average women
Total fertility rate per woman

1.1
in Ghana would have approximately 4 children
5 by the end of her reproductive age. Of those,
1 according to the survey in 2008, approximately
4 0.8 0.7 4 were reported to be wanted fertility, reflecting
0.5
substantial demand for having children.
3
5.3
2 4.2
3.6 3.7
4
1

0
1988 1993 1998 2003 2008

Unwanted total fertility rate Wanted total fertility rate

Ghana COUNTRY PROFILE 10

 Teenage pregnancy
Teenage pregnancy


% of women aged 15-19 pregnant with their first child




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


 


 
 

 
 



 
 


 

 

 


 
 





 






















Teenage pregnancy by age



% of women aged 15-19 pregnant with their first child

Because the absolute number in each category is

very small, it may be difficult to interpret trends.

However, the latest survey in 2008 showed that

7% of women at the age of 19 were pregnant with


their first child.









































































At subregional level, fluctuating trend was

Teenage pregnancy by subregion observed in western, central and other areas.
According to the recent survey in 2008,
approximately 7% of women at the age of 15-19 in
% of women aged 15-19 pregnant with their first child

the Volta area were reported to be pregnant with

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their first child.
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Ghana COUNTRY PROFILE 11

 Family planning
Modern contraceptive use
% of currently married women using modern contraceptives


At national level, according to the latest

 
survey in 2008, 17% of currently married


women were using modern contraceptives.

 
 

 
 

 
 
 


 

 

 


 

 

 


 



 















Modern contraceptive use by age

% of currentlyy married women usingg modern contraceptives


According to the latest survey in 2008, the

p

highest use of modern contraceptive methods was


reported in women at the age of 20-24 (17%).









 
 













 

















































 




















Modern contraceptive use by subregions

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% of currentlyy married women usingg modern contraceptives

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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.

Ghana COUNTRY PROFILE 12

 References
Ghana Statistical Service (GSS), Ghana Health Service. Ghana Demographic and Health Survey 2008. Calverton, Maryland: GSS, NMIMR, and
ORC Macro.
Ghana Statistical Service (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Macro. 2004. Ghana Demographic and
Health Survey 2003. Calverton, Maryland: GSS, NMIMR, and ORC Macro.
Ghana Statistical Service (GSS) and Macro International Inc. (MI). 1999. Ghana Demographic and Health Survey 1998. Calverton, Maryland:
GSS and MI.

Ghana COUNTRY PROFILE 13