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Abstract
Background: Despite historical urban advantages in maternal healthcare utilization, recent policy interventions in Ghana may have altered traditional patterns of institutional delivery disparities. This study sought to examine current patterns of institutional delivery between urban and rural women in Ghana using recent data and decompose the factors contributing to observed differences.
Methods: Using 2022 Ghana Demographic and Health Survey data, this study analysed institutional delivery patterns among 8,714 women of reproductive age (15-49 years) who had given birth within five years preceding the survey. The sample comprised 59.8% rural and 40.2% urban women. Oaxaca-Blinder decomposition analysis was employed to explain gaps in institutional delivery rates, using multiple decomposition methods to ensure robustness of findings.
Results: The analysis revealed a remarkable reversal of traditional patterns, with rural women demonstrating higher institutional delivery rates than urban women (58.4% vs 53.1%, p<0.001). The overall difference of 7.0 percentage points favoring rural areas was statistically significant across all decomposition methods. Key factors contributing to this gap included parity (number of children ever born), wealth distribution, and age categories. Near-universal National Health Insurance Scheme coverage was achieved (92.2% rural, 96.6% urban), reflecting successful health financing reforms.
Conclusion: Ghana has achieved a fundamental transformation in maternal healthcare equity, with rural women now outperforming urban women in institutional delivery utilization. This reversal of traditional urban-rural disparities demonstrates the effectiveness of sustained rural health system strengthening, infrastructure development, and health financing reforms. The findings provide evidence that comprehensive, equity-focused health policies can successfully eliminate and reverse historical healthcare disadvantages experienced by rural populations.