Background Characteristics Of Respondents
This section covers the socio-demographics of the respondents namely; age, residence, region, education, wealth status, marital status, occupation, parity and ethnicity as captured in the GDHS. The age of the respondents ranges from 15–49 years. The mean age of the respondents was 27 years in 1988 and 30 years in 2014. Table 3 shows that respondents were mainly aged 25–29 years. For example, in 1988, about 27 percent of the women were in the 25–29 age group and about 24 percent in 2014.
The majority of the respondents were from the rural areas, thus, about 72 percent in 1988 and a little above half (54 percent) in 2014.The level of education of the respondents varied. For instance, the majority of respondents had primary education in 1988 and 1993 whereas the highest proportions had secondary education in 1998, 2008 and 2014. In 2003, the highest proportion (39 percent) had no education.
With regards to the wealth status of the respondents, the proportion ranges from about 14 percent to about 25 percent (see Table 1). For example, in 2008, about 15 percent were in the richest wealth quintile while about 23 percent were in the poorest wealth quintile. The majority of respondents were married in all the years under review, even though there were variations in the percentages. For example, about 82 percent in 1988 and about 62 percent in 2014. There was sharp increment among those in cohabitation from 6 percent in 1988 to 22 percent in 2014. The highest proportion of respondents were from the Ashanti Region with the lowest proportion in the Upper West Region.
For instance, in 2014, about 18 percent were from the Ashanti Region while 3 percent were from the Upper West Region. Respondents from the Akan ethnic group dominated in all the years under review. For example, 51 percent were from the Akan ethnic group in 1988 and 47 percent in 2014.The occupational status under the years of review was mixed. For instance, in 1988, about 46 percent of the sampled women were not working whereas, in 1998, 2008 and 2014, women who were into sales had the highest proportions, thus, 34 percent, 36 percent and 38 percent respectively. Table 1 indicates that the highest proportion of the respondents had four births or more. For example, about 49 percent of the respondents had four birth or more in 1988 and about 39 percent of the respondents had four births or more in 2014.
Table 1
Background Characteristics
Variables
|
1988
n = 2703
|
1993
n = 1951
|
Year
1998
n = 2371
|
2003
n = 2777
|
2008
n = 2147
|
2014
n = 4285
|
Age
|
|
|
|
|
|
|
15–19
|
5.99
|
7.38
|
4.62
|
4.45
|
4.77
|
4.44
|
20–24
|
22.12
|
23.01
|
22.37
|
19.19
|
19.28
|
16.98
|
25–29
|
26.49
|
25.99
|
26.12
|
24.62
|
26.31
|
24.18
|
30–34
|
19.50
|
22.45
|
18.52
|
21.73
|
20.49
|
23.43
|
35–39
|
14.72
|
12.71
|
15.77
|
16.62
|
17.18
|
18.81
|
40–44
|
7.25
|
6.46
|
9.24
|
8.97
|
8.26
|
9.24
|
45–49
|
3.92
|
2.00
|
3.35
|
4.41
|
3.71
|
2.93
|
Residence
|
|
|
|
|
|
|
Rural
|
71.66
|
71.30
|
73.94
|
64.24
|
59.79
|
53.87
|
Urban
|
28.34
|
28.70
|
26.06
|
35.76
|
40.21
|
46.13
|
Education
|
|
|
|
|
|
|
No Education
|
44.06
|
40.03
|
36.54
|
38.74
|
30.80
|
26.07
|
Primary
|
50.68
|
54.18
|
20.28
|
22.26
|
24.35
|
19.60
|
Secondary
|
4.62
|
5.02
|
42.13
|
37.85
|
42.50
|
49.70
|
Higher
|
0.63
|
0.77
|
1.05
|
1.15
|
2.35
|
4.63
|
Wealth Status
|
|
|
|
|
|
|
Poorest
|
-
|
17.48
|
13.51
|
24.51
|
22.85
|
21.03
|
Poorer
|
-
|
15.94
|
19.68
|
21.05
|
21.97
|
20.29
|
Middle
|
-
|
18.45
|
23.81
|
20.18
|
19.07
|
19.98
|
Richer
|
-
|
23.68
|
23.23
|
17.91
|
20.79
|
19.57
|
Richest
|
-
|
24.45
|
19.76
|
16.36
|
15.32
|
19.13
|
Marital Status
|
|
|
|
|
|
|
Married
|
82.17
|
76.17
|
71.61
|
79.39
|
68.13
|
61.62
|
Never Married
|
2.92
|
2.36
|
2.41
|
3.71
|
6.13
|
9.48
|
Widowed
|
1.15
|
0.56
|
1.07
|
1.36
|
1.26
|
1.52
|
Divorced
|
7.66
|
5.74
|
8.90
|
5.89
|
5.08
|
5.82
|
Cohabitation
|
6.10
|
15.17
|
16.00
|
9.65
|
19.40
|
21.56
|
Region
|
|
|
|
|
|
|
Western
|
8.99
|
8.71
|
12.50
|
9.30
|
9.02
|
10.34
|
Central
|
11.02
|
10.51
|
11.14
|
7.98
|
9.52
|
10.94
|
Greater Accra
|
10.40
|
9.17
|
10.99
|
11.45
|
12.49
|
16.31
|
Volta
|
11.36
|
10.10
|
11.14
|
8.33
|
8.62
|
7.63
|
Eastern
|
15.21
|
11.28
|
13.74
|
10.06
|
8.83
|
9.41
|
Ashanti
|
16.72
|
18.04
|
16.14
|
19.16
|
18.85
|
17.76
|
Brong Ahafo
|
12.50
|
9.53
|
8.22
|
11.22
|
10.38
|
9.06
|
Northern
|
13.80
|
11.9
|
6.52
|
13.08
|
13.88
|
11.61
|
Upper East
|
-
|
7.12
|
6.66
|
3.15
|
5.65
|
4.30
|
Upper West
|
-
|
3.59
|
2.95
|
6.26
|
2.75
|
2.65
|
Ethnicity
|
|
|
|
|
|
|
Akan
|
51.50
|
16.40
|
16.11
|
47.20
|
46.51
|
47.37
|
Ga- Adangbe
|
8.29
|
3.23
|
3.94
|
7.53
|
5.01
|
6.42
|
Ewe
|
15.24
|
12.10
|
13.98
|
11.96
|
12.89
|
13.24
|
Guan
Mole-Dagbani
Grussi
Gruma
Mande
|
2.07
13.17
-
-
-
|
16.76
6.82
13.53
2.82
17.73
|
18.37
7.60
14.29
1.51
8.16
|
2.44
16.46
3.03
3.49
0.88
|
2.88
20.19
3.05
4.86
0.89
|
1.93
17.30
2.97
7.70
1.18
|
Others
|
9.73
|
10.61
|
16.04
|
7.01
|
3.72
|
1.88
|
Occupation
|
|
|
|
|
|
|
Not working
|
45.62
|
20.03
|
13.76
|
11.91
|
10.85
|
17.47
|
Managerial
|
2.66
|
1.59
|
1.34
|
1.60
|
2.06
|
4.55
|
Clerical
|
0.78
|
0.82
|
0.34
|
0.55
|
0.95
|
0.53
|
Sales
|
28.34
|
20.54
|
33.86
|
26.80
|
35.88
|
37.88
|
Agricultural
|
11.06
|
41.60
|
33.09
|
40.46
|
33.47
|
25.14
|
Services
|
1.37
|
2.11
|
4.48
|
4.74
|
7.96
|
1.67
|
Manual
|
10.17
|
13.30
|
13.13
|
13.94
|
8.83
|
12.77
|
Parity
|
|
|
|
|
|
|
One birth
|
18.94
|
20.30
|
22.23
|
21.35
|
22.27
|
22.78
|
Two births
|
17.20
|
20.25
|
20.28
|
19.29
|
20.78
|
20.24
|
Three births
|
15.39
|
16.15
|
14.42
|
16.25
|
16.65
|
17.86
|
Four or more births
|
48.46
|
43.31
|
43.07
|
43.10
|
40.31
|
39.11
|
Source: Computed from GDHS 1988, 1993, 1998, 2003, 2008 and 2014 |
Trends of Assisted Birth Delivery from 1988–2014
The majority of the respondents over the years were assisted by nurses during birth delivery. The proportion of respondents assisted by nurses during birth delivery increased from about 35 percent in 1988 to about 66 percent in 2014 (see Fig. 1). The proportion of women who were assisted by traditional birth attendants during delivery reduced from about 28 percent in 1988 to about 15 percent in 2014. Similarly, respondents who were not assisted by anyone during birth delivery were decreased by half from about 6 percent in 1988 to about 3 percent in 2014.
Logistic regression on assisted birth delivery
Women age 45–49 years had a higher likelihood (OR = 4.33, CI = 2.05, 9.15) of being assisted by a doctor during delivery compared to those age 15–19 years’. Also, women with secondary (OR = 1.78, CI = 1.34, 2.37) and higher (OR = 4.54, CI = 2.44, 8.46) education had a higher odd of being assisted by a doctor during delivery compared to those with no formal education (see Table 2). Women from rural areas (OR = 0.50, CI = 0.40, 0.63), who have had four or more births (OR = 0.37, CI = 0.27, 0.52) and with having agriculture (OR = 0.63, CI = 0.45, 0.88) as their occupation have a lesser likelihood of being assisted by a doctor during delivery compared to those from urban areas, with one birth and those who are not working respectively (see Table 2).
It was also observed that women age 35–39 years (OR = 2.26, CI = 1.64, 3.10), with secondary (OR = 1.68, CI = 1.44, 1.96), higher (OR = 4.54, CI = 2.44, 8.46) education and those with clerical (OR = 2.44, CI = 1.16, 5.11) occupation had a higher odd of being assisted by a nurse during delivery compared to those aged 15–19 years, with no formal education and those who are not working (see Table 2). Also, women with richest wealth status were seen to have a higher likelihood (OR = 1.72, CI = 1.42, 2.09) of being assisted by a nurse compared to those with poorest wealth status. The findings also showed that women from rural areas (OR = 0.33, CI = 0.29, 0.38), with four and more births (OR = 0.46, CI = 0.37, 0.56) and those from mole Dagbani ethic group (OR = 0.68, CI = 0.56, 0.83) had a lesser odd of being assisted by a nurse compared to those from urban areas, with one birth and those from Akan ethnic group (see Table 2).
Findings from the study also showed that women aged 20–24 years (OR = 0.64, CI = 0.47, 0.89), with higher education (OR = 0.18, CI = 0.04, 0.78), and richest wealth status (OR = 0.47, CI = 0.37, 0.06) had a lesser likelihood of utilizing the service of a traditional birth attendant during delivery compared to those aged 15–19 years, no formal education and those with poorest wealth status. Also women from the rural areas (OR = 2.71, CI = 2.26, 3.26) had a higher odd of being assisted by a traditional birth attendant during delivery compared to those from the urban areas. Women with four or more births are more likely (OR = 1.30, CI = 1.00, 1.60) to utilize the services of a traditional birth attendants during delivery compare to who have one birth (see Table 2).
Table 2
Logistic regression on assisted birth delivery
Variables
|
Doctors
|
Nurses
|
TBA
|
Odds Ratio (Confidence interval)
|
Odds Ratio (Confidence interval)
|
Odds Ratio (Confidence interval)
|
Age
|
|
|
|
15–19
|
Ref
|
Ref
|
Ref
|
20–24
|
1.38 (0.85–2.24)
|
1.26* (0.98–1.63)
|
0.90 (0.67–1.20)
|
25–29
|
1.19** (1.16–3.15)
|
1.62 ** (1.23–2.14)
|
0.64** (0.47–0.89)
|
30–34
|
2.64*** (1.54–4.52)
|
2.08*** (1.54–2.81)
|
0.58** (0.41–0.83)
|
35–39
|
3.66*** (2.08–6.46)
|
2.26*** (1.64–3.10)
|
0.62** (0.43–0.89)
|
40–44
|
4.33*** (2.34–8.01)
|
2.13*** (1.50–3.03)
|
0.64** (0.43–0.94)
|
45–49
|
4.33*** (2.05–9.15)
|
2.08*** (1.38–3.13)
|
0.56** (0.36–0.87)
|
Marital status
|
|
|
|
Never married
|
Ref
|
Ref
|
Ref
|
Married
|
1.06 (0.68–1.65)
|
0.88 (0.66–1.18)
|
1.50* (1.00–2.25)
|
Cohabitation
|
0.78 (0.49–1.25)
|
0.85 (0.63–1.15)
|
1.31 (0.86–2.00)
|
Widowed
|
0.54 (0.17–1.69)
|
0.97 (0.55–1.72)
|
1.26 (0.63–2.51)
|
Divorced
|
0.96 (0.56–1.63)
|
0.60 (0.51–1.00)
|
1.76** (1.12–2.76)
|
Education
|
|
|
|
No education
|
Ref
|
Ref
|
Ref
|
Primary
|
1.23 (0.92–1.65)
|
1.12 (0.97–1.30)
|
0.77** (0.66–0.90)
|
Secondary
|
1.78*** (1.34–2.37)
|
1.68*** (1.44–1.96)
|
0.58*** (0.48–0.70)
|
Higher
|
4.54*** (2.44–8.46)
|
1.90** (1.10–3.28)
|
0.18** (0.04–0.79)
|
Occupation
|
|
|
|
No occupation
|
Ref
|
Ref
|
Ref
|
Managerial
|
0.45** (0.23–0.89)
|
1.50* (0.94–2.42)
|
0.65 (0.28–1.51)
|
Clerical
|
2.08** (1.07–4.05)
|
2.44** (1.16–5.11)
|
0.58 (0.14–2.52)
|
Sales
|
1.11 (0.84–1.45)
|
1.37*** (1.15–1.63)
|
0.72** (0.58–0.89)
|
Agricultural
|
0.63** (0.45–0.88)
|
0.80** (0.67–0.96)
|
1.06 (0.87–1.29)
|
Services
|
1.14 (0.78–1.67)
|
1.67*** (1.28–2.16)
|
0.60** (0.41–0.89)
|
Manual
|
0.98 (0.71–1.36)
|
1.15 (0.95–1.41)
|
1.03 (0.81–1.30)
|
Ethnicity
|
|
|
|
Akan
|
Ref
|
Ref
|
Ref
|
Ga/dangme
|
1.19 (0.83–1.70)
|
0.88 (0.68–1.12)
|
0.82 (0.60–1.11)
|
Ewe
|
1.03 (0.77–1.38)
|
0.71*** (0.59–0.86)
|
0.66*** (0.53–0.83)
|
Guan
|
0.93 (0.66–1.31)
|
0.54*** (0.44–0.65)
|
0.30*** (0.23–0.39)
|
Mole Dagbani
|
0.99 (0.71–1.38)
|
0.68*** (0.56–0.83)
|
0.63*** (0.50–0.80)
|
Grussi
|
0.98 (0.67–1.43)
|
0.54*** (0.43–0.67)
|
0.61*** (0.46–0.79)
|
Gruma
|
0.90 (0.43–1.86)
|
0.54** (0.38–0.76)
|
0.76* (0.56–1.03)
|
Mande
|
0.80 (0.47–1.37)
|
0.26*** (0.20–0.35)
|
1.24 (0.94–0.63)
|
Other
|
0.95 (0.32–2.80)
|
0.45** (0.24–0.85)
|
1.04 (0.55–1.97)
|
Region
|
|
|
|
Western
|
Ref
|
Ref
|
Ref
|
Central
|
0.92 (0.59–1.43)
|
0.70** (0.55–0.89)
|
1.30** (1.00–1.69)
|
Greater Accra
|
2.20*** (1.53–3.16)
|
1.07 (0.84–1.36)
|
0.76 (0.53–1.09)
|
Volta
|
1.11 (0.71–1.74)
|
1.32** (1.02–1.70)
|
0.97 (0.72–1.31)
|
Eastern
|
0.88 (0.58–1.33)
|
0.95 (0.75–1.19)
|
1.21 (0.93–1.58)
|
Ashanti
|
1.62** (1.14–2.31)
|
1.21* (0.98–1.49)
|
0.57*** (0.44–0.73)
|
Brong Ahafo
|
0.96 (0.63–1.46)
|
2.05*** (1.63–2.58)
|
0.69** (0.53–0.91)
|
Northern
|
0.44** (0.25–0.80)
|
0.83 (0.63–1.09)
|
1.95*** (1.49–2.57)
|
Upper East
|
0.37** (0.17–0.81)
|
1.88*** (1.38–2.56)
|
0.72** (0.51–1.00)
|
Upper West
|
0.75 (0.41–1.38)
|
1.62** (1.20–2.19)
|
0.53*** (0.38–0.73)
|
Wealth Status
|
|
|
|
Poorest
|
Ref
|
Ref
|
Ref
|
Poorer
|
0.99 (0.71–1.39)
|
1.23** (1.04–1.45)
|
0.87 (0.74–1.03)
|
Middle
|
0.95 (0.68–1.33)
|
1.43*** (1.21–1.70)
|
0.83** (0.69–0.99)
|
Richer
|
1.02 (0.74–1.43)
|
1.70*** (1.43–2.04)
|
0.69*** (0.56–0.84)
|
Richest
|
1.18 (0.84–1.66)
|
1.72*** (1.42–2.09)
|
0.47*** (0.37–0.60)
|
Residence
|
|
|
|
Urban
|
Ref
|
Ref
|
Ref
|
Rural
|
0.50*** (0.40–0.63)
|
0.33*** (0.29–0.38)
|
2.71*** (2.26–3.26)
|
Parity
|
|
|
|
One birth
|
Ref
|
Ref
|
Ref
|
Two births
|
0.65** (0.51–0.85)
|
0.64*** (0.54–0.76)
|
1.15 (0.93–1.42)
|
Three births
|
0.47*** (0.34–0.64)
|
0.54*** (0.44–0.66)
|
1.36** (1.07–1.73)
|
Four or more births
|
0.37*** (0.27–0.52)
|
0.46*** (0.37–0.56)
|
1.30** (1.00–1.66)
|
Pseudo R2
|
0.1508
|
0.1730
|
0.1192
|
Prob > X2
|
0.0000
|
0.0000
|
0.0000
|
Ref = Reference category *p < 0.05 **p < 0.01 ***p < 0.001 |