The University of Southampton
University of Southampton Institutional Repository

Geographical access to care at birth in Ghana: a barrier to safe motherhood

Gething, Peter W., Amoako Johnson, Fiifi, Frempong-Ainguah, Faustina, Nyakro, Philomena, Baschieri, Angela, Aboagye, Patrick, Falkingham, Jane, Matthews, Zoe and Atkinson, Peter M. (2012) Geographical access to care at birth in Ghana: a barrier to safe motherhood , Southampton, GB ESRC Centre for Population Change 34pp. (Centre for Population Change Working Paper, 21).

Record type: Monograph (Working Paper)


Background: appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa.

Methodology and findings: we assembled detailed spatial data on health facilities, roads, rivers, and other landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care at birth. We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from any facility likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios.

Conclusions and significance: detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve

PDF 2012_WP21_Geographical_Access_to_Care_at_Birth_in_Ghana_Gething_et_al.pdf - Other
Download (3MB)

More information

Published date: 1 April 2012
Keywords: obstetric care, maternal mortality, geographical access, geographic information systems, Ghana
Organisations: Social Statistics & Demography, Centre for Population Change


Local EPrints ID: 338983
ISSN: 2042-4116
PURE UUID: dff2e915-7c92-4bc1-a948-ac22326f7a8b

Catalogue record

Date deposited: 23 May 2012 09:12
Last modified: 18 Jul 2017 05:55

Export record


Author: Peter W. Gething
Author: Faustina Frempong-Ainguah
Author: Philomena Nyakro
Author: Angela Baschieri
Author: Patrick Aboagye
Author: Jane Falkingham
Author: Zoe Matthews

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.