Women's Empowerment and Quality Antenatal Care in Ghana: Analysis of the SWPER Global Index in the Ghana Demographic Health Survey.

BackgroundWomens empowerment is a key determinant of maternal healthcare utilization, influencing antenatal care (ANC) quality in low- and middle-income countries (LMICs). While ANC is crucial for maternal and neonatal health outcomes, disparities persist in service uptake and quality in Ghana. This study examines the association between womens empowerment, measured using the Survey-based Womens emPowERment (SWPER) index, and the receipt of quality ANC in Ghana. MethodsA cross-sectional analysis was conducted using the 2022 Ghana Demographic and Health Survey (GDHS) data. The study included 8,715 women aged 15-49 who attended ANC during pregnancy. Quality ANC received four essential services: blood pressure monitoring, urine testing, iron supplementation, and blood sample collection. Womens empowerment was assessed across three SWPER domains: attitude toward violence, decision-making, and social independence, categorised into low, medium, and high levels. Logistic regression models examined the relationship between empowerment and quality ANC while adjusting for demographic and socioeconomic variables. ResultsThe study found that 95% of women received quality ANC services despite significant disparities across demographic and socioeconomic groups. Higher levels of womens empowerment were positively associated with quality ANC. Specifically, women with high empowerment in attitude toward violence (AOR: 1.92; 95% CI: 1.53 - 3.10), social independence (AOR: 1.82; 95% CI: 1.69 - 1.99), and decision-making (AOR: 1.31; 95% CI: 1.09 - 1.58) were significantly more likely to receive quality ANC than their low-empowerment counterparts. Other significant predictors of quality ANC included higher education, wealth index, older maternal age, urban residence, and media exposure. Women in rural areas and those in the Northern, Northeast, and Savannah regions were significantly less likely to receive quality ANC. ConclusionWomens empowerment is a key driver of quality ANC utilisation in Ghana. Strengthening empowerment initiatives such as increasing educational opportunities, enhancing economic autonomy, and promoting decision-making power can improve maternal health outcomes. Addressing regional disparities and integrating empowerment strategies into maternal health policies can enhance ANC quality and reduce maternal and neonatal mortality in Ghana.