Determinants of Inclusive Pathways to Skilled Deliveries for Women with Disabilities in Rural Northern Ghana

Abstract

Background: Women with disabilities in Ghana, particularly in the Northern Region, experience multiple forms of discrimination that limit their access to maternal healthcare services. Although Ghana has made progress toward universal health coverage, equitable access to skilled delivery services remains a significant challenge for this population. Objective: This study explored the barriers and facilitators influencing the utilization of skilled delivery services among women with disabilities in rural Northern Ghana to inform policies and interventions aimed at promoting equitable maternal healthcare. Methods: A mixed-methods study design was employed. Quantitative data were collected from 350 women with disabilities, while qualitative data were obtained through interviews with women with disabilities, family members, healthcare workers, and community health volunteers. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression, whereas qualitative data were analyzed thematically. Results: Overall,  27.4% of participants utilized skilled delivery services. Utilization was significantly lower among women with physical disabilities (22.7%) than among those with sensory (31.6%) and cognitive disabilities (29.4%) (p < 0.01). Distance to a health facility was a significant determinant of skilled delivery utilization (χ² = 15.62, p < 0.001); women residing more than 5 km from a health facility were 2.8 times more likely to deliver at home (OR = 2.8, 95% CI: 1.7–4.6). Educational attainment was also significantly associated with skilled delivery utilization (χ² = 12.44, p = 0.002), with women without formal education being less likely to access skilled delivery services. Qualitative findings identified transportation challenges (71%), inaccessible health infrastructure (68%), and stigma and discrimination (63%) as the major barriers to accessing skilled delivery care. Conclusion: Utilization of skilled delivery services among women with disabilities in rural Northern Ghana remains low due to intersecting socioeconomic, geographical, and health system barriers. Promoting equitable maternal healthcare requires disability-inclusive policies, improved physical accessibility of health facilities, strengthened community support and volunteer networks, accessible transportation, and targeted interventions to reduce stigma and discrimination.

Keywords: Women, disability; Skilled delivery; Maternal health; Rural Ghana; Health system responsiveness; Disability inclusion