{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:55:16Z","timestamp":1783011316386,"version":"3.54.6"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Stillbirth and perinatal mortality issues continue to receive inadequate policy attention in Ghana despite government efforts maternal health care policy intervention over the years. The development has raised concerns as to whether Ghana can achieve the World Health Organization target of 12 per 1000 live births by the year 2030.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Purpose<\/jats:title><jats:p>In this study, we compared stillbirth and perinatal mortality between two groups of women who registered and benefitted from Ghana\u2019s \u2018free\u2019 maternal health care policy and those who did not. We further explored the contextual factors of utilization of maternal health care under the \u2018free\u2019 policy to find explanation to the quantitative findings.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Methods<\/jats:title><jats:p>The study adopted a mixed method approach, first using two rounds of Ghana Demographic and Health Survey data sets, 2008 and 2014 as baseline and end line respectively. We constructed outcome variables of stillbirth and perinatal mortality from the under 5 mortality variables (n = 487). We then analyzed for association using multiple logistics regression and checked for sensitivity and over dispersion using Poisson and negative binomial regression models, while adjusting for confounding. We also conducted 23 in-depth interviews and 8 focus group discussions for doctors, midwives and pregnant women and analyzed the contents of the transcripts thematically with verbatim quotes.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Results<\/jats:title><jats:p>Stillbirth rate increased in 2014 by 2 per 1000 live births. On the other hand, perinatal mortality rate declined within the same period by 4 per 1000 live births. Newborns were 1.64 times more likely to be stillborn; aOR: 1.64; 95% [CI: 1.02, 2.65] and 2.04 times more likely to die before their 6<jats:sup>th<\/jats:sup>day of life; aOR: 2.04; 95% [CI: 1.28, 3.25] among the \u2018free\u2019 maternal health care policy group, compared to the no \u2018free\u2019 maternal health care policy group, and the differences were statistically significant, p&lt; 0.041; p&lt; 0.003, respectively. Routine medicines such as folic acid and multi-vitamins were intermittently in short supply forcing private purchase by pregnant women to augment their routine requirement. Also, pregnant women in labor took in local concoction as oxytocin, ostensibly to fast track the labor process and inadvertently leading to complications of uterine rapture thus, increasing the risk of stillbirths.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Conclusion<\/jats:title><jats:p>Even though perinatal mortality rate declined overall in 2014, the proportion of stillbirth and perinatal death is declining slowly despite the \u2018free\u2019 policy intervention. Shortage of medicine commodities, inadequate monitoring of labor process coupled with pregnant women intake of traditional herbs, perhaps explains the current rate of stillbirth and perinatal death.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0274573","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T19:05:35Z","timestamp":1664478335000},"page":"e0274573","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Evaluating the impact of maternal health care policy on stillbirth and perinatal mortality in Ghana; a mixed method approach using two rounds of Ghana demographic and health survey data sets and qualitative design technique"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7167-8175","authenticated-orcid":true,"given":"John","family":"Azaare","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Akweongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve Cecilia","family":"Aryeteey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duah","family":"Dwomoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"issue":"49","key":"pone.0274573.ref001","doi-asserted-by":"crossref","first-page":"6057","DOI":"10.1016\/j.vaccine.2016.03.044","article-title":"Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data \u0b1d","volume":"34","author":"F Tavares","year":"2016","journal-title":"Vaccine"},{"issue":"3","key":"pone.0274573.ref002","first-page":"176","article-title":"Seminars in Fetal & Neonatal Medicine Classi fi cation of causes and associated conditions for stillbirths and neonatal deaths The International Stillbirth Alliance Collaborative for Improving Classi fi cation of Perinatal","volume":"22","author":"V Flenady","year":"2017","journal-title":"Semin Fetal Neonatal Med"},{"issue":"4","key":"pone.0274573.ref003","doi-asserted-by":"crossref","first-page":"e503","DOI":"10.1016\/S2214-109X(18)30541-2","article-title":"Causes of stillbirths among women from South Africa: a prospective, observational study","volume":"7","author":"SA Madhi","year":"2019","journal-title":"Lancet Glob Heal"},{"key":"pone.0274573.ref004","article-title":"A Neglected Tragedy: The global burden of stillbirths","author":"World Health Organization UNICEF","year":"2020","journal-title":"New York"},{"key":"pone.0274573.ref005","article-title":"Ending preventable stillbirths 5 Stillbirths: ending preventable deaths by 2030","volume":"387","author":"Bernis L De","year":"2016","journal-title":"Lancet"},{"key":"pone.0274573.ref006","article-title":"countries?","volume":"12","author":"E Heen","year":"2022","journal-title":"Do we need a new global policy for ending preventable perinatal deaths in fragile low-income"},{"key":"pone.0274573.ref007","first-page":"587","article-title":"Ending preventable stillbirths 2 Stillbirths: rates, risk factors, and acceleration towards 2030","author":"JE Lawn","year":"2015","journal-title":"Lancet"},{"issue":"1","key":"pone.0274573.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/srep46681","article-title":"Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979\u20132010","volume":"7","author":"MK Sugai","year":"2017","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0274573.ref009","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ogrm.2015.11.003","article-title":"Maternal mortality in the UK: an update","volume":"26","author":"B. 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