Effect of a community‐based primary healthcare programme on adverse pregnancy outcomes in Northern Ghana

Background Pregnancy complications and adverse birth outcomes are among the major contributors to poor maternal and child health. Mothers in remote communities are at higher risk of adverse birth outcomes due to constraints in access to healthcare services. In Ghana, a community‐based primary healthcare programme called the Ghana Essential Health Interventions Programme (GEHIP) was implemented in a rural region to help strengthen primary healthcare delivery and improve maternal and child healthcare services delivery. This study assessed the effect of this programme on adverse pregnancy outcomes. Methods Baseline and end‐line survey data from reproductive‐aged women from the GEHIP project were used in this analysis. Difference‐in‐differences and logistic regressions were used to examine the impact and equity effect of GEHIP on adverse pregnancy outcomes using household wealth index and maternal educational attainment as equity measures. The analysis involves the comparison of project baseline and end‐line outcomes in intervention and non‐intervention districts. Results The intervention had a significant effect in the reduction of adverse pregnancy outcomes (OR = 0.96, 95% CI:0.93–0.99). Although disadvantaged groups experience larger reductions in adverse pregnancy outcomes, controlling for covariates, there was no statistically significant equity effect of GEHIP on adverse pregnancy outcomes using either the household wealth index (OR = 0.99, 95% CI:0.85–1.16) or maternal educational attainment (OR = 0.68, 95% CI: 0.44–1.07) as equity measures. Conclusion GEHIP's community‐based healthcare programme reduced adverse pregnancy outcomes but no effect on relative equity was established. Factoring in approaches for targeting disadvantaged populations in the implementation of community‐based health programs is crucial to ensuring equity in health outcomes. Highlights Community‐based healthcare programs can reduce adverse pregnancy outcomes (miscarriage and stillbirth) in rural poor settings. Community‐based health care programs have the potential to improve equity in adverse pregnancy outcomes in remote rural settings. Community‐based healthcare programs can play an important role in bringing socio‐economic and cultural factors that impact on adverse pregnancy outcomes in rural poor settings. Community‐based healthcare programme planners and implementers should factor in modalities for measuring and ensuring interventions do not widen equity gaps.