Beyond coverage: A dual‐standard cascade and latent class analysis of maternal healthcare continuity in Ghana—Identifying who gets left behind and why

Abstract Background Ghana's maternal care cascade shows persistently low full completion. The legacy antenatal care (ANC) 4+ visit standard might inflate coverage estimates. Methods We analyzed data from 6965 women in the 2022 Ghana Demographic and Health Survey. A dual‐standard cascade (ANC 4+ vs. ANC 8+), skilled birth attendance, and postnatal care were constructed. Latent class analysis identified care‐seeking typologies; multivariable logistic regression identified predictors of full cascade completion. Results Full cascade completion fell from 56.0% (ANC 4+) to 23.8% (ANC 8+). Four typologies were identified: Comprehensive Care Users (44.7%), Delivery‐Focused Users (18.0%), ANC‐Engaged/Delivery‐Disengaged (9.1%), and Minimal Care Users (28.3%). ANC quality score was the strongest predictor (odds ratio [OR] = 2.20, P <  0.001), followed by health insurance (OR = 1.97) and secondary education (OR = 1.55). Conclusion Applying the ANC 8+ standard reveals a larger coverage deficit than legacy metrics acknowledge. ANC quality is the dominant driver of care continuity and should be prioritized in Ghana's maternal health programming.