Does antenatal care utilisation vary in urban and rural health facilities in Ghana? A comparative cross-sectional study

Abstract Background Despite improvements in access to maternal services in Ghana, evidence on urban-rural differences in antenatal care (ANC) utilization remains limited. This study compared ANC utilisation among postpartum women attending urban and rural health facilities in the Bono Region of Ghana. Methods A facility-based comparative cross-sectional design was conducted among 722 postpartum women, using a multistage stratified sampling technique. Data were collected with a pretested structured questionnaire. Sociodemographic characteristics and ANC utilization indicators such as first booking, number of ANC visits, and adequacy of care were collected. Analyses were analysed using Jamovi version 2.4.1. Pearson’s chi square tests assessed urban-rural differences, while Mantel–Haenszel stratified analysis assessed the associations between sociodemographic factors and antenatal care utilisation, controlling for urban-rural health facilities. Statistical significance was set at P < 0.005. Results Most participants in urban 347 (96.1%) and rural 321 (88.9%) facilities were aged ≥ 20 years with significant differences in age distribution (χ² =13.5, P = 0.001). Educational level, marital status, and occupation also differed significantly between urban-rural (P < 0.005). However, no significant urban-rural differences were observed in timing of first booking, antenatal care utilisation, ANC adequacy and number of ANC of visits (P > 0.05). In stratified analysis, marital status was independently associated with adequate ANC utilization. Married women had higher odds of adequate utilisation compared with unmarried women (MH OR = 2.06; 95% CI: 1.21–3.51; P  = 0.007). Conclusion In conclusion, marital status was associated with ANC utilization, thus social support for unmarried pregnant women should be encouraged.