Maternal and Child Health Journal

, Volume 21, Issue 1, pp 85–95 | Cite as

Association of Household Savings and Expected Future Means with Delivery Using a Skilled Birth Attendant in Ghana and Nigeria: A Cross-Sectional Analysis

  • Larissa JenningsEmail author
  • Fan Yang
  • Easmon Otupiri
  • Ambrose Akinlo
  • Michael Okunlola
  • Michelle Hindin


Objectives This study examined the association between household savings and related economic measures with utilization of skilled birth attendants (SBAs) at last birth among women living in peri-urban households (n = 381) in Ghana and Nigeria. Methods Data were drawn from the 2011–2014 Family Health and Wealth Study. Multivariable logistic regression models were used to estimate the odds of delivery with an SBA for individual and composite measures of household savings, expected financial means, debt, lending, and receipt of financial assistance, adjusting for demographic and reproductive characteristics. Results Seventy-three percent (73 %) of women delivered with an SBA during their last birth (89 %, Ghana; 63 %, Nigeria), and roughly one third (34 %) of households reported having any in-cash or in-kind savings. In adjusted analyses, women living in households with savings were significantly more likely to deliver with an SBA compared to women in households without any savings (aOR = 2.02, 95 % CI 1.09–3.73). There was also a consistent downward trend, although non-significant, in SBA utilization with worsening financial expectations in the coming year (somewhat vs. much better: aOR = 0.70, 95 % CI 0.40–1.22 and no change/worse vs. much better: aOR = 0.46, 95 % CI 0.12–1.83). Findings were null for measures relating to debt, lending, and financial assistance. Conclusion Coupling birth preparedness and complication readiness strategies with savings-led initiatives may improve SBA utilization in conjunction with targeting non-economic barriers to skilled care use.


Skilled birth attendance Institutional delivery Birth preparedness Savings Economic Obstetric 



Adjusted odds ratio


Antenatal care


Birth preparedness and complication readiness


Confidence interval


Skilled birth attendant


Odds ratio



The authors wish to thank the Family Health and Wealth Study (FHWS) participants for making this research possible. We are also grateful for support from the Bill & Melinda Gates Foundation though the Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. The presented conclusions are those of the authors and do not necessarily reflect the views of the funding body.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Larissa Jennings
    • 1
    Email author
  • Fan Yang
    • 1
  • Easmon Otupiri
    • 2
  • Ambrose Akinlo
    • 3
    • 4
  • Michael Okunlola
    • 5
  • Michelle Hindin
    • 6
  1. 1.Program in Social and Behavioral Interventions, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
  3. 3.Department of Demography and Social Statistics, Faculty of Social SciencesObafemi Awolowo UniversityIfeNigeria
  4. 4.School of Research and Postgraduate Studies, Faculty of Human and Social SciencesNorth West University (Mafikeng Campus)MmabathoSouth Africa
  5. 5.Fertility Research and Endocrinology Unit, Department of Obstetrics and GynecologyUniversity College HospitalIbadanNigeria
  6. 6.Department of Population, Family, and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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