Free Maternal Health Insurance, Family Planning, and Child Feeding Practices in Ghana

Study Context

In many low- and middle-income countries, the high cost of healthcare prevents women from accessing essential maternal services. To address this, Ghana implemented a free maternal healthcare policy in 2008 under its National Health Insurance Scheme (NHIS), allowing pregnant women free access to comprehensive maternal and newborn care at accredited facilities. While the policy has been linked to declines in maternal and neonatal mortality, its broader impacts remain less understood. This study explored whether improved access to care through NHIS has influenced maternal health behaviors, such as child feeding practices and attitudes toward family planning, particularly in underserved regions of Ghana.

Study Design

Researchers applied Endogenous Switching Regression Model (ESR) using Ghana Demographic and Health Survey (DHS) data from 2008, 2014, and 2022 to estimate the policy’s impact on outcomes such as exclusive breastfeeding, dietary diversity for children aged 6 to 23 months, fertility preferences, and infant feeding practices. The team supplemented quantitative analysis with 72 key informant interviews—including beneficiaries, policymakers, and healthcare providers across Ghana’s northern, middle, and southern regions. The interviews generated qualitative data to better understand current practices and attitudes among beneficiaries of NHIS.

Results & Policy Lessons

Overall, the study found that the NHIS policy had mixed effects. It improved exclusive breastfeeding for some women: those with NHIS were 39% more likely to breastfeed exclusively, and uninsured women would have improved by 16% if they gained access. However, overall exclusive breastfeeding still dropped by about 4%, mainly because cultural beliefs, such as giving water or early foods, overpowered clinical advice. Dietary diversity improves under NHIS, consistent with interview evidence of greater exposure to nutrition advice, though economic constraints keep diets carbohydrate-heavy. Family planning attitudes show no improvement across both insured and uninsured women, as fertility desires and partner influence remain strong. These results suggest that while free maternal care increases access, it does not automatically change long-standing cultural norms around breastfeeding and fertility.