RESUMEN
This study aimed to investigate factors that influence antenatal care utilization and their association with adverse pregnancy outcomes [defined as low birth weight, stillbirth, preterm delivery or small for gestational age] among pregnant women in Kumasi. A quantitative cross-sectional study was conducted of 643 women aged 19-48 years who presented for delivery at selected public hospitals and private traditional birth attendants from July-November 2011. Participants' information and factors influencing antenatal attendance were collected using a structured questionnaire and antenatal records. Associations between these factors and adverse pregnancy outcomes were assessed using chi-square and logistic regression. Nineteen percent of the women experienced an adverse pregnancy outcome. For 49% of the women, cost influenced their antenatal attendance. Cost was associated with increased likelihood of a woman experiencing an adverse outcome [adjusted OR = 2.15; 95% Cl = 1.16-3.99; p = 0.016]. Also, women with >5 births had an increased likelihood of an adverse outcome compared with women with single deliveries [adjusted OR = 3.77; 95% Cl = 1.50-9.53; p = 0.005]. The prevalence of adverse outcomes was lower than previously reported [44.6 versus 19%]. Cost and distance were associated with adverse outcomes after adjusting for confounders. Cost and distance could be minimized through a wider application of the Ghana National Health Insurance Scheme