The Effects of Antenatal Care Utilization on Birthweight: Evidence from Ghana

In 2015, about 20.5 million babies were born with low birthweight (LBW), with the majority from low- and middle-income countries. The use of antenatal care (ANC) is a recommended health policy measure to reduce the risk of LBW. However, there is limited evidence for its effectiveness in reducing LBW in sub-Saharan Africa, although the region accounts for almost one-quarter of LBW babies, second only to Asia. Moreover, while the number of LBW in other regions is reducing, the number of LBW babies in sub-Saharan Africa is increasing. We therefore use data from Ghana (a sub-Saharan African country with a high incidence rate of LBW) to investigate the effect of using ANC on birthweight. The number of ANC visits and the month of ANC initiation were used as indicators for ANC utilisation. We applied an extended linear regression technique to deal with the potential sample selection bias and endogeneity associated with the use of ANC. The results from the study indicate that early ANC initiation and having more ANC visits are both associated with an increase in birthweight; however, the estimated effect of an early ANC visit is larger than having an additional visit. Therefore, we recommend that policies aimed at tackling the problem of LBW should mostly be geared towards promoting ANC utilisation, especially early ANC initiation. We also find that estimating the effect of ANC on birthweight without accounting for sample selection bias and endogeneity of ANC underestimates the effect of ANC on birthweight.