Socio-demographic factors Influencing National Health Insurance Registration for Free Maternal Healthcare among Pregnant Women in a Rural District in Ghana

Access to maternal healthcare services is crucial in reducing maternal mortality rates, particularly in rural areas of developing countries like Ghana. The National Health Insurance Scheme (NHIS) in Ghana offers free maternal healthcare services to registered pregnant women, yet uptake remains low in rural districts. Understanding the socio-demographic factors influencing NHIS registration among pregnant women is essential for targeted interventions to improve maternal health outcomes. A cross-sectional study was conducted in Offinso North District of Ghana, involving 397 pregnant women accessing antenatal care NHIS registration status. Data were analyzed using descriptive statistics and logistic regression to determine factors associated with NHIS registration. The prevalence of National Health Insurance Scheme (NHIS) registration among the interviewed pregnant women was exceptionally high, reaching 98%, with approximately 87% maintaining active NHIS membership. The NHIS registration exhibited statistically significant associations with marital status (χ2=7.20; p=0.01). Moreover, the maintenance of active NHIS membership was significantly associated with various demographic factors, including age (χ2=5.00; p=0.03), educational level (χ2=8.77; p=0.00), marital status (χ2=5.38; p=0.02), and gestational age of pregnancy (χ2=5.84; p=0.02). Married respondents demonstrated a twofold likelihood of NHIS registration compared to their unmarried counterparts (AOR=2.05, [95%CI (1.53-39.69)], p=0.013). Conversely, respondents aged over 19 years were 0.5 times less likely to maintain active NHIS membership compared to teenage respondents (AOR=0.95, [95%CI (1.00-6.667)], p=0.050). Notably, respondents in their 35th week of pregnancy exhibited twice the likelihood of maintaining active NHIS membership compared to those with pregnancies below 35 weeks (AOR=2.08, [95%CI (1.03-61.80)], p=0.047). Socio-demographic factors such as age, education level, marital status, and gestational age of pregnancy significantly influenced active membership of the National Health Insurance for free maternal healthcare among pregnant women in rural Ghana. These findings underscore the importance of targeted interventions to address socio-demographic disparities and enhance NHIS registration among pregnant women, ultimately improving maternal and child health outcomes in rural Ghana.