Few decades ago, maternal health outcomes in Ghana were a dire concern. In 1990, the country’s maternal mortality ratio (MMR) stood around an alarming 760 deaths per 100,000 live births. This placed Ghana among the high-mortality countries as it embarked on the Millennium Development Goals era. Through the 1990s and 2000s, concerted efforts were made to improve maternal care. Ghana was an early adopter of initiatives like the Safe Motherhood Program and set ambitious targets under MDG 5 (which aimed for a 75% reduction in maternal deaths by 2015). While Ghana ultimately fell short of that target, it did make significant progress: the MMR declined from 740 per 100,000 in 1990 to about 350 by 2010 . By 2015, Ghana’s MMR was roughly 319 per 100,000, signifying a marked improvement, though still unacceptably high.
Several policy interventions contributed to these early gains. Community-level initiatives like the CHPS (Community-based Health Planning and Services) program expanded access in rural areas, and skilled birth attendance rose from 41% in 1988 to 78% by 2008. Ghana pioneered a Free Maternal Healthcare Policy in 2008 including removing user fees for prenatal care and deliveries in public facilities aimed to reduce financial barriers to care and increase access. Studies show this policy has increased health facility utilization for childbirth, though out-of-pocket costs have not been eliminated (some women still pay for drugs or transport). Nonetheless, it was a pivotal step toward equitable access.
Perhaps one of the most important policy measures has been the establishment of systems to track and respond to maternal deaths. In 2014, Ghana officially adopted the Maternal Death Surveillance and Response (MDSR) system. Under MDSR, every maternal death in a health facility is supposed to be reported within 24 hours, reviewed by a district committee, and followed up with actions to fix any problems identified (whether clinical or systemic). This policy has elevated accountability such that no maternal death goes unexamined and is in line with global best practices. The Ministry of Health also began publishing annual reports on maternal health indicators and instituted scorecards for regions to foster competition in improving maternal outcomes.
Today, Ghana’s maternal health indicators show both how far the country has come and how much remains to be done. The maternal mortality ratio has plateaued in recent years. The most recent Ghana Population and Housing Census (2021) found an MMR of 301 per 100,000, almost the same as the 310 per 100,000 measured in the 2017 Maternal Health Survey.This minimal change over several years reflects a concerning stagnation, with maternal deaths remaining persistently high despite earlier gains.
For every woman who dies, many more suffer serious complications (“maternal near-misses”). Hospital studies in Ghana show that for each maternal death, roughly a dozen women survive severe life-threatening complications. Common emergencies include hemorrhage (severe bleeding), hypertensive disorders like preeclampsia, and infections. Indeed, the profile of causes of maternal death in Ghana appears to be shifting. Hypertensive disorders of pregnancy (e.g., eclampsia) have now overtaken hemorrhage as a leading cause of maternal death, accounting for an estimated 18% of maternal deaths in Ghana. This suggests some improvement in managing bleeding (thanks to better blood supply and uterotonics) but a need for stronger focus on blood pressure monitoring and treating preeclampsia. Maternal morbidity including conditions such as obstetric fistula and severe anemia also remain a concern.
Ghana faces persistent challenges in reducing maternal mortality and improving pregnancy outcomes. Foremost among these is the stagnation in progress – cutting maternal deaths has proven harder in the last mile. Many of the “easier” gains (like increasing basic maternity service coverage) have been achieved, and what remains are more systemic issues. One major challenge is the quality of care in health facilities. While almost 9 in 10 births occur with a skilled attendant, not all facilities can manage obstetric emergencies effectively. Some health centers lack the capacity to perform lifesaving procedures like c-sections or blood transfusions, leading to delays when complications arise. If a rural clinic must refer a hemorrhaging mother to a distant district hospital, precious time is lost. Delays in reaching care are still reported. For instance, transportation in rural areas or on bad roads can be a hurdle, despite ambulances (which themselves are few relative to need and sometimes lack fuel or staff). Additionally, shortages of critical supplies can occur: essential medicines (like magnesium sulfate for eclampsia or oxytocin for bleeding) and safe blood are not always available where needed. These supply-chain and resource issues disproportionately affect rural and remote facilities, contributing to the urban-rural outcome gap. Another challenge lies in the health workforce distribution and morale. Many remote communities lack experienced staff, and high workloads, burnout, and limited incentives discourage service in these regions. Additionally, the growing migration of healthcare professionals abroad further strains maternity care capacity.
Financing constraints continue to loom large. The reality is that Ghana’s health sector funding, while improved, remains below international benchmarks. In the 2025 budget, health received 6.32% of the national budget, which is a modest increase but still less than half of the 15% Abuja target pledged by African governments. This means that critical programs (including maternal health initiatives) compete for limited public funds. Moreover, the composition of spending is a concern: an overwhelming share goes to recurrent costs like salaries. In 2024, for example, nearly 98.6% of the government health budget was spent on personnel emoluments, leaving under 1.5% for goods, services, and investments. For 2025, the projection is similar – over 96% for salaries – which implies that essential items (medications, equipment, facility upgrades) may rely heavily on donor funds or internally generated funds from facilities. Indeed, it is estimated that 75% of health service goods and services in 2025 will be financed by patients’ out-of-pocket payments (often through facility charges or informal fees), with the government directly covering less than 10%. This heavy reliance on out-of-pocket financing undermines equitable care and can deter poor women from seeking timely care, despite the official free maternal care policy.
Ghana’s Maternal Death Surveillance and Response (MDSR) system has improved accountability within health facilities, prompting corrective actions. However, many maternal deaths outside facilities go unreported, leading to undercounting and missed opportunities for prevention. Incomplete data and a focus on in-facility deaths limit the system’s effectiveness. Strengthening community-level reporting through local volunteers and leaders, alongside better use of the civil registration system, is key to capturing the full scope of maternal mortality.
Despite these hurdles, there are significant opportunities and reasons for optimism. First, the high coverage of maternal health services (antenatal, skilled delivery, etc.) means Ghana has a solid platform to build quality improvements. Unlike some countries that still struggle to get women into clinics, Ghana can focus on what happens at clinics. This is arguably a more manageable problem of upgrading care protocols, training, and equipment-solvable with political will and resources. Second, the National Ambulance Service was expanded in 2019 with one ambulance per constituency which has improved the referral transport for obstetric emergencies in many areas. Ghana is also a leader in using technology for health since 2019. Medical drone delivery services (in partnership with Zipline) have been transporting blood and critical medicines to remote clinics. This innovation has significantly improved the management of postpartum hemorrhage and has enabled rural clinics to receive critical blood supplies much faster than traditional road transport would allow. Public-private partnerships and community-driven solutions continue to play a role. For example, the Ghana Red Cross and other NGOs train community volunteers as part of “mother-to-mother” support groups, who educate pregnant women on danger signs and the importance of delivering in facilities. Telemedicine initiatives, which have been piloted in Ghana’s Upper East Region, allow specialists to guide rural midwives through complications via phone or video and improving care in places lacking on-site doctors. The country’s strong mobile phone penetration can be leveraged for maternal health education (SMS reminders for antenatal visits, toll-free hotlines for obstetric advice, etc.).
Recent policy attention has further zeroed in on women’s health and rights. The 2025 national budget explicitly acknowledged issues affecting women and girls and introduced initiatives with potential indirect benefits for maternal health. For instance, the government announced funding for free sanitary pads for schoolgirls, which, while aimed at menstrual hygiene and keeping girls in school, also signals a commitment to women’s well-being. Staying in school longer is linked to later motherhood and improved maternal health outcomes. Additionally, Ghana has uncapped the National Health Insurance Levy (NHIL) in 2025, meaning more tax funds (about GH¢9.93 billion) will flow into the NHIS to pay for claims, essential medicines, and vaccines. This is intended to shore up the health financing needed to sustain free services and even cover a new “Free Maternal and Child Healthcare” trust, which is under consideration. If these funds are efficiently used to procure supplies and strengthen services, the quality of maternal care could improve. The challenge will be ensuring the money is actually released and spent on the intended interventions.
Finally, Ghana’s educated youth and active media landscape present a powerful platform for advancing maternal health. Public awareness is rising, with communities engaging in local solutions like emergency transport and blood donation schemes. Success stories, such as Agogo Hospital’s zero maternal deaths in 2023, highlight that with training, outreach, and collaboration, meaningful progress is achievable and scalable. All these policy measures, from high-level financing shifts to on-the-ground community programs, form a web of interventions for saving mothers’ lives Building on these efforts, the following recommendations outline practical steps Ghana can take to accelerate progress and reduce maternal mortality nationwide.
Boost Health Financing and Equity: Ghana must increase investment in maternal health and ensure funds reach the frontline. This means continuing to raise the health sector budget toward the Abuja target of 15% of total spending (from the current 6.3%) and ring-fencing adequate resources for maternal and neonatal care. Crucially, the government should allocate more money for medical supplies, infrastructure maintenance, and ambulances. Fully implementing the uncapped NHIL so that the promised GH¢9.93 billion flows into NHIS and is used for patient care is vital. Improve Quality of Care: The Ministry of Health and Ghana Health Service should accelerate efforts to ensure Comprehensive Emergency Obstetric and Newborn Care (CEmONC) is available in every district. This means obstetric units should be equipped and staffed to perform C-sections, manage hemorrhages (with a reliable blood bank or supply), treat eclampsia, and prevent infections. Investments in training are needed such as expanding simulation-based emergency obstetric training for perinatal care providers. Regular drills for handling obstetric emergencies (like “fire drills” for postpartum hemorrhage or neonatal resuscitation) can be mandated. Moreover, clinical mentorship programs can be expanded, where experienced obstetricians and midwives travel to peripheral facilities to coach local staff. Enhance Rural Access and Referral Systems: Ghana’s referral transport system for maternal care needs urgent improvement. This includes better funding and distribution of ambulances. Community-driven solutions like motorcycle or tractor ambulances for off-road communities can fill gaps. The drone delivery system should be scaled up to include critical maternal health supplies like oxytocin, sutures, and IV fluid so that no remote clinic runs out of stock during an emergency. A national tele-obstetrics program could also enhance care by enabling specialists to support remote providers in real time Enhance Data and Accountability: Strengthening the MDSR system, capturing community-level deaths, and using data to guide interventions and public accountability will improve transparency and responsiveness. Empower Women and Communities: Education, access to family planning, respectful maternity care, and community engagement especially involving men and traditional leaders are key to shifting behaviors and improving maternal outcomes.
Ghana has made notable progress in maternal health over the decades, saving thousands of lives through expanded access and targeted policies. However, recent stagnation and ongoing maternal deaths highlight that critical work remains. With maternal health now a national priority in the 2025 budget, the focus must shift to implementation. Ensuring quality care, reaching rural communities, and empowering women are essential. With collective commitment, Ghana can build on its gains and make safe childbirth a reality for all women.
Written by: Ruth Appiah-Kubi
For: Ghanaian Scholars Abroad
