Association of National Health Insurance Scheme Card Validity and Socio-demographic Characteristics with Recommended Antenatal Care Contacts among Postpartum Women in Kassena-Nankana Municipality: A Facility-Based Cross-Sectional Study

Abstract Background Antenatal care is a key intervention for enhancing pregnancy outcomes as maternal health remains a public health concern in sub-Saharan Africa. Although Ghana’s National Health Insurance Scheme offers free maternal healthcare services to eliminate financial obstacles, ANC attendance in rural areas like Kassena-Nankana Municipal remains below ideal levels. This study assessed the association of national health insurance scheme card validity and socio-demographic characteristics with recommended antenatal care contacts among postpartum women in kassena-nankana municipality Methods The study employed a facility-based cross-sectional design among 290 postpartum women who had given birth in the previous 12 months prior to the study. A structured questionnaire was used to gather data with the aid of electronic kobo collect app. Descriptive statistics, Fisher’s exact tests, chi-square tests, and binary logistic regression were used to analyze the data using SPSS version 27. Results The study revealed that only 46.9% of women in Kassena-Nankana Municipal achieved the WHO-recommended minimum number of ANC visits (8 times or more). Even though almost all the participants (97.6%) possessed valid NHIS cards, having a valid card was associated (unadjusted) with completing the recommended visits (p = 0.016): NHIS validity, and all women with invalid cards failed to meet the required visits. After adjusting for confounders, wealth status and educational level emerged as the predictors of ANC completion. Women with no formal education were 96% lower odds of completing the recommended ANC visits compared to those with tertiary education [AOR = 0.04; 95% CI: 0.02–0.12, p = 0.001], while women from rich households were 3.72 times more likely to complete the recommended number of visits than those from poor households [AOR = 3.72; 95% CI: 3.05–5.14, p = 0.001] Conclusion Less than half of expectant mothers completed the WHO-recommended minimum of eight or more ANC visits. NHIS enrolment alone did not ensure optimal ANC attendance, as socio-demographic factors have a major impact on ANC attendance. Socio-economic barriers must be addressed with targeted interventions focusing on disadvantaged women to improve equitable access to maternal healthcare services in Ghana