Correlates of self-reported pregnancy complications: a cross-sectional study in two districts in Northern Ghana

Maternal health remains a critical indicator of health system performance globally, yet its outcomes remain suboptimal in low-resource settings. In Ghana, pregnancy complications contribute to over 12% of maternal deaths among women aged 15–49 years and are a key driver of maternal morbidity. This study examined the health system and socio-demographic correlates of self-reported pregnancy complications in two rural districts in Ghana. A cross-sectional quantitative study was conducted among 274 women aged 15–49 years in the Wa West and Mamprugu Moagduri districts of Ghana. Data were collected via structured interviewer-administered questionnaires and analysed using STATA 17. Binary logistic regression was applied, with statistical significance set at p < 0.05 and 95% confidence intervals to determine associated factors of self-reported pregnancy complications. Overall, 38.7% of the respondents reported experiencing at least one pregnancy complication during their last birth. Stillbirth (63.2%) and miscarriage (26.4%) were the most reported pregnancy complications. Sub-district variations showed sharp differences within and across districts on pregnancy-related complications. Statistically significant socio-demographic correlates of pregnancy complications included being married (AoR = 0.16; 95% CI: 0.04–0.65), primiparous (AoR = 4.26; 95% CI:1.14–15.89), multiparity (AoR = 9.94; 95% CI: 2.80–35.3), higher income (AoR = 2.84; 95% CI: 1.49–5.41) and limited decision-making autonomy (AoR = 1.82; 95% CI: 1.37–3.99). Early antenatal care (ANC) initiation (AoR = 2.86; 95% CI: 1.08–7.54), and long distance to health facility (AoR = 2.12; 95% CI: 1.13–3.99) were associated with higher pregnancy complications, but facility-based pregnancy confirmation (AoR = 0.26, 95% CI: 0.12–0.59) was associated with lower reports of pregnancy complications. The high burden of self-reported pregnancy complications underscores systemic gaps in service delivery, workforce distribution, and governance. Geographic disparities reflect systemic inequities in resource allocation and supervision. Strengthening ANC outreach, empowering women through gender-responsive governance, and leveraging digital health innovations for early detection and referral coordination are essential to improving maternal outcomes and Ghana’s progress toward SDG 3.1. Not applicable.