Analysis of the 2003 Ghana Demographic and Health Survey shows that even though over 90% of pregnant women attend antenatal care in health institutions, only 43% deliver in the health institutions. The quality of antenatal care received is also lower than is expected for standard obstetric care. The national caesarean section rate of 3.7% reflects inadequate obstetric coverage. There is a need for continued education of health workers to improve the quality of antenatal care. The Ghanaian health system needs to consider how to improve obstetric coverage by skilled attendants and to study the reasons for inadequate use of delivery services in order to be able to achieve the target for maternal health set in the Millennium Development Goal