Background: Pregnancy complications and adverse birth outcomes are among the major contributors to poor maternal and child health. Mothers in remote communities are at higher risk of adverse birth outcomes due to constraints in access to maternal healthcare services. In Ghana, a community-based primary healthcare program called the Ghana Essential Health Interventions Program (GEHIP) was implemented in a rural region to help strengthen primary healthcare delivery and improve maternal and child healthcare services delivery. This study assessed the effect of this program on adverse birth outcomes. Methods: Secondary household survey data from reproductive-aged women from the GEHIP project were used in this analysis. Difference-in-differences regression and logistic regression were used to examine the effect of GEHIP on adverse birth outcomes and equity in the distribution of adverse birth outcomes using household wealth index and maternal educational attainment as equity measures. The analysis involves the comparison of project baseline and end-line outcomes in intervention and non-intervention districts. Results: The intervention had a significant effect in the reduction of adverse pregnancy outcomes (DiD=-0.043; p-value=0.010). Although disadvantaged groups experience larger reductions in adverse pregnancy outcomes, controlling for covariates, there was no statistically significant equity effect of GEHIP on adverse pregnancy outcomes using either the household wealth index or maternal educational attainment as equity measures. Conclusion: GEHIP’s community-based healthcare program reduced adverse birth outcomes but no effect on relative equity was established. Factoring in approaches for targeting disadvantaged populations in the implementation of community-based health programs is crucial to ensuring equity in health outcomes.