Barriers in physical access to maternal health services in rural Ethiopia

Abstract

BackgroundIdentifying women with poor access to health services may inform strategies for improving maternal and child health outcomes. The aim of this study was to explore risk factors associated with access to health facilities (in terms of physical distance) among women of reproductive age (15–49 years) in Dabat district, a rural area of north-western Ethiopia.MethodsA randomly selected cross sectional survey of 1,456 rural households was conducted. Data were collected during home visits. Data on household assets and socio-demographic data (including age, education level, occupation, religion and ethnicity) were collected on 1,420 women. A geographic information system (GIS) was used to map locations of all households, the district health centre and the smaller health posts. Travel time from households to health facilities was estimated, incorporating information on the topography and terrain of the area. The primary outcomes were: 1) travel time from household to nearest health post 2) travel time from household to health centre. Analysis was conducted using multiple linear regression models and likelihood ratio tests.ResultsThis study found evidence that educated women lived closer to health centres than uneducated women (adjusted mean difference (adj MD) travel time −41 min (95 % CI: −50,–31)) in this community. Woman’s age was also associated with distance to the health centre. Women aged 15–20 years were more likely to live in a poor access area compared with women aged 21–30 years (adj MD travel time −11 min (95 % CI: −23, 0)), and with women aged 31–49 years (adj MD travel time −32 min (95 % CI: −47,-17)). There was no evidence to suggest that travel time to the health centre was associated with household wealth.ConclusionsOur main aim was to address the almost total lack of research evidence on what socio-demographic characteristics of women of reproductive age influence access to health facilities (in terms of physical distance). We have done so by reporting that our study found an association that women with no education and women who are younger live, on average, further away from a health facility in this rural Ethiopian community. While we have generated this valuable information to those who are responsible for providing maternal and child health services locally, to fully understand access in health care and to promote equitable access to health care, our study could thus be extended to other components of access and explore how our findings fit into the wider context of other factors influencing maternal health outcomes and utilisation of maternal health services such as antenatal care or delivery at health facility.

Factors Associated with Maternal and Child Health Services Uptake and Their Association with Health Outcomes in Mashonaland East, Zimbabwe

“…These results slightly differ with what Okwaraji and others found in Ethiopia where educated women lived closer to health centers than uneducated women (Adjusted mean difference travel time -41 min 95% CI -50;-31). Women aged 15-20 years were more likely to live in poor access areas compared with women aged 21-30 years (adjusted mean difference travel -11 min 95% CI -23-0) [3]. One would expect the association between maternal age and complications to be significant since there is biological plausibility to that effect.…”

“…High maternal education and early care seeking, utilization of orthodox health facilities and drug use at home age <1 year were associated with early care seeking outside home and utilization of orthodox health services (p<0.001) [3]. Logistic regression showed that high maternal education and high family socio-economic status were strong predictors of early care seeking and care seeking outside home, maternal age, maternal education and family socio-economic status are predictors of appropriate health care-seeking behaviors for children [3].…”

Factors associated with perceived barriers of health care access among reproductive-age women in Ethiopia: a Secondary data analysis of 2016 Ethiopian Demographic and Health Survey

“…Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing the disease, reducing unnecessary disability and premature death, and achieving health equity for all women [7][8][9][10]. It agreed that socio-demographic, cultural, and geographical and literacy level and economic conditions plays a vital role to affect the accessibility and utilization of health care services among women [11][12][13][14][15]. Reproductive, maternal, newborn and child health are indictors of equity in health care access in the country [16][17][18][19][20].…”

Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian Demographic and Health Survey

“…It is known that literacy levels, economic conditions, socio-demographic and cultural characteristics, and geographical disparities play a vital role in affecting the accessibility and utilization of health care services among women [16][17][18][19][20]. Troubles conditions in accessing health care among reproductive-age women lead to diverse adverse health outcomes like unwanted pregnancies, unsafe abortion, maternal and child mortality resulting from low family planning uptakes, and home deliveries [7,9,14,15,21].…”