Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

Abstract

BackgroundAntenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia.MethodsData were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis.ResultsThirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people.ConclusionMaternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.

Facility-Based Delivery Service Utilisation Among Women of Childbearing Age in Nguti Health District, Cameroon: Prevalence and Predictors

“…In this study, participants' socio-demographic characteristics did not accurately distinguish women who deliver in health facility and those who did not. While women's level of utilisation of health facilities during delivery in this study is above average (68.7%), it contradicts what other studies elsewhere have stated that facility-based delivery service utilisation is still very low in most under developed countries [11,22,23] this high facility utilization rate does not explain or affect the still very high maternal mortality of over 800 per 100.000 pregnant women in Cameroon. We found no studies done in Cameroon on health facility delivery service utilisation before this one but a high level (95.9%) of non-health facility utilisation during delivery has been reported in a study done in Ethiopia [3].…”

Antenatal Care Service Utilization and its Associated Factors among Mothers who Gave Live Birth in the Past One Year in Womberma Woreda, North West Ethiopia

“…This finding was supported by another study where women's autonomy on health care spending was found to have a significant association with the utilization of antenatal care services [30]. Women's decision making power can have a significant effect on their ability to seek healthcare and/or even delay in accessing and receiving the services where they are readily available [31].…”

“…Similarly, women who had a job were more likely to use the ANC services [30]. Women who are employed and working earned money, they might have a better understanding of the ANC and thus they can have the economic ability to pay for the service.…”

Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde

“…Anversa et al 32 também identificaram um baixo percentual de adequação (59%) do pré-natal no município de Santa Maria (RS), quando avaliados o início do pré-natal antes de 20 semanas e o número mínimo de seis consultas. Baixa adequação da cobertura pré-natal também foi identificada na literatura internacional 20,33 . Destaca-se que, nos estudos citados, realizou-se pesquisa documental a partir dos registros em prontuário e cartão da gestante, enquanto no presente estudo, que apontou conformidade para esses dois critérios em 100% dos casos, avaliou-se a percepção dos gestores sobre a adequação.…”