Does women’s literacy affect maternal health services utilization in Ethiopia? A stratified analysis of 2019 mini Ethiopian Demographic and Health Survey

Abstract

Background Maternal mortality remains unacceptably high in sub-Saharan Africa with 533 maternal deaths per 100,000 live births, or 200,000 maternal deaths a year. This is over two-thirds (68%) of all maternal deaths per year worldwide. The lifetime risk of maternal death in low-income countries is 1 in 45. Most maternal deaths can be prevented if births are attended by skilled health personnel. Therefore, the current study examined the utilization of maternal health services among women in different sociodemographic statuses within different literacy strata in Ethiopia. Methods A total weighted sample of 3,839 women who gave birth within five years preceding the survey and whose literacy status was measured in the survey were included in this study. The dataset from the most recent Ethiopia Mini Demographic and Health Surveys (EMDHS) 2019 was used for this study. The EMDHS was a community-based cross-sectional study conducted in Ethiopia from March 21 to June 28, 2019. The survey used a two-stage stratified cluster sampling technique. Bivariate and multivariable logistic regression analyses were employed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported and statistical significance was set at a p-value < 0.05. Results In this study, nearly two-thirds (63.8%) of reproductive-age women were illiterate. The overall prevalence of ANC 1, ANC 4, skilled birth attendance, and postnatal care utilization was 74.9%, 43.5%, 51.9%, and 32.0%, respectively. Our analysis also revealed that literate women are more likely to receive ANC 1 (literate vs illiterate, 87.9% vs 67.5%), ANC 4 (59.4% vs 34.5%), skilled birth attendance (73.3% vs 39.7%), and PNC (51.2% vs 21.1) as compared to their illiterate counterparts (p < 0.001). Regional variation, wealth status, age at first birth, birth order, and birth intervals were found significant factors associated with maternal health care service utilization among both literate and illiterate reproductive-age women in Ethiopia. Similar to this, ANC booking timing and utilization, age of household head, and religious affiliation were associated with institutional delivery and PNC utilization. Conclusion Women’s literacy is an important associate for utilizing appropriate maternal healthcare, with other sociodemographic and obstetric related factors as modifying factors. Hence, wholehearted efforts should be directed toward educating and empowering women. On the other hand, literacy levels and other modifying factors should be considered when designing interventions that enhance maternal health care service utilization. For instance, such programs need to stratify the interventions according to the literacy level of the women.

Maternal health literacy and adherence to recommended ANC contact among pregnant women in Indonesian

“…7,23 Researchers have linked MHL to the utilization of maternal healthcare services. 8,10,24 MHL has been associated with the timing and frequency of ANC and some positive behaviours in pregnancy. [25][26][27] Inadequate MHL results in an inability to locate and understand the appropriate timing of the first ANC contact, which may negatively impact maternal and child health.…”

“…11 Pregnant women with a higher level of MHL can turn back the challenges they faced in deciding to make an ANC contact into an opportunity they have to maintain their health and their babies. 10,27 Pregnancy is a vulnerable condition requiring attention and support from healthcare providers, people around pregnant women, and significant others. 9,30 The pregnant women in this study exposed some supporting factors in routine ANC contacts, such as self-motivation, support from spouses and family members, and continuous support from cadres or community health volunteers.…”

“…MHL equips pregnant women to seek timely Antenatal care (ANC) as an element of maternal healthcare services for early detection and prevention of pregnancy complications. [8][9][10] ANC enables pregnant women to receive a broad range of medical services. 11 ANC should begin early in pregnancy, as it is critical to the continuum of care to ensure continuity of care for mothers, newborns, and children.…”

“…[16][17][18] Increasing MHL is essential to improve maternal healthcare services utilization, maternal health, and pregnancy outcomes. 7,10,19 Therefore, this study assessed MHL and adherence to recommended ANC contact. In addition, this study explored pregnant women's experiences in Indonesia accessing ANC during their pregnancy period.…”