Concept
Use of maternal health services
5 studiesEvidence last moved Sep 24, 2026
Maternal health service use covers whether women receive contraception, antenatal care, skilled help at delivery and postnatal care, and how they experience the care they get. The evidence here comes from national surveys in Ethiopia and Nigeria, interviews with young Kenyan women, and Swedish and Canadian studies of birth experience and breastfeeding.
Effective obstetric care only helps women who reach it. These studies show that who gets care is patterned by education, wealth, place and beliefs, and that how birth goes (for example, emergency caesarean) shapes women's experience and early breastfeeding.
Studies
5
Findings
5
8 supporting · 0 challenging · 0 qualifying citations
Open tensions
2
Latest change
Concept page published
Use of maternal health services
Currently
What we know
- In these settings most women gave birth without skilled help.
- Social position strongly predicts who reaches care.
- Where a woman lives shapes access, not only who she is.
- Knowing a method exists is not the same as trusting or being able to use it.
- Complicated or emergency births leave women with poorer experiences and more early breastfeeding difficulty.
Largest unresolved question
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
Common misconceptions
Low use of maternal services is mainly because women don't know the services exist.
Kenyan women all knew of modern contraceptives but held fears about side effects and faced partner opposition, and survey data from Nigeria and Ethiopia point to education, wealth, residence and facility supply as major correlates.
Survey associations prove that attending antenatal care causes women to use skilled delivery.
Ethiopian women who had antenatal care had higher odds of skilled delivery (1.3) and postnatal care (3.4), but this is a cross-sectional survey, so women who seek one service may simply differ in ways that also lead them to seek others.
Related
Claim ledger
What the evidence shows
Drawn from 5 studies in this library. Mix labels say which citation roles are present; they are not a strength score. Supports means evidence for a finding; Challenges means evidence against a stated position; Qualifies marks scope.
In these settings most women gave birth without skilled help.
Coverage of maternal services was low in national survey data: in Ethiopia only 33.9% of women had skilled antenatal care, 11.7% gave birth in a facility and 9.3% had a postnatal check, while in Nigeria 60.3% had antenatal care and 43.4% had a skilled attendant at delivery.
- Who uses pregnancy and birth care in Ethiopia, and who doesn't?
- What stops Nigerian women from using maternity care?
Study Role Design N Population Outcome Who uses pregnancy and birth care in Ethiopia, and who doesn't? Supports Cross-sectionalSecondary analysis of the 2011 Ethiopian Demographic and Health Survey (stratified two-stage cluster sample) using weighted bivariate and multivariable logistic regression. N=7908 · 7,908 women aged 15-49 who had at least one birth in the five years before the survey; outcomes refer to the most recent pregnancy/birth. Women of reproductive age with a recent birth, sampled from all regions of Ethiopia (Somali region under-covered). Antenatal care from a skilled provider, delivery with a skilled attendant, and postnatal check-up within six weeks. What stops Nigerian women from using maternity care? Supports Cross-sectionalSecondary analysis of the 2005 Nigerian National HIV/AIDS and Reproductive Health Survey with multilevel logistic models (individual, household, community and state fixed effects plus state random effects). N=2148 · 2,148 women aged 15-49 who had a baby in the five years before the survey, drawn from 4,685 surveyed women in all 36 states; each outcome refers to the most recent birth. Women of reproductive age across Nigeria with a recent birth. Use of antenatal care, delivery assisted by a doctor, nurse or midwife, and postnatal care. Social position strongly predicts who reaches care.
In both cross-sectional surveys, women's education, household wealth and urban residence were associated with more use of care; in Nigeria women with post-secondary education had about five times the odds of antenatal care, and in Ethiopia urban women had about 4.9 times the odds of a skilled birth attendant.
- Who uses pregnancy and birth care in Ethiopia, and who doesn't?
- What stops Nigerian women from using maternity care?
Study Role Design N Population Outcome Who uses pregnancy and birth care in Ethiopia, and who doesn't? Supports Cross-sectionalSecondary analysis of the 2011 Ethiopian Demographic and Health Survey (stratified two-stage cluster sample) using weighted bivariate and multivariable logistic regression. N=7908 · 7,908 women aged 15-49 who had at least one birth in the five years before the survey; outcomes refer to the most recent pregnancy/birth. Women of reproductive age with a recent birth, sampled from all regions of Ethiopia (Somali region under-covered). Antenatal care from a skilled provider, delivery with a skilled attendant, and postnatal check-up within six weeks. What stops Nigerian women from using maternity care? Supports Cross-sectionalSecondary analysis of the 2005 Nigerian National HIV/AIDS and Reproductive Health Survey with multilevel logistic models (individual, household, community and state fixed effects plus state random effects). N=2148 · 2,148 women aged 15-49 who had a baby in the five years before the survey, drawn from 4,685 surveyed women in all 36 states; each outcome refers to the most recent birth. Women of reproductive age across Nigeria with a recent birth. Use of antenatal care, delivery assisted by a doctor, nurse or midwife, and postnatal care. Where a woman lives shapes access, not only who she is.
Beyond individual factors, place mattered: in Nigeria over a third of the variation in antenatal care use lay between states, and fewer primary care facilities per resident meant less care, with state differences remaining after adjustment.
Knowing a method exists is not the same as trusting or being able to use it.
In a qualitative study of 34 young, low-income Kenyan women, all had heard of modern contraceptives, but many believed they cause infertility or other harms, got their information mainly from peers and partners rather than health workers, and faced partner opposition.
Complicated or emergency births leave women with poorer experiences and more early breastfeeding difficulty.
How birth unfolds affects women's experience and early feeding: in 920 Swedish first-time mothers, operative births, oxytocin augmentation and long labours were linked to lower childbirth-experience scores, and in a Calgary cohort of 3,021 women almost 40% after emergency caesarean could not breastfeed on the first try versus about 25% after other births.
- Can a questionnaire capture how women experience childbirth?
- Does having a caesarean make breastfeeding harder or shorter?
Study Role Design N Population Outcome Can a questionnaire capture how women experience childbirth? Supports Cross-sectionalQuestionnaire development (literature, midwife input, interviews, pilot) followed by a one-month postpartum postal survey analysed with exploratory factor analysis, multitrait scaling and known-groups comparisons N=920 · 920 primiparous women returned evaluable questionnaires out of 1177 invited (78% response); 25 women took part in the face-validity pilot Healthy first-time mothers with spontaneous onset of active labour at term at two Swedish hospitals, 1998-2003 Factor structure, internal consistency and known-groups validity of the Childbirth Experience Questionnaire Does having a caesarean make breastfeeding harder or shorter? Supports CohortProspective community pregnancy cohort (All Our Babies, Calgary) with questionnaires in pregnancy and at 12-16 weeks postpartum; logistic regression of mode of birth on breastfeeding cessation. N=3021 · 3021 women with singleton births; 2954 of them initiated breastfeeding and form the denominator for breastfeeding-difficulty analyses. Pregnant women in urban Calgary, Canada, enrolled from 2008; mostly married, highly educated, Caucasian and Canadian-born. Self-reported breastfeeding intention, initiation, early success, difficulties, support use, and any breastfeeding beyond 12 weeks postpartum.
Debates
Tensions and limits
Some items are genuine disagreements on the same question. Others mark different assays, populations, or outcomes.
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
PaperFren reads this as a limit on how far one study travels — different assays, populations, or outcomes — not a forced fight between papers.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
- Who uses pregnancy and birth care in Ethiopia, and who doesn't?
- Can a questionnaire capture how women experience childbirth?
- Does having a caesarean make breastfeeding harder or shorter?
Study Role Design N Population Outcome Who uses pregnancy and birth care in Ethiopia, and who doesn't? Supports Cross-sectionalSecondary analysis of the 2011 Ethiopian Demographic and Health Survey (stratified two-stage cluster sample) using weighted bivariate and multivariable logistic regression. N=7908 · 7,908 women aged 15-49 who had at least one birth in the five years before the survey; outcomes refer to the most recent pregnancy/birth. Women of reproductive age with a recent birth, sampled from all regions of Ethiopia (Somali region under-covered). Antenatal care from a skilled provider, delivery with a skilled attendant, and postnatal check-up within six weeks. Can a questionnaire capture how women experience childbirth? Supports Cross-sectionalQuestionnaire development (literature, midwife input, interviews, pilot) followed by a one-month postpartum postal survey analysed with exploratory factor analysis, multitrait scaling and known-groups comparisons N=920 · 920 primiparous women returned evaluable questionnaires out of 1177 invited (78% response); 25 women took part in the face-validity pilot Healthy first-time mothers with spontaneous onset of active labour at term at two Swedish hospitals, 1998-2003 Factor structure, internal consistency and known-groups validity of the Childbirth Experience Questionnaire Does having a caesarean make breastfeeding harder or shorter? Supports CohortProspective community pregnancy cohort (All Our Babies, Calgary) with questionnaires in pregnancy and at 12-16 weeks postpartum; logistic regression of mode of birth on breastfeeding cessation. N=3021 · 3021 women with singleton births; 2954 of them initiated breastfeeding and form the denominator for breastfeeding-difficulty analyses. Pregnant women in urban Calgary, Canada, enrolled from 2008; mostly married, highly educated, Caucasian and Canadian-born. Self-reported breastfeeding intention, initiation, early success, difficulties, support use, and any breastfeeding beyond 12 weeks postpartum.
PaperFren reads this as a limit on how far one study travels — different assays, populations, or outcomes — not a forced fight between papers.
Timeline
How understanding moved
Study years are when the paper was published. Evidence edits are dated changes to this page's claims. Explanations are when PaperFren added a Discovery — not a claim that the science happened that day.
2026
Concept page published
Use of maternal health services
Change log
What changed
Dated edits to this page's evidence: studies added or removed from a claim, claims added or withdrawn, and new explanations tagged here. Rewordings are not listed.
- Concept page published
Papers
5 studies in this library bear on Use of maternal health services, ordered by citations.
- What stops Nigerian women from using maternity care?
Whether Nigerian women used maternity care depended not only on their own education and wealth but also on their community and the state they lived in.
- Does having a caesarean make breastfeeding harder or shorter?
Women who had a caesarean had more trouble breastfeeding, and after accounting for other factors those with a planned caesarean were more likely to stop breastfeeding by about three months.
- Who uses pregnancy and birth care in Ethiopia, and who doesn't?
Very few Ethiopian women used skilled pregnancy, birth or after-birth care, and those who did were mostly more educated, wealthier, urban women who had attended antenatal visits.
- Can a questionnaire capture how women experience childbirth?
A new 22-item questionnaire captured four distinct parts of the birth experience and scored lower, as expected, for women with long, augmented or operative births.
- Why don't young Kenyan women use modern contraception?
Young women in Kenya knew about modern contraceptives, but myths about infertility and side effects spread by friends, family and partners kept many from using them.
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Questions
What is still open
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
Ask PaperFren about Use of maternal health services
Study this conceptflashcards and short-answer questions
Describe the individual and area-level factors associated with maternal health service use in sub-Saharan Africa.
National surveys in Ethiopia and Nigeria found low coverage of antenatal, delivery and postnatal care. In both, education, wealth and urban residence predicted more use; in Ethiopia women's say over health spending and lower parity also mattered. A multilevel Nigerian analysis showed that over a third of variation in antenatal care lay between states, and fewer facilities per resident predicted less use. Both are cross-sectional, so they identify associations rather than causes.
How can mode of birth affect women's experience and breastfeeding?
A Swedish questionnaire study of 920 first-time mothers found lower childbirth-experience scores after operative births, oxytocin augmentation and long labours, with the largest effect on women's sense of their own capacity. A Calgary cohort found almost 40% of women could not breastfeed on the first try after emergency caesarean, compared with about 25% after other births. After adjustment, planned rather than emergency caesarean was linked to stopping breastfeeding by 12 weeks, partly because those mothers had given birth before. Confounding by parity shows why adjusted analyses matter.
Flashcards
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