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.
Source
Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey
Study at a glance
- Design
- Cross-sectional — Secondary analysis of the 2011 Ethiopian Demographic and Health Survey (stratified two-stage cluster sample) using weighted bivariate and multivariable logistic regression.
- N
- 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.
- Population
- Women of reproductive age with a recent birth, sampled from all regions of Ethiopia (Somali region under-covered).
- Outcome
- Antenatal care from a skilled provider, delivery with a skilled attendant, and postnatal check-up within six weeks.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The researchers analysed the 2011 Ethiopian Demographic and Health Survey, a nationally representative household survey, focusing on 7,908 women who had given birth in the previous five years. They measured whether the woman's last pregnancy included antenatal care from a doctor, nurse or midwife, whether the birth was attended by such a professional, and whether she had a postnatal check. Guided by Andersen's behavioural model and the three-delays model, they used weighted logistic regression to relate these outcomes to socio-cultural, perceived-need and access factors.
What they found
Only 33.9% had antenatal care from a skilled provider, 19.1% had four or more visits, 11.7% gave birth in a health facility and 9.3% had a postnatal check within six weeks. Urban women were far more likely to have a skilled birth attendant (adjusted odds ratio 4.9), and higher education of both women and husbands, greater household wealth, lower parity and women's say over health spending were linked to more use. Attending antenatal care was associated with higher odds of skilled delivery (1.3) and especially of postnatal care (3.4). Maternal age and whether the pregnancy was wanted showed no independent association.
The limits
What it doesn't show
The survey is cross-sectional, so these are associations, not causes, and the factors themselves are closely intertwined (for example education, wealth and urban living). Women recalled events up to five years earlier, and the survey collected nothing on facility availability or quality, so the 'third delay' (inadequate care at facilities) could not be studied. Somali region was under-sampled. Some odds ratios in the results text have confidence intervals that do not contain the point estimate, which suggests reporting errors and calls for caution with specific numbers.
Key terms
- Demographic and Health Survey (DHS)
- A standardised, nationally representative household survey run in many low- and middle-income countries that collects data on health, fertility and service use.
- Adjusted odds ratio (AOR)
- The odds of an outcome in one group compared with another after statistically accounting for the other variables in the model.
- Three-delays model
- A framework for maternal deaths: delay in deciding to seek care, delay in reaching a facility, and delay in receiving adequate care there.
- Andersen's behavioural model
- A model of health service use built on predisposing factors (e.g., education), enabling factors (e.g., income, access) and need factors.
- Parity
- The number of times a woman has given birth.
- Sampling weights
- Adjustments applied in analysis so that a survey with unequal selection probabilities represents the national population correctly.
Flashcards
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Quiz yourself
Roughly what proportion of women gave birth in a health facility?
Common questions
Why does antenatal care predict skilled delivery and postnatal care?
Antenatal visits are a point of contact where women can learn why facility birth and follow-up matter and get connected to services. It may also reflect that women who attend are already more able to access care, which this design can't separate.
Why might women with more children use fewer services?
The authors suggest experienced mothers may feel confident giving birth at home, first-time mothers may worry more about complications, and larger families strain household resources.
If services are free, why does wealth still matter?
Women still pay for medicines and transport, and in rural areas travel can be long and costly, so poorer households face real barriers even when the consultation itself is exempt.
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