Maternal health
Who uses pregnancy and birth care in Ethiopia, and who doesn't?
Open access · cc by · source: Europe PMC
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.
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.
Key findings
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.
Methodology
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.
Limitations
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.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
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.
Evidence for the claim as stated.
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.
Evidence for the claim as stated.
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.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
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.
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