Determinants of Maternal Healthcare Utilisation Among Pregnant Women in Southern Ethiopia: A Multi-level Analysis
Abstract Background: In low- and middle-income countries, considerable proportions of women and newborns are dying from easily preventable pregnancy and childbirth-related causes. The utilisation of maternal health care (MHC) is a proven intervention that significantly reduces maternal and newborn morbidity and mortality. Despite efforts to make MHC available in rural Ethiopia, utilisation of these services remains low. Therefore, this study aimed to assess MHC services’ status and determinants in rural Ethiopia.Methods: The study used a community-based, cross-sectional design. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects, logistic regression model was used to identify individual and communal factors level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC). Adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were estimated at a p-value < 0.05, indicating statistical significance.Results: A total of 727 pregnant women from rural areas took part, with a response rate of 99.3%. About 63.4% of the women visited ANC clinics at least once during their last pregnancy while only 46.5% had given birth with SBA, and 32.8% had received PNC. The study revealed that women’s employment, awareness of danger signs and pregnancy planning were associated with increased MHC service utilisation from individual-level factors. The odds of using SBA (AOR=3.3; 95% CI: 1.8–5.9) and PNC (AOR=2.8; 95% CI: 1.2–6.7) were associated with ANC use. Similarly, PNC utilisation was associated with SBA (AOR=3.3; 95% CI: 1.8–6.1). At the cluster level, being a lowlands resident was found to be associated with ANC (AOR = 4.1; 95% CI: 1.1–14). Similarly, a proximity of less than two hours of travel time from the nearest health facility was found to be associated with SBA use (AOR=2.9; 95% CI: 1.4–5.8) and ANC use (AOR=1.9; 95% CI: 1.1–3.7).Conclusions: Individual and community-level factors play a key role in determining utilization of MHC services. Women’s empowerment, promotion of contraceptive methods to avoid unintended pregnancy and improved access to health care services, particularly in highlands areas, are recommended.