Abstract
BackgroundThe incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia.MethodsData were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chi-square test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals.ResultThe level of institutional delivery was 38.9%. Women’s who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73–3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32–3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10–10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women’s without formal education, giving birth at health facility was more likely for women’s who had primary education level (AOR = 1.77, 95% CI: 1.49–2.10), secondary education level (AOR = 3.79, 95% CI: 2.72–5.30), and higher education level (AOR = 5.86, 95% CI: 3.25–10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86–3.06) and middle (AOR = 1.66, 95% CI: 1.36–2.03) household wealth index were more likely to deliver at health facility compared to women’s who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level.ConclusionThe level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.
Highlights
Despite maternal mortality ratio declined from 1990 to 2015, the incidence of maternal mortality remains unacceptably high in developing countries, which accounted for 99% of global maternal deaths [1]
The consecutive Ethiopian Demographic and Health Survey (EDHS) reports showed that Maternal Mortality Ratio (MMR) was 871 per 100,000 live birth in 2000, 673 per 100,000 live births in 2005, 676 per 100,000 live births in 2011, and 412 per 100,000 live births in 2016 [2, 3, 5, 6]
Descriptive results of predictor variables with institutional delivery Of the 7174 women included in this study, 36.3% of the respondents had visited health facilities for Antenatal care (ANC) at least four times during their last pregnancy
Summary
The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. Despite maternal mortality ratio declined from 1990 to 2015, the incidence of maternal mortality remains unacceptably high in developing countries, which accounted for 99% of global maternal deaths [1]. Maternal mortality has been high in sub-Saharan Africa and South Asia. Sub-Saharan Africa alone accounts 56% of maternal mortality with Maternal Mortality Ratio (MMR) 500 per 100, 000 live births [2]. Ethiopia is the one of developing countries with a high maternal mortality rate in Sub-Saharan Africa [3]. According to the World Health Organization (WHO) 2010 report, nearly 9000 maternal deaths occurred in the country [4]. The consecutive Ethiopian Demographic and Health Survey (EDHS) reports showed that MMR was 871 per 100,000 live birth in 2000, 673 per 100,000 live births in 2005, 676 per 100,000 live births in 2011, and 412 per 100,000 live births in 2016 [2, 3, 5, 6]
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