Abstract
BackgroundImproving access to maternal health services has been a priority for the health sector in low-income countries; the utilization of facility delivery services has remained low. Although Ethiopia provides free maternal health services in all public health facilities utilization of services has not been as expected.ObjectiveThis study examined predictors of facility delivery service utilization in central Ethiopia.MethodsWe conducted a community-based case-control study within the catchment areas of selected public health facilities in central Ethiopia. Women who delivered their last child in a health facility were considered as cases and women who delivered their last child at home were considered as controls. Data were collected using a structured questionnaire. Multivariable logistic regression analysis was used to identify independent predictors of facility delivery utilization.ResultFacility delivery was positive and strongly associated with practicing birth preparedness and complication readiness (BPCR) (AOR = 12.3, 95%CI: 3.9, 39.1); partners’ involvement about obstetric assistance (AOR = 3.1, 95%CI: 1.0, 9.0); spending 30 or less minutes to decide on the place of delivery and 45 or less minutes to walk to health facilities (AOR = 7.4, 95%CI: 2.4, 23.2 and AOR = 8.1, 95%CI: 2.5, 26.9, respectively). Additionally, having knowledge of obstetric complication, attending ≥ 4 antenatal care (ANC) visits, birth order and the use of free ambulance service also showed significant association with facility delivery.ConclusionDespite the availability of free maternal services there are still many barriers to utilization of delivery services. Strengthening efforts to bring delivery services closer to home and enhancing BPCR are necessary to increase institutional delivery service utilization.
Highlights
Efforts to end preventable maternal and newborn deaths in low income settings have been hampered by low utilization of maternal health services [1]
In Sub-Saharan Africa (SSA) and Ethiopia utilization of facility-based delivery was affected by individual attributes (educational status, women’s autonomy to make decisions on birth places, cultural and traditional beliefs, and wealth status) [4,5,6,7,8], obstetric attributes [9] and barriers related to availability and accessibility of health services
Whereas: better education, higher socioeconomic status, urban residence, lower birth order, antenatal care (ANC) visits, availability of transport, having good knowledge of obstetric complications, knowledge of birth preparedness and complication readiness (BPCR), partners’ involvement to seek obstetric assistance, and women’s participation in social networks are the most identified facilitators associated with facility delivery utilization [14,15,16,17,18,19,20,21]
Summary
Efforts to end preventable maternal and newborn deaths in low income settings have been hampered by low utilization of maternal health services [1]. Improved access to and high coverage of institutional delivery alone could prevent about 50% of maternal deaths [2]. In Sub-Saharan Africa (SSA) and Ethiopia utilization of facility-based delivery was affected by individual attributes (educational status (both), women’s autonomy to make decisions on birth places, cultural and traditional beliefs, and wealth status) [4,5,6,7,8], obstetric attributes (parity and ANC use) [9] and barriers related to availability and accessibility of health services Improving access to maternal health services has been a priority for the health sector in lowincome countries; the utilization of facility delivery services has remained low. Ethiopia provides free maternal health services in all public health facilities utilization of services has not been as expected
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