Rural-Urban Disparity in Maternal Health Care Service Utilization in Four Regions of Ethiopia: Ecological and Decomposition Analysis

Abstract

Background: Maternal healthcare services utilization is very low in Ethiopia with a disparity among regions. Therefore, this study aimed to assess rural-urban disparity in maternal healthcare service utilization in four regions of Ethiopia. Method: This study used 2016 Ethiopian Demographic and Health Survey data. 2563 and 1555 women who delivered in 5-years and in 2-years prior to the survey from 220 clusters respectively included as respondents of the study. Partial ecological approach used a mixture of individual level and ecological variables (group level). Multivariable logistic regression, Blinder Oaxaca decomposition and Moran’s index were used during data analysis. Result: This study found; Media exposure in rural-urban, and wealth-index in rural areas as predictors of antenatalcare utilization. Wealth-index in rural, husband education level in urban, women autonomy for own healthcare and antenatal-care utilizations in rural and urban areas as predictors of place of delivery. Wealth-index in rural, antenatalcare utilization in urban; and place of delivery in both urban and rural areas predict postnatal-care utilization. Moreover; geographic clustering observed in the utilization of ANC (Moran’s I = 0.185031, p = 0.011056), health-facility delivery (Moran’s I = 0.271865, p = 0.000209), and PNC (Moran’s I = 0.315410, p = 0.000015). The study also revealed huge rural-urban disparities in utilization of maternal healthcare services in those four regions. Conclusion: Significant rural-urban inequalities in utilization of maternal healthcare services found in four regions of Ethiopia. Therefore, policymakers and concerned stakeholders needs to develop relevant strategies that will enhance maternal healthcare utilization in those marginalized regions.