Utilization Of Antenatal Care Services Research Articles

Factors Influencing the Utilisation of Antenatal Care Services among Women of Reproductive Age (15 – 49 Years) in Garowe, Puntland State of Somalia

Despite governments' and international development partners' efforts, maternal deaths remain prevalent in Somalia, with approximately 621 deaths per 10,000 live births. Most complications resulting in these deaths are amenable to the use of quality obstetric care services, especially antenatal care (ANC) services. While the prevalence and correlates of prenatal care use are well documented, limited studies have focused on antenatal care uptake in Garowe, Puntland state of Somalia. This study aims to highlight factors associated with antenatal care services use among women aged 15–49 in Garowe, Nugaal Region, Somalia. We used a descriptive cross-sectional design. A cluster sampling technique was used to select 384 participants for the study. Logistic regression was computed to identify independent factors associated with four ANC visits. Respondents’ average age was 30.2 years, with a range of 16 to 48 years. More than half (56.8%, n=218) of the respondents did not complete four ANC visits. Multivariable analysis established that those who lack insurance, (adjusted odds ratio (aOR)= 6.07, 95%CI: 3.41 – 10.80, p<0.00), used public transport (aOR = 3.68, 95%CI: 1.31 – 10.32, p =0.013), walk to the health facility (aOR =4.0, 95%CI: 1.80 – 8.77, p =0.001), agreed that women discourage ANC attendance in the community (aOR = 3.72, 95%CI: 1.63 – 8.49, p =0.002) and had used TBAs (aOR =13.13, 95%CI: 6.81 – 25.29, p<0.001 were likely to not complete four ANC visits compared to their counterparts. While the WHO now recommends eight antenatal care visits, most pregnant women in the study setting did not complete the previously recommended four antenatal care visits, largely due to social and economic factors. There is a need to provide support to women in the community through financial support and ensure that ANC services are affordable and accessible to increase uptake

Inequalities in antenatal care service utilization in Nepal: evidence from nationally representative Nepal multiple indictor cluster surveys 2014 and 2019

IntroductionAntenatal care (ANC) is essential for improving maternal and neonatal health outcomes, and its utilization is influenced by socioeconomic factors. This study aims to assess disparities in ANC service utilization by wealth, caste/ethnicity, and province among Nepalese women, using data from the nationally representative Nepal Multiple Indicator Cluster Surveys (MICS) 2014 and 2019.MethodsWe assessed the association of ANC service utilization with the household wealth index quintiles, caste/ethnicity and province using multivariable logistic and negative binomial regression models. We also measured wealth-related inequality using concentration curves and concentration indices.ResultsThe proportion of women who received four or more ANC visits increased from 60.6% in 2014 to 77.8% in 2019. However, in both 2014 and 2019, women in the highest wealth quintile were over five times more likely to receive recommended ANC visits than those in the lowest quintiles. Similarly, the expected number of ANC visits was 70% higher in 2014 and 35% higher in 2019 for women in the highest wealth quintile compared to the lowest quintile. Concentration curves showed a decrease in pro-rich inequality in ANC utilization by 2019 relative to 2014, though notable inequality remained. Geographic disparities were evident: Karnali and Madhesh provinces had significantly lower utilization of recommended ANC visits and fewer ANC visits than Koshi Province. Ethnic disparities were also prominent, with women from Dalit, Disadvantaged Janajati, and Other Madheshi caste groups being significantly less likely to complete recommended ANC visits.ConclusionOur findings reveal persistent wealth-related inequality in ANC service utilization in Nepal, with women from wealthier households, advantaged caste/ethnic groups and better-off provinces having higher odds of receiving recommended ANC visits and a higher number of ANC visits. Concerted efforts are needed to address these equity gaps in ANC service utilization, particularly for women from low-income households, disadvantaged caste/ethnic groups, and underserved provinces.

Delay in timing of first antenatal care utilisation among women of reproductive age in sub-Saharan Africa: a multilevel mixed effect analysis

BackgroundSeveral studies in sub-Saharan Africa and elsewhere have affirmed the importance of community-level factors in influencing maternal health seeking behaviour. However, literature shows no uniform pattern in terms of how contextual-level factors influence delay in seeking antenatal care service in different parts of the region. The association of contextual factors and timing of antenatal care is not well documented at regional level. Thus, this study was conducted to examine how community-level characteristics influence decision not to initiate antenatal care in the first trimester. Regional-level analyses of antenatal care utilisation in sub-Saharan Africa are important because they help identify geographic disparities in access and utilisation of the service. Thus, allowing for targeted interventions to improve maternal health outcomes.MethodsData from the most recent Demographic and Health Surveys conducted between January 2010 and December 2021 were used in this study. A sample of 222,436 women aged 15–49 who gave birth in the last five years preceding each of the 33 country surveys in the region was used in the analysis. The association between individual and contextual-level factors and timing of antenatal care was assessed using multilevel binary logistic regression models. Stata software version 17 was used to perform statistical analysis taking into account the complex survey design. Multivariable results were presented using adjusted odds ratios at 95% confidence interval.ResultsThe prevalence of delay in utilisation of first antenatal care service in sub-Saharan Africa was 61.1% [95% CI, 60.6, 61.5]. Mozambique had the highest prevalence of 85.5% [95% CI, [84.2, 86.7] while Liberia had the lowest prevalence at 27.8% [95% CI, [25.6, 30.1]. Women in the age groups 25–34 [aOR = 0.79, 95%CI = 0.76–0.82] or 35–49 [aOR = 0.66, 95%CI = 0.63–0.69], those with secondary or tertiary education [aOR = 0.97, 95%CI = 0.93–1.01] and [aOR = 0.71, 95%CI = 0.66–0.77], belonging to rich households [aOR = 0.91, 95%CI = 0.88–0.95], and those who experienced a pregnancy loss [aOR = 0.84, 95%CI = 0.81–0.87] were less likely to delay first ANC utilisation. Conversely, women living in rural areas [aOR = 1.18, 95%CI = 1.13–1.23], communities with a high proportion of women who experienced unwanted births [aOR = 1.08, 95%CI = 1.02–1.14] were more likely to delay first antenatal care visit.ConclusionBoth individual and community-level factors influenced women’s delay in seeking antenatal care service in sub-Saharan Africa. Integrating community level factors when designing maternal health promotion interventions would be key to improve early utilisation of antenatal care services. There is need to strengthen maternal health promotion initiatives such as Community Health Worker Outreach, Mobile Messaging Campaigns, Male Involvement Initiatives and, School and Youth Friendly Health Programmes targeting women in marginalised communities such as rural settings.

Factors Influencing Antenatal Care Services Utilization in Primary Health Care Centers in the Second Sector of Basra City Center

Factors Influencing Antenatal Care Services Utilization in Primary Health Care Centers in the Second Sector of Basra City Center

Utilization of Antenatal and Maternity Health Care Services among Nursing Mothers Attending Child Welfare Services in Epe Local Government Area, Lagos State, Nigeria

This study is to investigate the utilization of antenatal and maternity healthcare services among nursing mothers attending child welfare services in Epe Local Government Area of Lagos State, Nigeria. Three research questions and hypotheses were postulated for this study. Descriptive survey research design was adopted for the study. Multistage sampling was used to select primary health centre for the study. Simple Random sampling was used to select three primary health centres for the study in Epe Local Government, while the purposive sampling technique was used to select 150 nursing mothers for the study. The findings of the study revealed that there was significant utilization of antenatal care services among nursing mothers attending child welfare services in Epe Local Government Area, Lagos State, there was significant utilization of maternity health care services among nursing mothers attending child welfare services in Epe Local Government Area, Lagos State and significant relationship existed between utilization of antenatal care, maternity health care services, maternal and child health care among nursing mothers attending child welfare services in Epe Local Government Area, Lagos State. The study recommends that Lagos State Government and healthcare providers should work to improve access to antenatal and maternity healthcare services, particularly in rural and disadvantaged areas.

Predictors of Antenatal Care Service Utilization Among Women of Reproductive Age in Ethiopia: A Systematic Review and Meta-Analysis.

Objective: This study aimed to provide pooled predictors of ANC (antenatal care) service use among women of reproductive age in Ethiopia. Methods: Studies were systematically searched using PubMed, Medline, CINAHL, EMBASE, and Google Scholar. The Newcastle-Ottawa scale (NOS) tool was utilized for quality assessment (risk of bias). All data analyses were conducted by utilizing Stata version 17. A random-effects model was used to obtain the pooled predictors of ANC use. The publication bias was checked using a funnel plot and Egger's regression test. Results: Twenty-two studies with a sample size of 25,671 were included in this review. The identified predictors of ANC service use were highest wealth rank (AOR 1.92 [95% CI: 1.53-2.31]), formal women education (AOR 2.40 [95% CI: 1.75-3.06]), formal husband education (AOR 1.49 [95% CI: 1.36-1.66]), women age ≥ 20 (AOR 1.75 [95% CI: 1.47-2.17]), mass media exposure (AOR 1.44 [95% CI: 1.21-1.66]), good maternal knowledge about the pregnancy complication (AOR 1.49 [95% CI: 1.11-1.88]), planned pregnancy (AOR 1.59 [95% CI: 1.28-1.91]), women autonomy (AOR 1.42 [95% CI: 1.23-1.62]), and positive husband attitude about the ANC service use (AOR 2.63 [95% CI: 1.47-3.79]). Conclusions: Several predictors have increased the ANC service utilization, like wealth status, women's and their husbands' education, older/increasing women's age, media exposure, maternal knowledge about pregnancy complications, planned pregnancy, women's autonomy to decide on household health care, and positive husband attitude about the ANC service utilization.

Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: a qualitative descriptive study

IntroductionMaternal and newborn mortality are critical global health concerns. Achieving Sustainable Development Goal 3.8 (SDGs), which aims to improve these outcomes, is hindered by the poor quality of care in health facilities, a significant barrier to the utilization of antenatal care (ANC) services in Pakistan. This study aimed to explore the barriers to the underutilization of ANC services in Tehsil (sub-division of a district) Hazro, Punjab, Pakistan, from the perspective of pregnant women.MethodThe study employed four focus group discussions (FGDs) with 36 pregnant women who had attended at least three ANC visits. Data were collected through purposive sampling and analyzed using NVivo 12, ensuring rigor through Lincoln and Guba’s guiding principles.ResultThe findings revealed three key themes, following the three delays model: 1. Decision to Seek Care, 2. Delay in Reaching Healthcare Facilities, and 3. Delay in Acquiring Satisfactory and Appropriate Health Care. Women often made the decision to seek care with the support of their spouse, family, and lady health workers, highlighting the importance of their decision-making autonomy. Financial constraints did not significantly hinder access to healthcare services. However, long distances, travel time, and associated costs were identified as major barriers. Most importantly, the majority of women lacked awareness of danger signs and the importance of seeking timely medical help. This issue was compounded by the unavailability of healthcare personnel, negative staff attitudes, insufficient medicines and equipment, and a lack of referral services.ConclusionThis descriptive study underscores the urgent need for affordable, accessible, and responsive maternal and child healthcare. To address these barriers, stakeholders − including policymakers, public health experts, and maternal, neonatal, and child health (MNCH) providers − must prioritize MNCH initiatives and reforms. Collaborative efforts are crucial to translating MNCH policies into effective strategies at the community level.

Women’s Status and its Association with Antenatal Care Use: A Cross Sectional Study Conducted In Gilgit Baltistan

According to the WHO, more than 287,000 women died during pregnancy and after childbirth in 2020. Sub-Saharan Africa and south Asia are at high risk in maternal mortality rate. In Pakistan, the maternal mortality rate is 186 per 100,000 live births, and 49% of women still don’t visit for adequate antenatal care. Socio-cultural factors have a critical role in accessing maternal healthcare services. This study investigated the association between women’s autonomy and utilization of maternal healthcare services in Gilgit-Baltistan. In the study, a cross-sectional survey design was adopted, and multi-stage sampling techniques were employed. A total of 928 samples were selected from the four districts of the Baltistan division. The results show that women and their husband’s education strongly associated with the utilization of antenatal care services (OR, 4.230, CI: 95% 2.761-6.479 with P-value .000), Women’s involvement in decision making about reproductive health related matters also significantly associated with women receiving antenatal care services (OR 5.082, CI: 95% 3.366-7.673 with Pvalue-.000). Keeping in view the current findings it strongly recommended that state agencies and non-governmental organization should focus on female literacy and women empowerment

Utilisation of eight or more antenatal care visits and its associated socio-economic-related inequalities in sub-Saharan Africa: A decomposition analysis.

Inadequate utilisation of maternal healthcare services, particularly antenatal care (ANC), poses a challenge in sub-Saharan Africa (SSA). There is a dearth of regional studies that address the socio-economic disparities in the use of ANC in SSA. Therefore, we examined the wealth and education-based inequalities in the utilisation of ANC services among women in SSA. We analysed secondary data obtained from the Demographic Health Survey conducted in fifteen countries in SSA. We estimated the degree of wealth and education-related inequalities using concentration curves, concentration indices (CIX), and decomposition analysis, which identified the factors contributing to the disparities in the utilisation of ANC. All the analyses were conducted using Stata version 17.0 (Stata Corporation, College Station, TX, USA). The results revealed a significant socio-economic gap in utilising ANC in SSA. We found positive and statistically significant wealth index-related (CIX = 0.30; p-value < 0.0001) and education-based inequalities (CIX = 0.33; p-value < 0.0001) in eight or more ANC visits. The extent of wealth index-related and education-based inequalities varied across the fifteen countries. The decomposition analysis showed that educational attainment accounted for about 21% of the inequalities in eight or more ANC visits. Wealth index contributed 12.14% of the inequalities in eight or more ANC visits. Our results further showed that women's education, wealth, parity, and place of residence significantly contributed to the utilisation of eight visits or more among women in SSA. This study shows the disparities in ANC coverage, contingent upon wealth index and educational attainment. Our study highlights the importance of adopting a holistic approach involving robust cooperation between healthcare and other social service sectors. It is crucial to prioritise the primary social factors contributing to disparities in the utilisation of ANC services, including women's education, parity, place of residence, and economic status. Policymakers and stakeholders must prioritise efforts to combat obstacles to healthcare access, including the provision of easily accessible, affordable, and culturally appropriate services.

Antenatal care services utilization and their associated factors among postnatal women in Dodoma city: a cross-sectional study

BackgroundIn 2016, the World Health Organization (WHO) updated its antenatal care (ANC) guidelines to improve the quality and effectiveness of ANC services. Whether in Tanzania the services are utilized according to the WHO’s guidelines remains a subject for investigation. Thus, the aim of this study was to assess the utilization of ANC services in line with the antenatal care guidelines among postnatal women in Dodoma City, Tanzania.MethodsWe employed an analytical cross-sectional study design. A questionnaire was developed based on information from literature and the Tanzania ANC guideline of 2018 to obtain data about social demographic characteristics and ANC services utilization. A total of 426 postnatal women were sampled using a proportionate systematic random sampling procedure. Data were collected using a face-to-face interview and abstraction from the ANC card. Using SPSS software version 26, We performed descriptive and regression analyses using SPSS software version 26 to determine the utilization of services and the associated factors. Data were considered significant at a p-value < 0.05 and reported along with 96% confidence intervals.ResultsThe majority of the postnatal women (63.2%) initiated ANC visits during their first trimester. The availability of ANC support person was the key factor associated with the early initiation of ANC services. The median number of antenatal contacts was 4, with only 6.8% of postnatal women being able to meet the minimum of eight contacts as recommended by WHO. The top ANC services provided to the majority of women include education about the use of bed nets to prevent malaria during pregnancy (92.9%), Tetanus Toxoid (TT) vaccination (86.8%), Intermittent Preventive Therapy for malaria (IPTp-SP) medication (90.8%) and mebendazole medication to treat or prevent parasitic infections (90.1%).ConclusionOverall, the majority of women in Dodoma initiate ANC contacts within the first trimester, but only a small proportion complete eight contacts as recommended by WHO. The health care system should prioritize addressing the factors identified in this study, particularly by encouraging ANC support persons to increase the frequency of ANC contacts.

Impact of Covid-19 on antenatal care: evidence from Madagascar Demographic and Health Survey.

Despite the growing literature on the impact of Covid-19 on antenatal care (ANC) and maternal/neonatal and child health outcomes globally, substantial knowledge gaps remain about the population-level impact in sub-Saharan Africa (SSA). Existing evidence on the ANC impact of Covid-19 in SSA is largely based on health facility or small-scale qualitative research, which are limited in providing population-level understanding. This paper examines the extent to which Covid-19 impacted ANC service utilisation and identifies what population sub-groups were most adversely impacted. It is based on a secondary analysis of the Madagascar Demographic and Health Survey (DHS), the first DHS in SSA released following the Covid-19 pandemic. Multilevel logistic regression analysis was used to estimate the net effect of Covid-19 on ANC and identify the most at-risk population sub-groups. The findings show that all ANC measures considered (no ANC, early ANC, adequate ANC visits) were significantly affected by Covid-19 (p<0.05). On average, Covid-19 was associated with a 42% increase in the odds of having no ANC, a 22% reduction in the odds of starting early ANC during the first trimester, and a 22% reduction in the odds of receiving adequate ANC (at least four visits, starting during the first trimester). Births to older mothers and to mothers with no education were disproportionately affected during Covid-19. Although youth aged 15-24 had poorer ANC compared to older women before the pandemic, the pattern was reversed during the pandemic. Also, the protective effect of education was stronger during than before the pandemic. These findings underscore the importance of Covid-19 impact mitigation strategies targeting the most at-risk groups (e.g. older mothers). Furthermore, essential information/education during pandemics should be in formats accessible to non-literate women. This paper advances understanding of the population-level impact of Covid-19 on ANC and emphasises the need for further research to better understand the population-level impact of Covid-19 across countries of SSA.

Challenges Faced by Pregnant Women in Utilizing Antenatal Care Services

Background: Utilization of antenatal care services is very important for the health of mother as well as the child. However, most of pregnant women in Pakistan fail to utilize those services due to various challenges. Objectives : To identify barriers faced by pregnant females in seeking antenatal care services in Lahore, Pakistan. Methods: This cross-sectional study was conducted in Public hospitals of Lahore, over a period of 1 month from June 1 to June 30. A sample size of 99 pregnant females in their third trimester from all social backgrounds was taken. A chi-square test was used for analysis. Results: The mean age of women was 29±5 years with 66% from urban side. Most of them women had completed higher secondary education i.e. 35%, and their spouse income was under 50k rupees i.e. 87%. The non-utilization of care was observed in 20% women, partial utilization of antenatal care was observed in 50% women and complete utilization of antenatal care was observed in 30% women. The most important variables found to be challenges for utilization of antenatal care services were prenatal care awareness (p=0.001), nearby (p=0.000), transportation issues (p=0.013), availability of skilled workers (p=0.023), adequate info about pregnancy (p=0.044), awareness of regular checkups (p=0.001), community support groups (p=0.002), and referral to specialist (p=0.013) Conclusion: In our study, , it was observed that a large percentage of women don't avail antenatal care services completely, i.e. 20 % of them don't utilize antenatal services at all and 50 % only utilize them partially. The most significant challenges faced by pregnant women in utilization of antenatal care services were prenatal care awareness, nearby facilities for antenatal care, transportation issues, availability of skilled workers, adequate awareness about importance of regular checkups, and lack of community support groups, and referral to specialists.

Optimizing Maternal Healthcare Access: A Mixed Method Study on Dual Utilization of Public and Private Antenatal Care Services in Puducherry, India

Abstract Background: Access to antenatal care (ANC) services has improved. However, it is also noted that some antenatal women seek multiple healthcare services. Exploring this practice will identify gaps in service provision and pave the path toward improving the quality of services. Objective: This study aimed to measure the concurrent use of public and private healthcare services for various components of ANC and understand the reasons for the dual utilization. Methodology: This explanatory mixed-method study enrolled 177 mothers residing in Puducherry, who had given birth in the last three years. A pretested, semi-structured questionnaire was administered, and six key informant interviews were conducted. Integration was performed in the interpretation stage, and a joint display was used to depict the results. We adopted the Donabedian model during the analysis and organized the codes under these major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Result: Most pregnant women (81.9%, 95% CI = 75.2%–86.8%) sought care from both public and private healthcare facilities, however, they preferred public facilities for delivery (74.6%, 95% CI = 67.6%–80.4%). The qualitative analysis revealed three major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Primary reasons for opting for private facilities included perceived superior ANC quality, organized care evident in scheduled appointments, reduced waiting time, frequent ultrasounds, personalized medication, and enhanced rapport with family. Women also believed that visits to government facilities are essential to avail the monetary benefits and have a seamless admission during delivery. They felt that government hospitals perform fewer cesarean sections. Conclusion: Strengthening public-private partnerships could enhance antenatal care utilization, benefiting pregnant women and streamlining healthcare delivery.

Utilization of Antenatal Healthcare Services, Associated Factors, and Pregnancy Outcomes Among Postnatal Women Who Delivered in Selected Rural Healthcare Centers in Odisha, Southeastern India.

Adverse pregnancy outcomes remain a prevalent health issue in India. Many of the negative consequences could be avoided if mothers used prenatal care. However, in many low-resource Indian situations, the use of this service and its drivers has not been thoroughly studied. Therefore, this study was conducted to assess the utilization of antenatal care (ANC) services and the various factorsaffecting this utilization andpregnancy outcomes. Acohort study was conducted among 326 recently delivered mothers in Khordha District, Odisha, in the southeastern community of India. A multistage sampling technique was used to select the desired sample. Demographic variables were obtained through a structured demographic proforma; maternal knowledge was evaluated using a structured knowledge questionnaire; and a factor-related structured questionnairewas used to identify factors associated with ANC service utilization. An interview method was used to collect the information from the participants. The data were entered using EpiData version 1.4.4.0 (Buenos Aires, Argentina) and exported to IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York) for analysis. Bivariate and multiple logistic regressions were applied to identify participants and predictor variables, respectively. This study revealed that 227 (69.6%) had attended four or more recommended antenatal visits. The main perceived barriers to ANC access were unplanned pregnancy, delay in pregnancy confirmation, uncooperative partner, lack of family support, and distance from the health facility. It was found that 287 (88.1%) of women had adequate knowledge about the danger signs of pregnancy, and 174 (53.4%) were aware of available ANC healthservices in their locality. Knowledge of women was revealed to be a major factor impacting the utilization of ANC healthservices in this study (crude odds ratio (cOR) 24.03; 95%CI 12.37-46.65; p<0.01). It is also found that poor antenatal utilization was associated with an increased likelihood of complications arising during the antenatal period (cOR 2.43; 95%CI 0.34-18.71, p=0.01), immediate postnatal complications (cOR 1.77; 95%CI 2.43 0.83-17.15; p=0.02), cesarean section and operative vaginal delivery rate (cOR 1.88; 95%CI 1.11-3.17; p=0.03), and post-term babies (cOR 5.64; 95% CI 1.31-24.4; p=0.01). The utilization of WHO-recommended ANC service in the present study area was found to be poor. The quality of ANC and maternal awareness among the population were found to be the factors that influence women's good utilization of ANC. Underutilization of ANC healthservices had a significant impact on adverse pregnancy outcomes, such as complications that arise during the antenatal and immediate postnatal period, cesarean sections, and operative vaginal delivery rates, as well as post-term pregnancy. These results can be utilized to develop a health intervention program to enhance maternal health utilization practices and, ultimately, improve maternal and child health quality in low-resource settings in India.

Intimate partner violence and maternal antenatal care utilization: is there a dose-response relationship? Findings from the Ethiopian National Demographic and Health Survey.

Maternal mortality in sub-Saharan Africa (SSA) is an enduring public health challenge. Adequate utilization of antenatal care (ANC) services is one strategy to mitigate the problem by identifying and managing pregnancy risks early. Yet, in SSA, uptake of ANC remains low. Intimate partner violence (IPV) may be a deterrent to ANC uptake. We measured the dose-response relationship between IPV and adequate ANC utilization (defined as four or more visits [ANC-4]) using data from the Ethiopia Demographic and Health Survey (EDHS) 2016. We used complex sample logistic regression to measure the impact of three IPV subscales (emotional, sexual and physical) on ANC-4 while controlling for sociodemographic, obstetric and women empowerment factors. A total of 2599 (weighted) currently married or in-union women were included. There was a significant dose-response relationship between IPV and ANC utilization. Emotional (adjusted odds ratio [aOR] 0.78 [confidence interval {CI} 0.64 to 0.97]) and sexual (aOR 0.68 [CI 0.50 to 0.92]) violence decreased ANC-4 uptake while controlling for the covariates. IPV is common, yet often invisible, in Ethiopia. Health workers may begin directly screening pregnant women for IPV in order to increase targeted support of ANC uptake. This is the first known study to confirm IPV has a dose-response relationship with ANC-4 uptake.

Trends and socioeconomic inequalities of recommended antenatal care services utilization in Ethiopia: A decomposition analysis using Ethiopian nationwide Demographic Health Surveys 2011-2019.

Antenatal care (ANC) services are essential to reduce maternal and newborn morbidity and mortality rates. However, the trends and socioeconomic inequality of utilizing recommended ANC services has not been well studied in Ethiopia. Therefore, this study aims to investigate the trends and socioeconomic disparities in receiving recommended ANC services among Ethiopian women. This study used recent Ethiopian Demographic Health Surveys (EDHS) conducted in 2011, 2016, and 2019. Binary logistic regression model was employed to assess the association between receiving the recommended ANC services and explanatory variables and socioeconomic disparities were estimated through concentration index (CIX) analysis. Moreover, Wagstaff approach was used to decompose the relative CIX to the contribution of explanatory variables for the observed disparities. This study found that 37.37% (95%CI: 36.46-38.28%) of mothers utilized the recommended ANC services in Ethiopia. The trend in the coverage of recommended ANC services increased from ~ 30% in 2011 to 44.70% in 2019. Mother's age and education, household wealth status, distance of the nearest health facility, and experiencing domestic abuse (i.e., wife beating) were significantly associated with utilization of recommended ANC services. The relative estimated CIX for wealth index, mothers education, Ethiopian administrative regions, and residence were 0.15 (P < 0.001), 0.14 (P < 0.001), 0.07(P < 0.001), and -0.11(P < 0.001), respectively. Wealth status of the households contributed for almost two-thirds (66.58%) of the observed disparity in recommended ANC service utilization across wealth categories. The study revealed that Ethiopian women's utilization of recommended ANC services was unequal by their socioeconomic classes, with better off women more likely to utilize the recommended ANC services than worse off women. Hence, the responsible body should improve the access and quality of antenatal care services for underprivileged women in Ethiopia.

Antenatal care visits and its determinants among women in Afar regional state: North Eastern Ethiopia

BackgroundAntenatal care is an essential component of maternal healthcare that plays a crucial role in promoting the health and well-being of both mother and baby. While previous studies have examined factors influencing antenatal care visits in other parts of Ethiopia, there is a lack of research specifically focusing on the Afar region. This study aimed to assess determinants of antenatal care visits among pregnant women in Afar region, Ethiopia.MethodsThe data is 2019 Ethiopian Mini Demographic and Health Survey. In this study 641 weighted sample womens were included. Negative binomial regression model is applied.ResultsAbout 27.77% achieve optimal ANC visits. Living rural (IRR = 0.575, 95%CI: 0.467, 0.708). Reading whole sentences (IRR = 1.683, 95%CI: 1.212, 2.339). Under five children in house 1–2 (IRR = 0.789, 95%CI: 0.632, 0.984), 3–4 (IRR = 0.692, 95%CI: 0.509, 0.941), > = 5 (IRR = 0.075, 95%CI: 0.021, 0.268). Married (IRR = 1.550 95%CI: 1.172, 2.051), Widowed (IRR = 2.043, 95%CI: 1.238, 3.372). Age first birth 16–20 (IRR = 0.805, 95%CI: 0.652, 0.992). ConclusionThe study examined the utilization of antenatal care services among women in Afar regional state, North Eastern Ethiopia. The findings reveal that a significant proportion of women did not receive the recommended number of antenatal care visits during their pregnancy. Factors such as residence, mother’s literacy rate, age at first birth, number of living children, number of under five children in the house and marital status were major determinants of ANC (Antenatal Care) visit in Afar region. Increase access to antenatal care services by improving the availability and quality of health facilities in the region. Maternal health-care program should be expanded and mainly in rural areas of the region. Moreover, the necessary assessment and follow-up of ANC health care services should be encouraged in Afar region to decrease maternal mortality.

Level of and trends in women’s empowerment inequalities in antenatal care services in Ethiopia: further analysis of the Ethiopia demographic and health surveys, 2000-16

BackgroundMaternal health care services and women’s empowerment have received attention in the Sustainable Development Goals. Limited evidence exists on the extent of distribution of antenatal care services across the ladder of women’s empowerment in Ethiopia. In this study, we sought to shed light on whether and how such disparities changed over time.MethodsData for the study came from the 2000 and 2016 Ethiopia Demographic and Health Surveys. The outcome variables were three measures of antenatal care services: quality antenatal care, early antenatal care, and four or more antenatal care services. Women’s empowerment was measured through a newly developed index, SWPER Global. Specifically, we used two domains of the measure: attitude to violence and social independence. Disparities in antenatal care services were measured using the Erreygers concentration index, Relative Index of Inequality, Average marginal effect, and second difference of the average marginal effects. We decomposed the concentration index to study the contributions of different factors to the empowerment disparities in the services in 2000 and 2016 as well as to the over-time change in the disparities. The Oaxaca-type decomposition technique was applied to investigate social determinants’ role on the change in the disparities between 2000 and 2016. A generalized linear regression model was used for the analyses.ResultsAccording to the concentration index, women’s empowerment disparities in the utilization of antenatal care services existed in both surveys, where the services were disproportionately concentrated among women with better levels of empowerment. By the measure of average marginal effect, there were disparities favoring empowered women based mainly on the point estimates, except that the attitude toward violence disparity in 2016 occurred to the advantage of poorly empowered women. However, the confidence intervals suggest mixed findings. The concentration indices showed that disparities mostly increased in 2016 and the change was underpinned by the changes in the inequalities of various factors and sensitivities of antenatal care services with respect to these variables, such as wealth, maternal education, media exposure, place of residence, and women’s empowerment itself. Overall, the results of the second difference showed no large change in the disparities between 2000 and 2016. However, relative disparities decreased substantially during the same time.ConclusionsWhile concentration index-based absolute inequalities increased, relative inequalities decreased, suggesting the importance of using both absolute and relative measures in a study. The decomposition analyses suggest that working on the equitable distribution of social determinants could improve empowerment disparities in antenatal care services.

Quality of antenatal care services in Afghanistan: findings from the national survey 2022–2023

BackgroundThe optimum use of antenatal care (ANC) services can reduce pregnancy-related complications and deaths. However, there is limited information on the quality of ANC services in Afghanistan. This study aimed to assess the quality of ANC services and examine the influence of sociodemographic factors on the quality of ANC services received by pregnant women in Afghanistan.MethodsThis study analyzed the data from the 2022–23 Afghanistan Multiple Indicators Cluster Survey (MICS), including 9,243 ever-married women aged 15–49 years who had given birth two years prior to the survey. ANC quality was classified as "good" if a woman had at least four ANC visits, initiated ANC during the first trimester, and received all four essential ANC services. Binary logistic regression was employed to examine the likelihood of receiving good-quality ANC across various sociodemographic variables.ResultsOnly 6.2% of women received good-quality ANC. Factors significantly associated with receiving good-quality ANC included woman’s secondary (AOR:1.87, 95%CI: 1.33–2.63) and higher education levels (AOR: 1.75, 95%CI: 1.01–3.03), household head’s higher education level (AOR:1.63, 95%CI: 1.11–2.40), and wealth status (1.71, 2.26, 1.92, and 1.97 higher odds of receiving good-quality ANC for 2nd, 3rd, 4th, and 5th as compared to 1st quintiles of wealth, respectively).ConclusionThe low utilization of good-quality ANC among women in Afghanistan, particularly among those at lower wealth status, with low education levels, underscores the need for targeted interventions to improve access and utilization of antenatal care services.

Women’s Sociodemographic Characters and Antenatal Care Services in Rwanda: A Secondary Analysis of Rwanda Demographic Health Survey 2019–2020

Background and Objectives: Rwanda, a country in Sub-Saharan Africa, is among the most underprivileged nations. Women in Rwanda face significant challenges in achieving good health and well-being. This study aims to explore the impact of various sociodemographic factors on the utilization of antenatal care (ANC) services in Rwanda. Methodology: This study is based on secondary research using data extracted from the Rwanda Demographic Health Survey conducted in 2019–2020. 14,634 women were interviewed, and their data were analyzed using SPSS 24.0. The statistical significance level was set at 5% and a confidence interval of 95% was used in the analysis. Results: The average age of the survey respondents was 29. Over 87% of them visited ANC before their 5th month of pregnancy, and only a very small percentage (0.04%) had more than six visits. The logistic regression analysis results showed that women aged over 45 years were twice as likely to visit the clinic as women aged 15–30 years (odds ratio (OR): 2.022, 95% confidence interval (CI): 1.241–3.293, P = 0.005). Women who completed primary education were 4.2 times more likely to use ANC clinics than uneducated women (OR: 4.190, 95%CI: 1.230–2.653, P = 0.003). Pregnant women who read the newspaper at least once a week were 1.4 times more likely to visit the clinic than those who did not read the newspaper at all (OR: 1.148, 95%CI: 1.097–2.028, P = 0.014). Conclusions: The utilization of antenatal care ANC services is significantly influenced by sociodemographic factors. Therefore, these elements should be considered when developing strategies to improve antenatal services in Rwanda.