Determinants of antenatal care and skilled birth attendance in sub‐Saharan Africa: A multilevel analysis

Abstract

Objective To determine individual‐ and country‐level determinants of utilization of key maternal health services in sub‐Saharan Africa (SSA). Study Setting We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245 178 women who had at least one live birth 5 years preceding the survey. Study Design We used a two‐level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy. Principal Findings While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle‐income country increased the individual‐level association between ANC and SBA (OR = 2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services. Conclusions This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.

Spatial Pattern and Associated Factors of ANC Visits in Ethiopia: Spatial and Multilevel Modeling of Ethiopian Demographic Health Survey Data

“…Similarly, women whose husbands have acquired primary and secondary education increased the odds of not having ANC as compared with husbands who were unable to read and write. This finding is in line with a study conducted in several Sub-Saharan Africa (SSA) countries [ 10 ] and Afghanistan 2015 Demographic and Health Survey [ 9 ].…”

“…Female education increases the odds of not having ANC as compared with women who are unable to read and write. This study is in line with a study conducted in Bangladesh [ 10 ] and Pakistan [ 35 ]. The difference could be explained by the fact that women who are unable to read and write were more likely associated with inequalities in service delivery care [ 36 ].…”

“…is study is in line with a study conducted in Bangladesh [10] and Pakistan [35]. e difference could be explained by the fact that women who are unable to read and write were more likely associated with inequalities in service delivery care [36].…”

“…ANC utilization can be affected by sociodemographic and economic factors such as educational status of mothers [ 8 – 10 ], rural residency [ 9 , 11 ], wealth index [ 10 , 11 ], religion [ 12 ], regional variation [ 13 ], maternal factors and child factors like presence of the previous history of low birth weight (LBW) child [ 14 ], history of preterm birth [ 15 ], maternal death [ 6 ], planned pregnancy [ 8 ], history of stillbirth [ 8 ], birth order [ 16 ], early age [ 17 ], unwanted pregnancy [ 18 ], and intimate partner violence [ 19 ], and inequality in maternal service delivery and existing health system [ 20 , 21 ]. Moreover, a systematic review and meta-analysis in Sub-Saharan Africa showed that socioeconomic factors (residence, age, maternal education, partner education, occupational status, marital status, not having health insurance, and religion), maternal factors (parity, having an unplanned pregnancy, previous pregnancy complications, awareness of danger signs, timing, and an adequate number of previous antenatal visits), exposure to mass media, attitude towards ANC utilization, autonomy, husband's support, distance to a health facility, and cost of services affect ANC utilization [ 22 ].…”

Women’s education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region

“…Although several studies used DHS data sets from African nations to evaluate maternal health services, evaluation on the cross-country assessment in the SSEA region is limited [34][35][36][37][38]. For a consistent nationwide data collection process with similar methodologies followed in the selected LMICs, this study was limited to DHS surveys between 1990 and 2017.…”