Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study

Abstract

BackgroundEthiopia has high maternal mortality ratio and poor access to maternal health services. Attendance of at least four antenatal care (ANC) visits and delivery by a skilled birth attendant (SBA) are important in preventing maternal deaths. Understanding the reasons behind the poor use of these services is important in designing strategies to address the problem. This study aimed to determine the coverage of at least four ANC visits and delivery by a SBA and to identify determinants of utilisation of these services in three districts in South West Shoa Zone, Ethiopia.MethodsA cross-sectional survey of 500 women aged 15–49 years with a delivery in two years prior to the survey was conducted in Wolisso, Wonchi and Goro districts in February 2013. Data were collected using an interviewer administered questionnaire. Logistic regression models were used to explore determinants of ANC attendance and SBA at delivery.ResultsCoverage of at least four ANC visits and SBA at delivery were 45.5 and 28.6 %, respectively. Most institutional deliveries (69 %) occurred at the single hospital that serves the study districts. Attendance of at least four ANC visits was positively associated with wealth status, knowledge of the recommended number of ANC visits, and attitude towards maternal health care, but was negatively associated with woman’s age. SBA at delivery was negatively associated with parity and time to the health facility, but was positively associated with urban residence, wealth, knowledge of the recommended number of ANC visits, perceived good quality of maternal health services, experience of a pregnancy/delivery related problem, involvement of the partner/family in decision making on delivery place, and birth preparedness.ConclusionsRaising awareness about the minimum recommended number of ANC visits, tackling geographical inaccessibility, improving the quality of care, encouraging pregnant women to have a birth and complication readiness plan and community mobilisation targeting women, husbands, and families for their involvement in maternal health care have the potential to increase use of maternal health services in this setting. Furthermore, supporting health centres to increase uptake of institutional delivery services may rapidly increase coverage of delivery by SBA and reduce inequity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-015-0067-y) contains supplementary material, which is available to authorized users.

Institutional Delivery Service Utilization and Associated Factors among Women of Child Bearing Age at Boset Woreda, Oromia Regional State, Central Ethiopia

“…The order of pregnancy revealed women with first pregnancy are two and half times more likely to utilize institutional delivery as compared to those who are pregnant for two or more times. This finding is consistent with other studies, which indicate that women are more likely to utilize professional assistance for their first births [28,33,34,37]. Study done in Kenya and others reported better institutional delivery among women with lower parity [31,36,38].…”

“…This may be those mothers greater than 18 years of age are matured and had economic advantage of negotiation and decision than below 18 years to utilize health services including delivery. The finding is in accord with other study results [28,33]. The order of pregnancy revealed women with first pregnancy are two and half times more likely to utilize institutional delivery as compared to those who are pregnant for two or more times.…”

“…This study also showed that women educated to primary level and above were two times more likely to utilize institutional delivery than those are not able to read and write. The result was in line with studies in other areas [25,27,28,32,33]. This may be explained by educated women's access to information and awareness of pregnancy problems positively influences their behavior of institutional delivery.…”

“…More over having own income helps to empower women to decide on their own health. The finding was alike with other studies [27,28,34,35] in Ethiopia and in other country Africa [36]. The finding of this study similarly identified place of delivery was decided by their husbands for the majority [82.3%] of the women.…”

“…In this study the magnitude of institutional services utilization was 60%. The finding of this study is higher than the institutional delivery services utilization of 18.3 in Dangla District of Amhara region [25], 20.91 in Ankasha Guagusa Woreda of Amhara region [26], 4% in Tigray Region [27], 28.6% in South West Shoa of Oromia [28], 14.5 in Oromia at regional level [14] and 15.4 at national level of Ethiopia [14]. The possible reason for the discrepancy could arise from the time difference between the current study and other studies which were done before two years of data generation.…”