Trends and inequalities in women's use of quality antenatal care, intrapartum care, and immediate postnatal care services in Ethiopia: multivariate decomposition, secondary data analyses of four demographic and health surveys over two decades (2001-2019).

Negero, MG; Sibbritt, D; Dawson, A

Trends and inequalities in women's use of quality antenatal care, intrapartum care, and immediate postnatal care services in Ethiopia: multivariate decomposition, secondary data analyses of four demographic and health surveys over two decades (2001-2019).

Negero, MG Sibbritt, D

Dawson, A

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Open, 2025, 15, (3), pp. e099309
Issue Date:: 2025-03-28

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Field	Value	Language
dc.contributor.author	Negero, MG
dc.contributor.author	Sibbritt, D https://orcid.org/0000-0003-3561-9447
dc.contributor.author	Dawson, A https://orcid.org/0000-0003-0926-2202
dc.date.accessioned	2025-09-18T05:10:06Z
dc.date.available	2025-01-23
dc.date.available	2025-09-18T05:10:06Z
dc.date.issued	2025-03-28
dc.identifier.citation	BMJ Open, 2025, 15, (3), pp. e099309
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/189970
dc.description.abstract	OBJECTIVE: This study aimed to examine the trends and inequalities in women's use of quality antenatal care (ANC), quality intrapartum care and immediate postnatal care (PNC) services, and the determinants that contributed to changes in receiving these services from 2001 to 2019 in Ethiopia using the Ethiopia Demographic and Health Surveys (EDHSs) data. DESIGN, OUTCOMES, SETTING AND ANALYSIS: Secondary data analyses of four waves of nationally representative EDHSs from 2005 to 2019 were conducted. We defined quality ANC as having blood pressure measurement, blood and urine tests, iron supplementation and being informed of pregnancy-related complications during ANC visits; quality intrapartum care as having health facility birth, birth assisted by skilled personnel and newborn put to the breast within 1 hour of birth and immediate PNC as having maternal and newborn PNC within 24 hours of birth. We used control charts, multivariate logistic regression decomposition analyses and equiplots to measure and analyse trends and inequalities over two decades using data from EDHSs 2005-2019. RESULTS: Over the period 2001-2019, there were increases in the percentage of quality ANC (3.7%-39.6%), intrapartum care (3.9%-43.3%) and immediate PNC (2.6%22.1%) services received. However, there were widening inequalities between these services received by women, favouring those from advantageous socioeconomic backgrounds. From 2001-2019, the largest significant increases in the percentage of women receiving quality ANC and immediate PNC services were due to changes in the distribution of sociodemographic and maternal care characteristics, while the largest significant increase in the percentage of women receiving quality intrapartum care was due to changes in the effects of these characteristics. CONCLUSIONS: The healthcare system in Ethiopia should expand access to all the recommended maternal healthcare interventions to disadvantaged population subgroups. Universal coverage of quality maternal and newborn healthcare across the continuum is needed. There is also a need to promote ≥4 ANC, early initiation of ANC, girls' and women's education and enabling women's economic empowerment.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2025-099309
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.classification	52 Psychology
dc.subject.mesh	Humans
dc.subject.mesh	Female
dc.subject.mesh	Ethiopia
dc.subject.mesh	Prenatal Care
dc.subject.mesh	Adult
dc.subject.mesh	Pregnancy
dc.subject.mesh	Postnatal Care
dc.subject.mesh	Young Adult
dc.subject.mesh	Quality of Health Care
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Adolescent
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Health Surveys
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Multivariate Analysis
dc.subject.mesh	Patient Acceptance of Health Care
dc.subject.mesh	Secondary Data Analysis
dc.subject.mesh	Humans
dc.subject.mesh	Postnatal Care
dc.subject.mesh	Prenatal Care
dc.subject.mesh	Health Surveys
dc.subject.mesh	Multivariate Analysis
dc.subject.mesh	Pregnancy
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Quality of Health Care
dc.subject.mesh	Patient Acceptance of Health Care
dc.subject.mesh	Ethiopia
dc.subject.mesh	Female
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Young Adult
dc.subject.mesh	Secondary Data Analysis
dc.subject.mesh	Humans
dc.subject.mesh	Female
dc.subject.mesh	Ethiopia
dc.subject.mesh	Prenatal Care
dc.subject.mesh	Adult
dc.subject.mesh	Pregnancy
dc.subject.mesh	Postnatal Care
dc.subject.mesh	Young Adult
dc.subject.mesh	Quality of Health Care
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Adolescent
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Health Surveys
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Multivariate Analysis
dc.subject.mesh	Patient Acceptance of Health Care
dc.subject.mesh	Secondary Data Analysis
dc.title	Trends and inequalities in women's use of quality antenatal care, intrapartum care, and immediate postnatal care services in Ethiopia: multivariate decomposition, secondary data analyses of four demographic and health surveys over two decades (2001-2019).
dc.type	Journal Article
utslib.citation.volume	15
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/School of Public Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Women & Children’s Health Research Collaborative (WCHC)
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Wellbeing and Health
pubs.organisational-group	University of Technology Sydney/UTS Groups/Australian Research Consortium in Complementary and Integrative Medicine (ARCCIM)
pubs.organisational-group	University of Technology Sydney/UTS Groups/Stroke Research Collaborative
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2025-09-18T05:10:04Z
pubs.issue	3
pubs.publication-status	Published online
pubs.volume	15
utslib.citation.issue	3

Abstract:

OBJECTIVE: This study aimed to examine the trends and inequalities in women's use of quality antenatal care (ANC), quality intrapartum care and immediate postnatal care (PNC) services, and the determinants that contributed to changes in receiving these services from 2001 to 2019 in Ethiopia using the Ethiopia Demographic and Health Surveys (EDHSs) data. DESIGN, OUTCOMES, SETTING AND ANALYSIS: Secondary data analyses of four waves of nationally representative EDHSs from 2005 to 2019 were conducted. We defined quality ANC as having blood pressure measurement, blood and urine tests, iron supplementation and being informed of pregnancy-related complications during ANC visits; quality intrapartum care as having health facility birth, birth assisted by skilled personnel and newborn put to the breast within 1 hour of birth and immediate PNC as having maternal and newborn PNC within 24 hours of birth. We used control charts, multivariate logistic regression decomposition analyses and equiplots to measure and analyse trends and inequalities over two decades using data from EDHSs 2005-2019. RESULTS: Over the period 2001-2019, there were increases in the percentage of quality ANC (3.7%-39.6%), intrapartum care (3.9%-43.3%) and immediate PNC (2.6%22.1%) services received. However, there were widening inequalities between these services received by women, favouring those from advantageous socioeconomic backgrounds. From 2001-2019, the largest significant increases in the percentage of women receiving quality ANC and immediate PNC services were due to changes in the distribution of sociodemographic and maternal care characteristics, while the largest significant increase in the percentage of women receiving quality intrapartum care was due to changes in the effects of these characteristics. CONCLUSIONS: The healthcare system in Ethiopia should expand access to all the recommended maternal healthcare interventions to disadvantaged population subgroups. Universal coverage of quality maternal and newborn healthcare across the continuum is needed. There is also a need to promote ≥4 ANC, early initiation of ANC, girls' and women's education and enabling women's economic empowerment.

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http://hdl.handle.net/10453/189970