Access to quality maternal healthcare services in Ethiopia: A multilevel analysis

Abstract Background The quality of care a woman receives during antenatal care (ANC), intrapartum care, and postnatal care (PNC) affects the health of the woman and her child and her likelihood of seeking care in the future. This study aimed to assess the recommended interventions received by a mother and/or her newborn during ANC, intrapartum care and PNC, and their determinants in Ethiopia using data from the nationally representative 2019 Mini Demographic and Health Survey. Methods We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling; quality intrapartum care as having: a health facility birth, skilled birth assistance, and newborn put to the breast within one hour; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design. Results Thirty-six percent (n=1,048), 43% (n=1,485), and 21% (n=374) women received quality ANC, intrapartum, and PNC, respectively. Private health facilities provided higher-quality ANC and PNC but poor intrapartum care quality, compared to public health facilities. Receiving ≥4 ANC contacts and commencing this during the first trimester, higher levels of women's education and household wealth were positive predictors of quality ANC. Government health posts were less likely to provide quality ANC. Richer, urban residing women with education and ≥4 ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Adolescent mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49. Conclusions We recommend standardizing the components of maternal healthcare provided in all health facilities; and promoting early and ≥4 ANC contacts, effectiveness, sensitivity, and vigilance of care provided to adolescent mothers, digital clinical decision support tools, and women's education and economic empowerment.