|Disparities in the use of antenatal care service in Ethiopia over a period of fifteen
||Elias Ali Yesuf, Ronit Calderon-Margalit
||BMC Pregnancy and Childbirth , 13:131 doi:10.1186/1471-2393-13-131
Little is known about factors contributing to inequities in antenatal care use in Ethiopia. We
aimed to assess inequities in the use of antenatal care on the basis of area of residence,
administrative region, economic status and education.
This study was based on data from repeated cross-sectional surveys carried out by Measure
Demographic and Health Survey and Central Statistical Authority of Ethiopia. The surveys
were conducted in February-June 2000, April-August 2005, and December 2010-June 2011.
The surveys employed a cluster sampling design to select a nationally representative sample
of 15–49 year-old women. The main outcome variable was at least one antenatal care visit for
the last live birth in the 5 years preceding the surveys. Statistical analysis was completed by
applying the sampling weights in order to consider the complex sampling design.
A total of 7978, 7307 and 7908 weighted number of women participated in the three surveys,
respectively. The rate of antenatal care coverage in Ethiopia has increased from 26.8% in
2000 to 42.7% in 2011. The odds of antenatal care use were 2.4 (95% CI: 1.7-3.2, p <
0.0001), 1.6 (95% CI: 1.2-2.2, p = 0.003) and 1.8 (95% CI: 1.3-2.6, p = 0.001) times higher
among women from urban areas than those from rural areas at the three time points,
respectively. The odds ratio of antenatal care use among women with secondary or higher
education compared with women of no education increased from 2.6 (95% CI: 2.0-3.4, p <
0.0001) in 2000 to 5.1(95% CI: 2.8-9.4, p < 0.0001) in 2011. Moreover, the odds of use
among women from the richest households at the three time points were 2.7(95% CI: 2.1, -
3.6, p < 0.0001), 4.4(95% CI: 3.3, -6.0, p < 0.0001), and 3.9(95% CI: 2.8, -5.5, p < 0.0001
times higher compared with their counterparts from the poorest households. Furthermore, we
have observed a wide regional variation in the use of ANC in Ethiopia.
The wide inequities between urban and rural areas, across economic and educational strata in
the use of antenatal care highlight the need to put more resources to poor households, rural
areas, and disadvantage regions. We suggest further study to understand additional factors for
the deep unmet need in rural areas and some regions of Ethiopia.