Spatial patterns of maternal health service utilisation and determinant factors in Ethiopia

Access to and utilisation of maternal health services are very limited in low- and middle-income countries. Maternal morbidity and mortality are very high in these countries due to the limited access to and use of maternal health services. This is the case in Ethiopia, where a high number of maternal deaths occur every year. A geographically linked data analysis using population and health facility data is valuable for mapping maternal health service access and use. It also enables the identification of both the demand- and supply-side factors associated with the use of this service. This study aimed to assess the geographic variations and determinants of maternal health service use in Ethiopia. This thesis used data from national population and health facility-based surveys. The two datasets were linked using geographic data linking methods. After linking these datasets, spatial analyses were carried out to identify geographic variations in maternal health service use in Ethiopia. Multilevel analyses were also undertaken to identify determinants of maternal health service use in Ethiopia. There were wide geographic variations in maternal health service use across Ethiopia. Maternal health service use was influenced by both demand- and supply-side factors. Women and their spouses’ education, parity, household wealth and place of residence were the most important demand-side factors in using maternal health services. Geographic access to and the availability of maternal health services, and the service readiness of healthcare facilities, were the most important supply-side factors. There are geographic variations in maternal health service use in Ethiopia, revealing critical gaps in service availability and readiness. This indicates a need for targeted future investment to increase access to and use of these services, which in turn will contribute to the reduction of maternal morbidity and mortality.