Women's Use of Quality Maternal Healthcare Services Across the Continuum in Low and lower-middle-income Countries, With a Focus on Ethiopia.
- Publication Type:
- Thesis
- Issue Date:
- 2023
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This study aimed to identify the level, determinants, and inequalities of receiving quality maternal healthcare across the continuum and the role that human resources for health (HRH) can play in improving maternal and newborn health in LLMICs, with a focus on Ethiopia.
We conducted a SR employing deductive content analysis and secondary data analyses of DHS across LLMICs. The DHSs data analyses comprised nationally representative data from four waves of Ethiopia DHSs: 2005, 2011, 2016 and 2019, and the latest DHSs from 28 LLMICs using statistical control charts, equiplots, concentration curves, concentration indices, and the slope index of inequality to measure trends and inequalities in receiving quality maternal healthcare across the continuum, and multilevel mixed-effects and multivariate decomposition regression analyses models to determine the key predictors.
Results-based financing (RBF); community-based recruitment, training, local deployment and modest financial and non-financial incentives for community health workers; skills-based, regular and clinical simulation-assisted in-service training of skilled birth attendants; and facility-based maternal death audits improved quality maternal healthcare across the continuum in LLMICs. In Ethiopia, the uptake of quality maternal healthcare is low, with widening inequality between population subgroups. Private healthcare facilities provided higher-quality antenatal care (ANC) and postnatal care (PNC) but poor-quality intrapartum care. Early and ≥4 ANC visits and advantageous socio-demographics were positive predictors of quality maternal healthcare. Women who received quality ANC and skilled birth assistance were more likely, while teenage mothers were less likely, to receive quality PNC. Only 8.2% of women across LLMICs received quality maternal healthcare across the continuum, with substantial attrition along the care continuum and wider gaps between population subgroups, favouring those with advantageous socio-demographics. First trimester ANC, exposure to mass media, healthcare insurance, lower parity, intended pregnancy, birth spacing, and higher maternal education and household wealth indices were positive predictors of quality care across the continuum. In contrast, women who had to gain permission to seek medical care and reported a lack of companionship and longer distances to healthcare facilities as barriers to accessing care were less likely to receive quality care across the continuum.
We recommend maternal and perinatal death audits in all facilities; woman-centred care as a criterion of RBF; expanding quality maternal healthcare for disadvantaged population, including teenage mothers; promoting early and ≥4 ANC visits, healthcare insurance, birth spacing, reproductive healthcare services; and ensuring women’s autonomy in LLMICs. Women's education and economic empowerment need to be progressed as per the SDG targets.
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