Maternal health, service utilisation and its determinants among women who gave birth in the last 12 months across Afar, Benishangul-Gumuz, Gambella and Somali region, Ethiopia: a cross-sectional study in four developing regional states of Ethiopia

Objectives This study aims to assess maternal health and service utilisation and identify the key determinants across Afar, Benishangul-Gumuz, Gambella and Somali, the four developing regional states (DRS) of Ethiopia. Design A community-based cross-sectional study was conducted from September 2020 to February 2021 using stratified multistage cluster sampling for permanent residents and a random route approach for refugee populations. Setting The study was conducted at the community level across the DRS of Ethiopia, including Afar, Benishangul-Gumuz, Gambella and Somali regions. Participants A total of 1226 women who gave birth within the last 12 months participated, including 1028 non-refugees and 198 refugees living in temporary settlements. The mean age of participants was 26.4 years (SD±5.7). Primary and secondary outcome measures The primary outcome was maternal health service utilisation, defined as receiving at least one of the two services, antenatal care (8+ contacts) or postnatal care (staying in a health facility after delivery or visiting a health facility within the first 45 days postpartum and being checked for early postpartum danger signs and taking treatments accordingly). Result Overall, across the four regions, only 33% of women who had given birth within the last 12 months utilised maternal health services. Regional variation (Benishangul-Gumuz region (AOR=3.269, 95% CI 2.128 to 5.021; p value<0.001), refugee status (AOR=4.022, 95% CI 2.753 to 5.876; p value<0.001) compared with non-refugees, type of residence (urban residents (AOR=1.608, 95% CI 1.129 to 2.291; p value=0.008)), educational status of secondary school or higher (AOR=3.441, 95% CI 1.882 to 6.29; p value<0.001) and women who made decisions by herself or jointly with her husband (AOR=1.872, 95% CI 1.255 to 2.792; p value=0.002) compared with those who do not have decision-making power regarding maternal and child health were significantly associated with maternal health service utilisation. Conclusion Maternal health service utilisation remains critically low in Ethiopia’s DRS. Efforts to improve maternal health outcomes should focus on expanding educational opportunities, disseminating trusted information and empowering women in household decision-making.