Effective coverage of antenatal care service utilisation in Ethiopia using service provision assessment and demography and health survey data

Background: Globally, maternal deaths due to pregnancy and childbirth-related causes are still high. In response to the high maternal deaths, countries committed to achieving universal health coverage (UHC) by 2030. Effective coverage (EC) is a key metric for tracking the progress in the service coverage component of UHC.

Objectives: This study aimed to assess the magnitude of EC of four or more antenatal care (ANC4+) in Ethiopia.

Design: Ethiopian Mini-Demography and Health Survey (EMDHS) 2019 and Ethiopian Service Provision Assessment (ESPA) 2021–2022 cross-sectional surveys were used for analysis.

Methods: EC of ANC4+ was estimated using the EMDHS 2019 with a weighted sample of 3617 women with their most recent live birth and ESPA 2021–2022 data with a sample of 659 health facilities. Accordingly, crude coverage (CC) was calculated from the EMDHS 2019, while a quality score was calculated from the ESPA 2021–2022 data. ArcGIS Pro software was used to display EC of ANC4+ across the administrative regions of Ethiopia.

Results: In this study, the overall CC and EC of ANC4+ were 41.5% (95% CI: 38.9, 44.0) and 21.6% (95% CI: 20.0, 23.2), respectively with the lowest in Somali region and the highest in Addis Ababa. The overall facility-weighted quality of ANC was 52.1% (95% CI: 51.3, 52.8) with the lowest in Gambela and the highest in Benishangul-Gumuz region.

Conclusion: This study revealed that the EC of ANC4+ was low due to low achievement in the CC of ANC4+ and quality of care with high regional disparities. Without urgent action, Ethiopia is unlikely to meet Sustainable Development Goal-3 (SDG-3) targets for maternal health. Therefore, administrative region-specific intervention strategies should be designed to improve community engagement, infrastructure, access, and quality of ANC in Ethiopia.