The prevalence of zero utilization of antenatal care (ZUANC) remains a pressing public health issue in Ethiopia, where approximately 25.56% of pregnant women do not receive any form of antenatal care. This alarming statistic highlights the urgent need for targeted health policies to improve maternal and child health outcomes across the country.
Despite global standards set by the World Health Organization, which recommends at least eight contacts with healthcare providers throughout pregnancy, many women remain outside the reach of these necessary services. Previous research reveals significant individual, household, and community-level factors driving this issue, and recent findings suggest pronounced spatial clustering of ZUANC across various regions of Ethiopia.
Conducted as part of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS), this study analyzed responses from 3,926 women aged 15 to 49 who had delivered within the past three years. The results showed not only how widespread ZUANC is but also the demographic inequalities affecting healthcare access. Key findings highlight how women without formal education, those from poorer socio-economic backgrounds, and residents of rural areas exhibit considerably higher odds of experiencing ZUANC.
"The prevalence of ZUANC in Ethiopia was 25.56% (95% CI: 24.87, 27.63)," noted the researchers. The analysis revealed significant geographic hotspots where ZUANC was most prevalent, including the Somali region, which recorded some of the highest rates of non-utilization of antenatal services.
Looking at the community dynamics, the data collected indicated notable disparities based on educational attainment and wealth. Women with no education faced the highest risks. Specifically, those with no formal education were 6.42 times more likely to have never accessed ANC services than women with secondary education or higher. Similarly, women from poor households had higher odds of ZUANC compared to their wealthier counterparts.
Additional findings pointed to the delineation between urban and rural healthcare access. Women residing in rural regions exhibited nearly two times the odds (AOR = 2.03; 95% CI: 1.28, 3.21) of zero-utilization compared to those living in cities. These trends were compounded by cultural norms, particularly within the Somali communities, where traditional practices often overshadow formal healthcare options.
The study also found marriage positively correlates with ANC utilization, significantly reducing the likelihood of zero-use among married women (AOR = 0.26; 95% CI: 0.09, 0.73). It indicates the potential for targeted health interventions and education campaigns aimed at increasing awareness about the importance of antenatal care.
Spatial analysis employed tools such as the Moran’s I statistic and Getis-Ord Gi* statistics to assess and demonstrate the clustering of ZUANC across Ethiopia. The results pointed to significant areas, or hotspots, where non-utilization rates are disproportionately high. Noteworthy was the finding where women from the Somali regions had 5.08 times higher odds of zero-utilization of ANC care as compared to their counterparts from the capital, Addis Ababa.
Based on these findings, the implication for public health is clear: targeted interventions focusing on education and accessibility are urgently needed, particularly within identified hotspots. Efforts should be directed at increasing the awareness of ANC importance and accessibility, especially for those living in rural or underserved regions.
Addressing ZUANC is not simply a matter of improving healthcare provision; it involves uplifting educational levels, supporting women's empowerment, and ensuring community engagement around maternal health. Such initiatives are fundamental as Ethiopia strives to meet sustainable development goals aimed at reducing maternal and child mortality rates.
Every pregnant woman deserves access to antenatal care, yet social determinants continue to create barriers with lasting impacts. The detailed analysis conducted sheds light on the importance of these issues. Moving forward, Ethiopia must be committed to overcoming these challenges and ensuring every woman is supported throughout her pregnancy.