Trends, regional inequalities and determinants in the utilization of prenatal care and skilled birth attendant in Ethiopia: A multilevel analysis

Background: Ethiopia has made a substantial reduction in maternal mortality over the last two decades. However, maternal health care utilization among 15-49 aged women remains low despite this progress. The study aimed to examine trends, regional inequalities, and potential determinants associated with prenatal care utilization and a skilled birth attendant from 2000 to 2016 in Ethiopia. Methods: Nationally representative data extracted from the 2000 to 2016 Ethiopia Demographic and Health Surveys (EDHS), conducted every five years among 15-49 age women in Ethiopia. We used multilevel logistic analysis incorporating the demographic, socioeconomic, and health variables that are independently associated with prenatal care (PNC) and skilled birth attendant (SBA) use. Results: The prevalence of prenatal care utilization was relatively stagnant between 2000 and 2011 but showed an overall increase nationwide from 26.7% to 62.4% between 2000 and 2016 (p-value < 0.001). The prevalence of skilled birth assistance increased only by 16.5% in the past fifteen years, from 5.6% in 2000 to 22.1% in 2016. Rural type of residence, lower maternal education, lower household wealth index, lower partner's education, an immense distance of getting medical help were steadily significantly associated with prenatal health care use and skilled birth attendants. Further, male household heads, younger age women, and no covered health insurance were associated with lower odds of skilled birth attendant use. Conclusions: Though overall prenatal care and skilled birth attendant use prevalence have improved nationally, the regional disparity is uneven. Therefore, to sustain the progress equals more attention is needed for Afar, Somali, and Oromia regions to increase maternal health care services utilization in Ethiopia.