Trends in utilization of antenatal care and skilled delivery for pregnancies ending between 1995 and 2011 in rural Ethiopia: How has usage changed following implementation of the Health Extension Program?

Purpose
The Ethiopian Ministry of Health’s Health Extension Program has trained and deployed >34,000 community-based health extension workers (HEW) throughout rural Ethiopia since its implementation in 2003.  Despite these successes, few studies have assessed the impact of HEW deployment on antenatal care (ANC) and skilled delivery utilization in rural Ethiopia using nationally-representative samples such as the Demographic and Health Surveys (DHS) used here.

Methods
We pooled data from the 2000, 2005, and 2011 Ethiopia DHS, which cover pregnancy history for births occurring from 1995-2011 in rural areas (n=17,718).  We fitted logit models to estimate the likelihoods of: (1) having ≥4 ANC visits and (2) use of skilled delivery among rural women for each birth year.  We used the midpoint of the observed period (2003) as the reference year.  We controlled for maternal characteristics, household characteristics, and region of residence. 

Results
Rural women who gave birth in 2004 (odds ratio [OR]=1.61, p=0.005) and from 2006-2010 (OR range: 2.81-2.41, all p<0.05) were more likely to have ≥4 ANC visits than those who gave birth in 2003.  Although estimates for all birth years for utilization of skilled delivery were not significant at the 5% level, women who had ≥4 ANC visits were also 3.04 times more likely to have skilled delivery (p<0.001).

Conclusions
We found that ANC utilization among rural Ethiopians was generally higher in the years following HEW deployment compared to 2003, but we did not find differences in skilled delivery utilization.  Future efforts should focus on increasing skilled delivery service use.