Agumasie Semahegn, Gizachew Tadele Tiruneh, Alemnesh H. Mirkuzie, Mesele Damte Argaw, Nebreed Fesseha, Mikiyas Teferi, Hillina Tadesse, Addis Girma, Mebrie Belete, Chala Tesfaye, Muluken Dessalegn Muluneh, Sintayehu Abebe Woldie, Meskerem Abebaw, Rediet Daniel, Zemzem Mohammed, Yibeltal Kiflie Alemayehu, Wubegzier Mekonnen, Salsawit Shifarraw, Lidiya Tefera, Frank DelPizzo, Addis Tamire, Temesgen Ayehu, Dessalew Emaway, Misrak Makonnen
BACKGROUND: Lack of access to essential maternal health service remains a significant public health challenge in low-income countries. Gender dynamics play a critical role in determining women’s access to and use of maternal health services. We assessed the influence of gender dynamics on women’s use of maternal health services in Ethiopia. METHODS: A community-based cross-sectional study was conducted using a mixed method in 10 selected districts from the agrarian and pastoral contexts of Ethiopia. Systematic sampling was used to recruit 3,097 women to collect quantitative data using a web-based platform. Multi-level mixed-effects logistic regression analysis was carried out to identify predictors of maternal health services utilization using adjusted odds ratio (AOR) at 95% Confidence Interval (CI). Purposively selected 148 participants were interviewed, audio recorded, transcribed, and coded using ATLAS.ti software and thematically analyzed. RESULTS: The proportion of pregnant women who had antenatal care was 65.5% (95% CI: 63.8–71.0%). Most pregnant women gave birth at home (68.4%; 95% CI:66.8–70.0%). About one-third (95%CI:30.4–33.6%) attended immediate postnatal care. Women who had the autonomy to seek maternal health services, attended at least primary school, women and partner engaged in paid job, partner accompanied, strong social support, and accepting attitude towards equitable gender-norms were the factors associated with use of maternal health services. Nevertheless, women who lived in a far distance from the health facilities, had large family sizes, and live in pastoralist contexts negatively impacted maternal health services use. The old-fashioned gender-norms, lack of access to finance, fear for their safety, and a lack locally-tailored culturally-sensitive care were the barriers to maternal health service use. CONCLUSIONS: Maternal health services uptake in Ethiopia is limited and marked by huge disparity between agrarian and pastoral contexts. Geographic inaccessibility, and gender dynamics including limited autonomy, lack of culturally- and women-friendly care, inequitable gender-norms, low men’s accompaniment, and large family size affected maternal health services use. Hence, re-designing maternal health service delivery platforms to make culturally-acceptable and accessible care, transform gender barrier through enhancing women’s autonomy, encouraging male’s accompaniment, and strengthening social support are crucial in the primary setting.