Factors associated with antenatal care utilization among women with disabilities in Ethiopia: Using Andersen's Behaviour Model of Health Service Use

Abstract

Quality antenatal care is critical for reducing the risk of adverse pregnancy and childbirth outcomes such as abortion, stillbirth, preterm birth, and perinatal death. However, women with disabilities continue to face numerous barriers to accessing equitable and high-quality antenatal care services in low- and middle-income countries, including Ethiopia. Therefore, this study aimed to assess antenatal care utilization and associated factors among women with disabilities in the Central Ethiopia Regional State, Ethiopia. A community-based cross-sectional study was conducted, and a multistage random sampling technique was used to recruit 572 participants. The data were collected by face-to-face interviews using structured questionnaires. The Kobocollect mobile app was used to collect the data. A multivariate analysis evaluated the significant association between the explanatory variables and the utilisation of antenatal care services. The Andersen Behavioural Model of Health Service Use framework was used to categorise the predictors of antenatal care. Only 47.3% [95% CI: 43.1, 50.7] of pregnant women with disabilities used antenatal care [ANC]. Predisposing factors like higher women's education, employment, awareness of ANC services, increasing gravidity and planned pregnancy; enabling factors like enrolling in community-based health insurance, availability of disability-inclusive health services, transportation system and health facility infrastructure; and need factor [experience of pregnancy-related complication during pregnancy] were found to have a statistically significant positive effect on ANC utilization among women with disabilities. The utilisation of antenatal care among pregnant women with disabilities was relatively low, which is attributed to predisposing, enabling and need factors. This finding underscores that the Ministry of Health and other stakeholders should pay more attention to enhancing awareness of ANC service and pregnancy planning, ensuring disabilities-sensitive healthcare services and disability-friendly health facilities and transportation to improve antenatal care services utilization by women with disabilities, which helps to meet Sustainable Development Goal 3.1, which aims to reduce maternal mortality to less than 70/100,000 live births by 2030.

Fig 1. The magnitude of antenatal care utilisation among women with disabilities in the Central Ethiopia Regional State, Ethiopia [N = 562].

Fig 2. Barriers to accessing antenatal care among women with disabilities in the Central Ethiopia Regional State, Ethiopia [n = 296].