Hindawi

Journal of Pregnancy
Volume 2023, Article ID 9031344, 5 pages
https://doi.org/10.1155/2023/9031344

Research Article
Disparities in Antenatal Care Visits between Urban and Rural
Ethiopian Women

Senahara Korsa Wake ,1 Abera Botore,2 Ahmed Mohammed,3 Kolato Gemede,2

Moyata Bariso ,4 and Urge Gerema4
1
College of Natural and Computational Sciences, Ambo University, Ambo, Ethiopia
2
Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
3
Department of Health Communication and Health Behavior, Jimma University, Jimma, Ethiopia
4
Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia

Correspondence should be addressed to Senahara Korsa Wake; [email protected]

Received 28 March 2023; Revised 14 August 2023; Accepted 16 September 2023; Published 27 September 2023

Academic Editor: Süleyman Cemil Oğlak

Copyright © 2023 Senahara Korsa Wake et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Background. Utilizing antenatal care is one of the best ways to identify issues that are already present or could arise throughout
pregnancy. Despite increased efforts to expand health services and antenatal care utilization, less is known regarding antenatal
care disparities across different population segments. Therefore, the purpose of this study was to assess the degree of
discrepancies between urban and rural Ethiopian pregnant women’s use of antenatal care. Methods. A total sample of 3927
women who gave birth to living children between 2014 and 2019 was included in the study from the 2019 Ethiopia Mini
Demographic and Health Survey. Negative binomial Poisson’s regression was adopted to analyze the data. Results. The
majority of pregnant women (73.8%) attend at least one antenatal care. Pregnant women in rural areas visited fewer number of
antenatal care (68.36%) than those in urban areas (90.1%). Women with age range of 30-40 (IRR: 4.56, 95% CI: 1.07-19.34),
women with attending incomplete primary education (IRR: 0.05, 95% CI: 0.02-0.12), women with attending complete primary
education (IRR: 0.17, 95% CI: 0.07-0.42), women from middle-income households (IRR: 0.12, 95% CI: 0.06-0.24), women from
richer household (IRR: 0.26, 95% CI: 0.14,0.5), women from the richest household (IRR: 0.45, 95% CI: 0.24-0.86), and
pregnant women from rural areas (IRR: 0.615, 95%: 0.56-0.67) were observed to be linked with the frequency of antenatal care
visits. Conclusion. In Ethiopia, three-fourths of pregnant women attend at least one antenatal care. Place of residence,
educational attainment, age in five years’ group, and wealth index for urban/rural were related to the frequency of antenatal
care visits.

1. Introduction care, skilled care at birth, and postnatal care for mother and
baby could avert half of under-five fatalities, which happen
According to the World Health Organization (WHO), among newborn newborns [4]. The high maternal mortality
“every pregnant woman and newborn receives quality care rate in many parts of the world is a result of unequal access
throughout the pregnancy, childbirth, and postnatal period” to high-quality medical care. In 2015, problems from preg-
[1]. Utilizing antenatal care (ANC) is one of the best nancy and childbirth killed almost 303000 women and ado-
methods for spotting issues that are already present or could lescent girls [5].
arise during pregnancy [2]. Preparation for birth, evaluation According to the WHO, ANC is the care given to preg-
of the mother and fetus, information on pregnancy risk indi- nant women and teenage girls by trained medical profes-
cators, nutritional counseling, and detection and manage- sionals to ensure the best conditions for mother and child
ment of obstetric difficulties are all included in ANC [3]. during pregnancy [6]. A woman who attends at least 8
However, achieving a high coverage of high-quality prenatal ANC visits has a 61-time lower risk of dying from
2 Journal of Pregnancy

pregnancy-related causes than one who attends no ANC richer, and richest), each comprising 20% of the popula-
visits [7]. A study on the use of ANC services in Ethiopia tion [13].
revealed regional variations in the outcomes. The percentage
of ANC services used ranged from 25% to 96% in the Somali 2.4. Data Processing and Analysis. Information was gathered
region and Addis Ababa, respectively [8]. from all qualified women aged 15 to 49. Inquiries about
Even though expanded efforts to promote access to these women’s backgrounds, reproductive processes, use of
healthcare and ANC usage are crucial for further improving contraception, pregnancies, and postpartum care were the
mother and child health, less is known regarding discrepan- main subjects of the questions.
cies in ANC among different segments of the population, The 2019 EMDHS interviewers recorded the inter-
and factors impacting the use of these services should be rec- viewees’ responses using tablets. The computer-assisted per-
ognized [9–11]. Therefore, this study used data from the sonal interviewing system’s remote electronic file transfers,
2019 Ethiopia Mini Demographic and Health Survey to including the transmission of assignments from supervisors
explore the scope of urban-rural discrepancies in the use of to interviewers and completed questionnaires from inter-
ANC services and factors that can be linked to the observed viewers to supervisors, were made possible by the tablets’
variations. Bluetooth technology. The electronic data collection system
deployed in the 2019 EMDHS was developed by the DHS
2. Materials and Methods Program using the mobile version of the Census and Survey
Processing (CSPro) System [10]. First, a statistical test was
2.1. Study Area and Data Source. The study was done in performed on SPSS version 25 using Poisson’s regression
Ethiopia. Ethiopia is home to various ethnic groups and cul- to determine whether overdispersion exists. We detected a
tural diversity, with its population speaking more than 80 potential problem with overdispersion with a scale factor
different languages. There are two city administrations and (value/DF) greater than 1. Then, we used negative binomial
nine regional states in Ethiopia [9, 12]. The 2019 EDHS, Poisson’s regression for the analysis, which can handle the
which is publicly accessible at http://www.dhsprogram problem.
.com/, served as the source of the data.
2.2. Study Population, Sample Size, and Sampling Procedure. 3. Results
The sample for the 2019 EDHS was made to offer estimates
3.1. Sociodemographic Characteristics of Participants. The
of important indicators for the nation overall, for urban and
current study showed that overall three-fourths (73.8%) of
rural areas separately, and for each of the nine regions and
pregnant women visit at least one antenatal care. Pregnant
the two administrative cities. The sample was selected in
women in rural areas had 68.36% fewer antenatal care visits
two stages.
on average than those in urban areas (90.1%). As we can see
In the first stage, 305 enumeration areas (93 in urban
from Table 1, about 74.8% of the women were from rural
areas and 212 in rural areas) were chosen using a probability
Ethiopia. Only 25% of pregnant women in rural Ethiopia
proportional method. From January to April 2019, a house-
received at least four ANC visits during their pregnancies,
hold listing operation was conducted in each of the desig-
compared to 25% of women living in urban areas, where
nated enumeration zones. In the second round of selection,
9% of pregnant women received at least four ANC visits.
a specified number of 30 households per cluster were chosen
The mean age of women who gave birth in five years was
from the newly produced household listing with an equal
34.62 (standard deviation of ±7.63) years. Approximately
likelihood of systematic selection. All females between the
30.8% of women were within the age range of 25–29 years.
ages of 15 and 49 were eligible to participate in the survey [9].
Over 51.9% of the women had no education, while 28.1%
had incomplete primary education. With regard to wealth,
2.3. Study Variables and Data Analysis. The number of ANC 23.6% of the women fell in the wealthiest quintile, and
visits each woman had during her most recent pregnancy 28.1% were grouped in the poorest quintile.
served as the response variable. Residence, educational level, Urban residence areas had a larger mean number of
educational standing of the husband, age of the women, ANC visits (5.32) than rural residence areas (2.62). The
autonomy of women for health care, wealth index for mean number of ANC visits varied significantly by age
rural/urban, age in 5-year groups, birth order number, and group, with women in the 30 to 34 age group having
area were independent factors included in the study. the highest number of visits (3.47), while women in the
45 to 49 age group had the lowest mean number of visits
2.3.1. Wealth Index. We gave scores to households according (1.94). Women with a complete secondary education had
to the number and types of consumer goods they own, rang- the highest mean number of ANC visits (7.73) compared
ing from a television to a bicycle or car, and housing fea- to women with no education (2.14). Women who lived
tures, including flooring materials, toilet facilities, and in households with the highest household wealth index
source of drinking water. National wealth quintiles are com- had the highest mean numbers of ANC visits (4.74)
piled by assigning the household score to each usual house- (Table 1).
hold member, ranking each person in the household
community by individual score, and after separating the dis- 3.2. Factors Related to ANC Visits during Pregnancy. To
tribution into five equal categories (poorest, poorer, middle, investigate factors related to ANC visits, negative binomial
Journal of Pregnancy 3

Table 1: Sociodemographic characteristics and the number of pregnant women who visit ANC services.

Variable Category n % Mean (95% CI)

Urban 1004 25.2 5.32 (4.67,5.97)
Place of residence
Rural 2975 74.8 2.62 (2.46,2.78)
15-19 246 6.2 2.79 (1.99,3.6)
20-24 808 20.3 3.31 (2.89,3.74)
25-29 1225 30.8 3.46 (3.1,3.82)
Age 30-34 809 20.3 3.38 (2.95,3.81)
35-39 558 14 3.47 (2.77,4.17)
40-44 247 6.2 2.85 (2.03,3.66)
45-49 86 2.2 1.94 (1.5,2.39)
No education 2065 51.9 2.41 (2.18,2.63)
Incomplete primary 1119 28.1 3.67 (3.24,4.09)
Complete primary 187 4.7 4.77 (3.32,6.22)
Educational attainment
Incomplete secondary 336 8.4 4.78 (3.97,5.5)
Complete secondary 40 1 7.73 (3,12.45)
Higher 232 5.8 5.42(4.58,6.26)
Poorest 1119 28.1 1.96 (1.6,2.31)
Poorer 606 15.2 2.66 (2.31,3.01)
Wealth index Middle 642 16.1 3.42 (2.89,3.94)
Richer 673 16.9 3.97 (3.4,4.54)
Richest 939 23.6 4.76 (4.3,5.23)
Orthodox 1264 31.7 4.14 (3.76, 4.52)
Catholic 25 0.6 2.08 (1.47, 2.69)
Protestant 780 19.6 2.84 (2.56, 3.12)
Religion
Muslim 1862 46.8 2.99 (2.66, 3.33)
Traditional 35 8.8 1.26 (0.59, 1.92)
Other 13 0.3 1.77 (0.78,2.76)

regression was used. Type of residence, educational attain- had at least four ANC visits during their pregnancies. When
ment, age in five years’ group, and wealth index for urban/ compared to earlier Ethiopian demographic health surveys
rural were related to the ANC visits during pregnancy at p conducted in 2000, 2005, 2011, and 2011, which found that
value < 0.05. Women between the ages of 30 and 34 had 27.6%, 28.2%, 34.5%, and 62.9% of women lived in urban
7% more prenatal care visits than women between the ages areas, respectively, nearly half of the pregnant women had
of 15 and 19 (IRR: 4.56, 95% CI: 1.07-19.34). Compared to at least four ANC visits. This indicates an increase in ANC
women who had no education status, women who attended utilization [14]. This improvement may be due to increased
incomplete primary education and complete primary educa- awareness creation activities, health promotion, health cov-
tion had higher antenatal care visits (IRR: 0.05, 95% CI: erage, and skilled health professional increment in rural
0.02-0.12; IRR: 0.17, 95% CI: 0.07-0.42), respectively. On area. There were still disparities from region to region and
the other hand, women from household’s middle-income, from rural to urban regarding antenatal care visits. This
richer household, and richest household had more antenatal might result from inequalities in accessibility of maternal
care visits compared to women from poorer families (IRR: and child health, the disparity in the number/skill and com-
0.12, 95% CI: 0.06-0.24; IRR: 0.26 (0.14, 0.5); IRR: 0.45, mitment of health professionals of access to education,
95% CI: 0.24-0.86), respectively. Furthermore, pregnant absence/poor transportation, and country policy and pro-
women from urban areas visited antenatal care more fre- gram implementation differences between rural and urban
quently than women from rural areas (IRR: 0.615, 95% regarding maternal health services.
0.56-0.67) (Table 2). In this study, place of residence, educational attainment,
age in five years’ group, and wealth index for urban/rural
4. Discussion were associated with the number of ANC visits during preg-
nancy. The present study showed that women aged groups
The current study found that a significant portion of the par- 30 to 34 and 40 to 44 years had seven and three percent
ticipants (three-fourths of the women) were from rural Ethi- more ANC visits compared to women aged 15-19 years,
opia, and only one-third of pregnant women in these areas respectively. This finding was supported by studies done in
4 Journal of Pregnancy

Table 2: Results of negative binomial regression.

Variable Category IRR (95% CI) p value

15-19 1
20-24 2.34 (0.46, 11.8) 0.304
25-29 3.95 (0.91, 17.15) 0.067
Age 30-34 4.56 (1.07, 19.34) 0.040∗
35-39 4.21 (0.97,18.28) 0.055
40-44 4.61(1.03, 20.66) 0.046∗
45-49 2.47 (0.49, 12.51) 0.275
No education 1
Incomplete primary 0.05 (0.02, 0.12) <0.001∗
Complete primary 0.17 (0.07, 0.42) <0.001∗
Educational attainment
Incomplete secondary 0.52 (0.15,1.84) 0.312
Complete secondary 0.53 (0.18,1.58) 0.254
Higher 10.04(1.12,89.71) 0.039∗

Poorest 1
Poorer 0.06 (0.03,0.12) <0.001∗
Wealth index Middle 0.12 (0.06, 0.24) <0.001∗
Richer 0.26 (0.14,0.5) <0.001∗
Richest 0.45 (0.24,0.86) 0.016∗
Rural 1
Place of residence
Urban 0.615 (0.56-0.67) <0.001∗
∗
Significance at 5%. IRR: incidence rate ratio.

different countries [14–16] that showed the association sample size and a wide geographic scope are some of the
between increased age and antenatal care visits of the strengths of the study.
women. Birth complications and health conditions of the
women are higher in older women which increase the 5. Conclusion
demand for antenatal care visit. Additionally, the current
study found that women who attended school had more The current study showed that overall three-fourths (73.8%)
antenatal care visits than women who did not attend school. of pregnant women visit at least one ANC. Pregnant women
This study is in line with the study done in Ghana [17] and in rural Ethiopia experienced fewer ANC visits on average
Congo [18]. than those in urban. Type of residence, educational attain-
Furthermore, the results of negative binomial regression ment, age in five years’ group, and wealth index for urban/
showed that the wealth index of the household had a signif- rural were related to the frequency of ANC visits during
icant effect on a number of ANC visits during pregnancy. pregnancy.
The pregnant women from middle income had twelve per-
cent more likely to visited ANC when compared to pregnant Data Availability
women from poor households. Similarly, pregnant women
from richer households and richest households had fourteen The data used in this study is publicly available at https://
and twenty-four percent more antenatal care visits when dhsprogram.com.
compared to women from poor households. The finding is
similar to studies conducted in different countries [19, 20]. Conflicts of Interest
The current study also showed that, compared to women
from rural areas, women from urban areas had 61 percent The authors of this study declare that they have no compet-
more antenatal care visits. ing interests.

4.1. Limitation of the Study. The nature of the data from Authors’ Contributions
EDHS is cross-sectional type in which the temporal relation-
ship between the outcome variable and predictors could not SKW is involved in conceiving idea, study design, and for-
be assessed; EDHS data is a questionnaire-based survey that mulation of methodology. AB, AM, KG, MB, and UG are
could recall biased and incomplete data. The use of a large substantial to data analysis, interpretation, writing the
Journal of Pregnancy 5

manuscript, and managing the overall process of the study. [12] J. Chataut and S. Jonchhe, “Rural mountainous area of Nepal: a
The final manuscript was read and approved by all authors. community based cross sectional study,” Kathmandu Univer-
sity Medical Journal, vol. 18, no. 4, pp. 407–413, 2022.
[13] Ethiopian Public Health Institute (EPHI) and International
Acknowledgments Coaching Federation, “Ethiopia Mini Demographic and
Health Survey 2019: Final Report,” 2021 https://dhsprogram
We would like to thank the Central Statistical Agency for .com/pubs/pdf/FR363/FR363.pdf.
providing the data. [14] M. Arefaynie, B. Kefale, M. Yalew, B. Adane, R. Dewau, and
Y. Damtie, “Number of antenatal care utilization and associ-
ated factors among pregnant women in Ethiopia: zero-
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