Socio-economic Determinants of Maternal Healthcare Utilization in Addis Ababa

Background Despite progresses over the last two decades, Ethiopia is one of the countries in the world with significant number of maternal deaths and service use for antenatal, labour and childbirth is low. This study intended to identify the underlying causes of low coverage of maternal health services in Addis Ababa. Methods We conducted a comparative cross-sectional study in Addis Ababa in July 2017. A three stage sampling technique was applied to select the study population. The first step was to select study Ketenas using simple random sampling. The villages within the Ketenas were then identified, which led to the second stage of the sampling process. In the third stage, a fixed number of 20 households per village were selected with an equal probability random selection from the newly created household listing. All women aged 18–49 years who gave birth one year preceding the date of data collection were then invited to a face-to-face interview. Both multiple linear regression and logistic regression were applied to estimate crude and adjusted associations. Results Less than 45.0% of women from the poorest households received all the recommended ANC contacts at the right time, while 71.4% of women from richest households received all the recommended contacts at the right time. The majority of women from poorest households gave birth at health centres (66.2%), followed by public hospitals (30.9%). The largest proportion of women from richest households gave birth at private hospitals (46.1%), followed by public hospitals (16.1%). Meanwhile, only 52.5% of women with primary education had all the recommended ANC contacts, while 78.5% of women who completed tertiary education had all the recommended ANC contacts (p < 0.001). Women from richest households were less likely to face multiple barriers to use maternal health services as compared to women from poorest households (OR = 0.57, p = 0.032). Conclusion There is a huge inequality in maternal healthcare coverage in Addis Ababa. To achieve universal maternal health coverage, affordability of the service is not adequate although it is one of the requirements. Other underlining social determinants deserve the attention of policy makers and program designers.