Women in Tigray, Ethiopia Who Attended the Recommended Number of Prenatal Visits were More Likely to Deliver in Health Institutions

Background Saving the lives of mothers and newborns requires prompt access to appropriate health services. Ethiopia is committed to improving access to maternity care by expanding the number of health facilities and health workers. However, institutional delivery is not yet universal, even when the service is free and available within a reasonable geographic distance. Objective To identify factors associated with institutional delivery service utilization in Adigrat town, Tigray Regional State, Ethiopia. Methods We conducted a community based cross-sectional study using mixed quantitative and qualitative approaches. Employing cluster sampling, we collected quantitative data through interviewer-administered questionnaires from 767 mothers from Adigrat town who gave birth within 2 years of the study. Bivariate and multivariate logistic regressions were used to identify factors associated with institutional delivery. We also collected qualitative data with two focus group discussions, which were thematically analyzed. Ethical approval was granted by the Institutional Review Board of Mekelle University, and informed consent was obtained from each participant. Results In our sample, 81% (621) of mothers reported that their last deliveries were conducted at health institutions. Of the 682 women who received antenatal care services in their last pregnancy, 85% (580) had all 4 recommended antenatal care (ANC) visits. In multivariate analyses, institutional delivery was significantly higher among mothers who had 4 or more ANC visits (AOR= 1.99; 95%CI:1.09, 3.63) than those with fewer visits. In addition, the odds of institutional delivery were higher among mothers who conceived for first time at the age of 20-34 years than those who conceived as teenagers. The qualitative findings suggested that the increased utilization of health institutions for delivery was due to efforts made by health extension workers. However mothers who delivered at health institutions expressed concern about how they were treated by care providers and the facilities’ hygienic conditions. Conclusions Strengthening the antenatal care services and improving the quality of delivery services can potentially help achieve universal institutional delivery in Ethiopia. Keywords: Institutional delivery; Antenatal care; Health extension workers; Home delivery; professionals’ approach; Ethiopi