The principal objective of the Ethiopia Demographic and Health Survey (DHS) is to provide current and reliable data on fertility and family planning behavior, child mortality, children’s nutritional status, the utilization of maternal and child health services, and knowledge of HIV/AIDS. This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Authority to plan, conduct, process, and analyze data from complex national population and health surveys. Moreover, the 2000 Ethiopia DHS is the first survey of its kind in the country to provide national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. As part of the worldwide DHS project, the Ethiopia DHS data add to the vast and growing international database on demographic and health variables. The Ethiopia DHS collected demographic and health information from a nationally representative sample of women and men in the reproductive age groups 15-49 and 15-59, respectively. The Ethiopia DHS was carried out under the aegis of the Ministry of Health and was implemented by the Central Statistical Authority. ORC Macro provided technical assistance through its MEASURE DHS+ project. The survey was principally funded by the Essential Services for Health in Ethiopia (ESHE) project through a bilateral agreement between the United States Agency for International Development (USAID) and the Federal Democratic Republic of Ethiopia. Funding was also provided by the United Nations Population Fund (UNFPA).

Analysis unit

Woman, Birth, Child, Man, Member

Universe

Women age 15-49, Births, Children age 0-4, Men age 15-59, All persons

Kind of data

Demographic and Household Survey [hh/dhs]

Sampling procedure

MICRODATA SOURCE: Central Statistical Authority [Ethiopia] and ORC Macro.

SAMPLE UNIT: Woman SAMPLE SIZE: 14070

SAMPLE UNIT: Birth SAMPLE SIZE: 39881

SAMPLE UNIT: Child SAMPLE SIZE: 9861

SAMPLE UNIT: Man SAMPLE SIZE: 6033

SAMPLE UNIT: Member SAMPLE SIZE: 67540

Mode of data collection

Face-to-face [f2f]

Background: Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time.Methods: The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro International, USA in 2005, 2011, and 2016. A negative binomial with random effects at cluster level was used to model the number of ANC visits whereas a multilevel binary logistic regression modeled binary responses relating to whether a woman had at least 4 ANC visits or not. The model estimates were obtained with the statistical software Stata SE 15 using the restricted maximum likelihood method.Results: Although the median number of ANC visits significantly increased between 2005 and 2016, the majority of the women do not obtain the four ANC visits during pregnancy as recommended. The odds of having at least four ANC visits were significantly lower among women: below 20 years, those living in the rural areas, having higher birth order, or Muslim. In contrast, higher educational attainment, higher socio-economic status, exposure to mass media, and self-reporting decision empowerment were significantly associated with having at least four ANC visits.Conclusion: The use of ANC visits is driven mostly by the social determinants of health rather than individual health risk. The importance of the various SDHs needs to be recognized by Ministry of Health policy and program managers as a key driving force behind the country's challenges with reaching targets in the health agenda related to maternal health, particularly related to the recommended number of ANC visits.