Utilization of Maternity Services and Associated Factors among Women 1 Living in Addis Ababa Ethiopia Nifas Silk Lafto Sub-city, Woreda 1 2

1 Background: Maternal health service is the health service provided to mothers (women in 2 their child bearing age). In Ethiopia mothers and children make up over 2/3 rd of the whole 3 population. Most pregnant women in developing world receive insufficient or no prenatal 4 care and deliver without the help of appropriately trained health care provider. The situation 5 in countries like Ethiopia is worsened by different factors such as poor infrastructure and lack 6 of accessibility to health facilities. Taking this into account this study mainly focuses on the 7 utilization of maternal service and associated factors among women living in selected villages 8 in Nifas silk Lafto, Woreda 1. 9 Method: A community based cross-sectional study design was used to assess the utilization 10 of maternal health service utilization and associated factors from January to March 2020. 11 Mothers who gave birth in the past five years were included in the study. A pre tested 12 Interview administered questionnaire was used for data collection; Data was coded, entered 13 and analyzed using SPSS version 23. 14 Result: The result showed that there is 38.6% maternal health service utilization practice. 15 Avail ability of health facility ( OR: 0.489, 95%CI(0.282,0.847), ) and accessibility (OR: 3.130, 16 95%CI (1.390,7.048) are found to have significant association with maternal health 17 utilization practice. 18 Conclusion: The finding revealed that the majority of the respondents have poor maternal health service utilization practice; it’s also indicated the majority of the respondents don’t 20 have knowledge regarding danger signs of pregnancy and the risks associated with pregnancy 21 and child birth.

have an impact on health conditions and outcomes(4). Among young women (aged 20-24), 22 12 percent gave birth by age 18, nearly 240 babies die each day before reaching their first month; 13 258 stillbirths occur every day(3). The poor health and nutrition of women and the lack of care 14 that contributes to their death in pregnancy and child birth also compromise the health and 15 survival of the infants and children they leave behind(5).

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The link between early and regular attendance of antenatal care and health facility delivery and 18 improved maternal health outcomes has been documented for a considerable time. However, at 19 least half of all births in developing countries occur in the absence of skilled birth attendants. 20 This is largely influenced by socio-cultural factors, lack of understanding on the importance of 21 skilled attendance at birth, financial hardship and physical accessibility to health facilities(6).. The health policy of Ethiopia emphasizes universal access for all segments of population, and 9 geographic coverage by health services is estimated to be 89% in 2010 (8) woreda 1 with population number of 39512 which is 13.84% of the sub city population. Even 11 though the number of individuals is relatively high in woreda 1. Due to poor infrastructure and 12 rapid urbanization pregnant women are unable to access health service facilities which make the 13 area more favorable for conducting the study. The study was conducted from January to March 14 2020. The study was conducted on women who live in selected villages in woredas 1, Nifas Silk/ Lafto 8 sub city who are mothers of < 5 children. Since there were no researches conducted on similar setting by taking P=50%, α= 5%, Z α/2= 1 1.96, margin of error (d) = 5% and applying single population proportion formula. The 2 calculated sample size = 384 3 By applying finite population correction formula, multiplying the calculated sample size by 4 design effect and adding 10% non response rate the final sample size was found to be = 302 5 Proportional allocation was used and 129 participants were selected from Dulamariam, 86 from 6 Eartu Abo and 87 from Teklehaymanot, the participants from each stratas were selected 7 randomly. Stratified sampling technique was used among the residents in woreda1 Nifas silk Lafto sub 10 city, Addis Ababa Ethiopia, the stratas were selected by using purposive sampling technique and 11 the stratas were defined by geographic location. The selected stratas are Eartu Abo,

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Teklehaymanot and Dulamariam and women in a reproductive age group who were pregnant 13 during the time the data collection or who gave birth in the past five years were selected 14 randomly.  Interview-administered questionnaire was prepared in English and translated into Amharic and 9 data collectors who can also communicate inAffan Oromo, the local language of the study area 10 were included. A one day training regarding the data collection was given to the data collectors.

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The Amharic and the English Versions of the questionnaire was communicated. The inclusion 12 and Exclusion criteria of the study participants was also be described.. Any difficulty in 13 understanding the questions or a language barrier among the study participants was well handled 14 by the data collectors. The questionnaire include questions about socio-demographic 15 characteristics, maternity service utilization practice, quality of care related questions. Data were coded and entered in to data entry and analysis software SPSS version 23 and was 2 checked for missing values, incompleteness and mistakes during the data entry process. During 3 analysis the variables were defined and frequencies of different variables were calculated. Cross 4 tabulation was used to test the presence of relationship between two or more variables. Descriptive statistics was by using proportion with percentages also bar graphs and pie charts 6 were used. The association between the dependant variable with each of the independent 7 variables was analyzed at 95% CI using bivariate analysis .variables with a p-value of < 0.25 8 were taken to the multivariable analysis model and association of the variables with the 9 independent variable was assessed in the presence of confounders.

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Characteristics of the study area and population 12 A total of 298 mothers of < 5 children, who live in the selected three villages in woreda 1, Nifas 13 silk lafto sub city, participated in the study giving a response rate of 98.6%. In the study 85 14 participants were included from Eartu abo, 126 from Dula mariam and 87 from Tekle haymanot.

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The findings showed that majority (43.3%) of the respondents are in the age group of 24-29 with 16 a mean age of 28. More than half of the respondents 159(53%) got married when they were in showed that majority of the husband and the mother's are not employed and 1.7% of the mother 22 1 monthly income is less than 1000ETB only 11 (3.7%) reported they earn greater than 4000 ETB.

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The table below show the socio demographic characteristics of the study participants.      The maternal health service utilization practice for the three villages when observed separately is 2 indicated in the figure below.   Maternal health is one of the prior agendas in any development goals this is due to the fact that 3 women comprise more than half of the total population and most of the problems faced during 4 pregnancy and child birth could be prevented by following certain measures. It is also known to 5 have economical implication since it is one way of saving a huge out of pocket money that might 6 be lost due to morbidity and mortality associated with pregnancy and birth.

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The finding from this research revealed that there is 38.6% maternal health service utilization 1 practice and 61.4% poor practice. The poor practice is found to be associated with accessibility 2 of health facility nearby, transportation system to the nearest health facility study also indicates that the odds of having good practice is three times greater for those who 10 travel by car than those who travel by walking 11 Early marriage is found to be prevalent among 58(19.5%) of the respondents. which is illegal as 12 per the revised Ethiopian family code of Article 7 which stated that "Neither a man nor a woman 13 who has not attained the full age of eighteen years shall conclude marriage."(32) which is shown 14 to have an impact on educational status of the mother's in which 74% are found to have no 15 formal education or can only read and write .The mean age at marriage is found to be 20 yr with 16 a minimum of 10 year and maximum of 33 years.

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In addition to having early marriage, the mean and median age at first pregnancy was found to be On utilization of ANC service WHO recommends at least four ANC visit as a standard. EDHS 4 report showed that only 20% of women had their ANC during the first trimester, 26% during 5 their fourth to fifth month of pregnancy, and 14% during their sixth to seventh month of 6 pregnancy. Two percent of women did not receive any ANC until the eight month of pregnancy 7 or later(15). Here in this study 72.1% reported they had at least four follow up visits during their 8 pregnancy, 13.4% started when they were 1-3 months, 45% started when they were 4-6 months 9 and 37.6% did not start follow up until they were 7-9months in to their pregnancy. This figure is  32.9% mother's answered they did not know they had to take the visit, 3.7% mother's answered Birth Spacing which represents the age difference between children of consecutive pregnancies 5 was also assessed and the average spacing was found to have a mean of two years, minimum 1 6 year and maximum of 12 years. Evidence from systematic reviews and meta-analyses indicates 7 that short and long intervals between pregnancies are independently associated with increased 8 risk of adverse maternal, perinatal, infant, and child outcomes Inter pregnancy intervals shorter 9 than 18 months and longer than 59 months are associated with increased risk of adverse prenatal 10 outcomes spacing longer than 59 months is associated with preterm birth, low birth-weight and 11 short intervals are associated with increased risk of premature membrane rupture utero-placental The authors would like to thank Ethiopian Catholic University of La Salle as the research 13 was conducted with the financial and material support from the university. Also we 14 would like to thank the study participants, data collectors, supervisors and everyone who 15 has contributed for the completion of the research.