Magnitude of maternal health services
In this study, 66.1% pregnant women were attended the recommended ANC visits which was consistent with different studies(17–20). However, it was lower than studies in South Asia and Sub-Saharan Africa (18), Debre Berhan(21) and Northern Bangladesh(22). But, it was higher than evidence in Pakistan(23), Ratanakiri(24), Khammouane(25), Sub–Saharan Africa(26), EDHS-2014(27), Arbaminch(28), West Gojjam(29) and Tigrary(30). This is due to variability of socio-demographic, wealth status of the nations, availability and accessibility HFs and medical equipment’s in the health system.
This study revealed that 58.3% of birth attended by skilled providers which was consistent with other study(23). This finding was lower than study in Cambodia(19); Tanzania(31); Bihar(20). Whereas, it was higher than evidence in Ratanakiri(24), Khammouane(25), West Gojjam(29) and South Ethiopia(28). This discrepancy might be due to variation of culture, belief, time of study and design. However, reason mention for facility delivery, the main reasons for home delivery: labour was going well and being feel more comfortable at home delivery which were consistent with study done in West Gojjam(29).
This study found that 58.6% of women received the recommended PNC visits, which was lower than study in Pakistan(23), Sub – Saharan Africa(26) and Ghana(32). Whereas, it was higher than study in West Gojjam(29), Ratanakiri(24), Arbaminch(28) and Khammouane(25).
Determinant of maternal health services
In this study, women who had information on MHS were two times higher to receive recommended ANC visits which was supported by studies conducted in different setting (5, 8). Women who had history of pregnant related problems and stillbirth were two times higher to completed whole visits of ANC which was supported by other study(9). This is because prior bad experiences give good lesson for women that encourage them to consult health professional during pregnancy.
Similarly, women who had decision making power were almost two times higher to receive the recommended ANC visits. This finding is consistent with study done in Nigeria(6). This might be because if the household resources are controlled by others and no power to decide on their resources, women do not have the freedom to access health services whenever they need care. Education of women was positively significant effect on the utilization of institutional delivery services which was supported by other studies(1, 5, 6, 9, 10). This positive correlation can be explained by the fact that educated women are more aware on the importance of medical services to their mothers. Household wealth index is strongly linked to place of delivery: as household wealth index increases, the uptake of institutional delivery service is also increase. This evidence is supported by different studies(1, 5–7, 11).
Uptake of PNC service is directly related with partner education which showed a positive association which was consistent with other studies(5, 6, 12). This is because educated husbands may have a better understanding on the benefit of maternal health services. Similarly, receiving the recommended, timely initiation of ANC visits and skilled delivery are strongly significant association with utilization of PNC. This evidence is strongly supported by SRMA pooled result(33) and other studies(4–6).
Generally, the coverage of ANC 4th visits, skilled delivery and PNC services were low as compared with national target. This study explored different individual and community level factors that influenced utilization of the services which had important programmatic implication. Hence, we strongly recommended that reinforcing women’s autonomy and community based interventions to enhance utilization of maternal health services.