Socio demographic characteristics
A total of 15,683 reproductive-age women were included in the final analysis of the study. The median age of women was 27 with (IQR: 20 to 35) years, nearly two-thirds (67.5%) of women gave birth in the past at which 18 years is the median time to the first birth. More than three fourth (77.8%) were rural dwellers, 47.8% of women had no formal education, 63.8% were married, 46.3% rich wealth index, 43.2% were orthodox religion followers. The majority (94.7%) of women had no health insurance coverage, among interviewed women, 7.2% of them were pregnant during data collection and 41.6% of them visited health facilities in the past 12 months (Table 2).
Table 2: Socio demographic and reproductive characteristics of women who aged 15-49 years in Ethiopia, 2016 (n=15,683)
Characteristics
|
Category
|
Frequency
|
Percentage
|
Age in years
|
15-19
|
3381
|
21.6
|
20-34
|
8064
|
51.4
|
35-49
|
4238
|
27
|
Residence
|
Urban
|
3476
|
21.2
|
Rural
|
12207
|
77.8
|
Religion
|
Orthodox
|
6786
|
43.3
|
Muslim
|
4893
|
31.2
|
Protestant
|
3674
|
23.4
|
Other
|
330
|
2.1
|
Education level
|
No formal education
|
7498
|
49
|
Primary school
|
5490
|
35
|
Secondary school
|
1818
|
11.5
|
Diploma and above
|
877
|
5.5
|
Marital status
|
Never married
|
4037
|
25.7
|
Married/living together
|
10223
|
65.2
|
Divorce/widowed/separated
|
1423
|
9.1
|
Wealth index
|
Poor
|
5442
|
34.7
|
Middle
|
2978
|
19
|
Rich
|
7263
|
46.3
|
Gave birth in the last five years
|
Yes
|
7590
|
48.4
|
No
|
8093
|
51.6
|
Place of delivery (n=7,590)
|
Home
|
5066
|
66.7
|
Health facility
|
2524
|
33.3
|
Had ANC follow up(n=7,590)
|
Yes
|
2818
|
37.1
|
No
|
4772
|
63.9
|
Contraceptive use and intention
|
Yes
|
3974
|
25.34
|
No
|
11,708
|
74.66
|
Visited health facility in the last 12 months
|
Yes
|
6526
|
41.6
|
No
|
9157
|
58.4
|
Sex of household head
|
Male
|
11960
|
76.3
|
Female
|
3723
|
23.7
|
History of abortion
|
No
|
14447
|
92.1
|
Yes
|
1326
|
7.9
|
Working status
|
Working
|
5220
|
33.3
|
Not working
|
10463
|
66.7
|
Ever heard of fistula
|
Yes
|
5990
|
38.4
|
No
|
9625
|
61.6
|
Health insurance coverage
|
Yes
|
830
|
5.3
|
No
|
14853
|
94.7
|
Currently pregnant
|
No
|
14,547
|
92.8
|
Yes
|
1,135
|
7.2
|
Correlation between perceived barriers of health care access and reproductive health services
The chi-square analysis result showed that there is a correlation between reproductive health service (contraceptive utilization history, place of delivery and previous ANC follow-up). The reproductive variables cannot be included in the GEE marginal analysis model because no use of these services may not be an indicator of health care perceived barriers (Table 3).
Table 3:- The association between perceived barriers and reproductive health services using EDHS 2016
Reproductive health services
|
perceived barriers of health care access
|
Chi-square(1)
|
p-value
|
Big problem
|
Not a big problem
|
Contraceptive utilization history
|
Yes
|
8051
|
5151
|
252
|
<0.001
|
No
|
2033
|
448
|
Place of delivery for the recent child
|
Institution
|
1351
|
1247
|
471
|
<0.001
|
Home
|
3493
|
902
|
Had previous ANC follow up
|
Yes
|
3011
|
1701
|
252
|
<0.001
|
No
|
2033
|
448
|
Perceived barriers of health care access among reproductive age women
In this study, more than two-third (69.9%, 95%CI: 69.3 to 70.7) of reproductive-age women had at least one perceived barrier to access health care, of which, money (54.8%), distance of health facilities (50.3%) were the commonest barriers mentioned. Furth more, out of currently pregnant women during data collection period, about 73% of them had perceived barriers of health care access. Of the parameters used to assess perceived barriers of health care access, about 21.5% of women had multiple barriers (money, distance, companionship, and permission) (Figure 1).
Factors associated with perceived barriers of health care access
The result of the bi-variable analysis showed that all explanatory variables were associated with the perceived barriers of healthcare access at 20% level of significance. The final multivariable generalized estimated equation (GEE) model showed that variables such as residence, marital status, age group, educational level, wealth index, and health insurance were significant determinants of health care perceived barriers at 5% level of significance (Table 4).
Table 4:- Bivariable and multivariable generalized estimating equation (GEE) regression analysis reproductive age group women in Ethiopia, 2016 (n=15,683)
Characteristics
|
Health care access problem
|
Crude odds ratio (95%CI)
|
Adjusted OR (95%CI)
|
Yes
|
No
|
Residence
|
|
|
|
|
Urban
|
1584
|
1892
|
1
|
1
|
Rural
|
9392
|
2814
|
4.00(3.40 , 4.70)
|
2.13(1.79,2.53)*
|
Household head
|
|
|
|
|
Male
|
8466
|
3495
|
1
|
1
|
Female
|
2511
|
1211
|
1.11(1.04,1.19)
|
1.05(0.97,1.11)
|
Marital status
|
|
|
|
|
Married/living together
|
7345
|
2877
|
1
|
1
|
Never married
|
2592
|
1443
|
0.98(0.91,1.06)
|
1.13(0.95,1.25)
|
Divorced/widowed/ separated
|
1038
|
384
|
1.37(1.22,1.54)
|
1.34(1.17,1.54)*
|
Age group
|
|
|
|
|
15-19
|
2291
|
1089
|
1
|
|
20-34
|
5582
|
2481
|
1.014(0.94,1.09)
|
1.06(0.99,1.23)
|
35-49
|
3103
|
1135
|
1.21(1.11,1.32)
|
1.24(1.09,1.40)*
|
Level of education
|
|
|
|
|
Diploma and above
|
349
|
527
|
1
|
1
|
No formal education
|
5847
|
1650
|
2.74(2.37,3.17)
|
2.30(1.95,2.72)*
|
Primary education
|
3906
|
1584
|
1.99(1.74,2.28)
|
1.84(1.58,2.15)*
|
Secondary education
|
873
|
943
|
1.33(1.17,1.52)
|
1.31(1.13,1.51)*
|
Working status
|
|
|
|
|
Working
|
3407
|
1812
|
0.96(0.90,1.02)
|
0.99(0.92,1.06)
|
Not working
|
7569
|
2893
|
1
|
1
|
Wealth status
|
|
|
|
|
Rich
|
4101
|
3161
|
1
|
1
|
Poor
|
4574
|
867
|
2.72(2.46,3.02)
|
2.09(1.86,2.35)*
|
Middle
|
2300
|
677
|
1.92(1.71,2.16)
|
1.57(1.38,1.79)*
|
Health insurance
|
|
|
|
|
Insured
|
460
|
369
|
1
|
1
|
Non-insured
|
10551
|
4337
|
1.27(1.05,1.53)
|
1.19(1.01,1.45)*
|
Gave birth in the last five years
|
|
|
|
|
Yes
|
3288
|
2804
|
1
|
1
|
No
|
5688
|
1901
|
1.07(1.01,1.14)
|
1.09(0.98,1.19)
|
Ever heard of fistula
|
|
|
|
|
Yes
|
7395
|
2229
|
1
|
1
|
No
|
3521
|
2468
|
0.73(0.68,0.78)
|
0.79(0.75,1.05)
|
* shows statistical significance at p-value less than 0.05
Those women who resides in rural areas were 2.13 times more likely to had perceived barriers of health care access compared to urban residents (AOR= 2.13, 95%CI: 1.79 to 2.53). Similarly, women aged 35-49 years, the odds of perceived barriers of health care access were 1.24 times higher compared to those aged 15-19 years (AOR= 1.24, 95%CI: 1.09 to 1.40). The likelihood of perceived barriers of health care access among divorced/separated women increased by 34% compared to those married/live together (AOR= 1.34, 95%CI: 1.17 to 1.54). The odds of perceived barriers of health care access to those who had no formal education (AOR= 2.30, 95%CI: 1.95 to 2.72), primary (AOR= 1.84, 95%CI: 1.58 to 2.15) and secondary (AOR= 1.31, 95%CI: 1.13 to 1.51) higher compared to those who attended college and above. For women who had poor and middle wealth status, the odds of perceived barriers of health care access were 2 and 1.57 times higher compared to rich women, respectively (AOR= 2.09, 95% CI: 1.86, 2.35) and (AOR=01.57, 95% CI: 1.38, 1.79). Women who had no health insurance coverage, the odds of perceived barriers of health care access increased by 19% compared to women who had health insurance(AOR=1.19, 95% CI: 1.01, 1.45) (Table 3).