All of 561 women who had children less than one year old were responded to the questionnaire by making the response rate of 100%. Greater than half (59.2%) of the respondents were in the age group of 25–34 with a mean age of 28.53 + 5.3 years. Nearly more than half (52%) of the participants had attended formal education and the rests were never attended formal education. About 42% of the respondents were orthodox religion followers, 98.8% of them were farmers in occupation and 87.9% were Oromo in ethnicity. Regarding number of children, half of the respondents had 1–3 children with the mean number of children 3.65 + 0.967 and about 2/3 of the husbands were attended primary and above school respectively [Table: 1].
Accessibility of the health facilities and source of information
The nearest health facility takes the about 30–60 minutes per a trip, with the mean time of 57 + 44.5 minutes and almost 98% of the respondents went to the health facility on foot to get the maternal health services. Regarding sources of information about maternal health services, 91.8% about ANC, 64.2% about institutional delivery, 57.2% about PNC and 51.8% about family planning mothers were got Information. Their main sources of information (92.2%) were health workers (HEWs). The result of the FGD also supports this idea a 30 years old woman (who had 5 children and cannot read and write) said that: “Most of the time I got maternal health service information from HEWs.
Antenatal Care service Utilization
In this study, about 89% of the mothers had at least one antenatal care (ANC) visit during their last pregnancy, out of which 60% of them visit health center/hospital [Figure 4]. Among the antenatal care utilizes, 79% of them had less than four antenatal care visits during their last pregnancy and about 85% of mothers visited health facility to know their health and their baby health status. The FGD result also shows that almost all of the discussants said that “We seek maternal health services during pregnancy, delivery and for child vaccination. And also we seek maternal care for checkup of our own and child’s health status. From all the discussants (n = 14), about 93% of them visited health facility greater or equal to three times for ANC check-up.
As one discussant (30 years old woman who had 5 children and cannot read and write) explained; “I visited health institution four times for ANC follow up and the health provider gave me the appointment for delivery.”
Regarding the types of services given for ANC users, 97.2% had got tetanus injection, 71.2% got iron tablet/syrup supplementation, 65% had physical examination (including weight, blood pressure, heart rate measurement) and 57.6% had HIV/STD testing. Some of Reasons mentioned by Non-users of ANC services includes unplanned pregnancy (52%), distance of the health facility (25%) and thought that the service is unnecessary (23%).
One of the discussant (a woman aged 24 years having 3 children and completed grade one) said that, “As I know most mothers were too busy to follow the ANC care. Additionally, lack of awareness, healthy problem of the mothers and interrupt the services leading to poor quality service utilization. For example, if you take these two women’s previously told us they visited three times health facility for ANC visit. But, they delivered at home which was risky and visited health facility after one and half month for child vaccination” (Figure –1.
Among the respondents, 64% were delivered at health center/hospital by health workers and the rest were delivered at home and on the way while travelling to health facility by assisted by the HEWs, TBA and relatives. The main reasons for home delivery were sudden onset of labour (75.5%) which was followed by transport problem (29.7%) [Figure 6, 7]. The result obtained from FGD also supported this result as one discussant (a 30 years old woman who had 5 children and cannot read and write) explained; “I visited four times for ANC checkup and the health provider gave me the appointment for delivery. But, before the appointment time I delivered at home by TBA which found around my home due to sudden onset of labour. And also I know the risk of delivering at home; however, I had no chance to deliver at health facility due to lack of someone around who may support me at that time.”
Another woman aged 20 years who had two children and completed grade six shared her experience regarding home delivery as follow; “I saw my neighbor who delivered at home and her children were exposed to air during delivery. In addition, to these cord tying was inappropriate. And also most of the time her child was sick and exposes her to extra payment to treat the baby. So, as my opinion home delivery is not recommended and I advise my friends and neighbors to go health facility for delivery service.”
Additionally, a woman aged 24 years having three children and completed grade one said that; “home delivery is forbidden because before there is a reason like cultural ceremony done at home while women delivered at home. But, know at health facilities there are different ceremonies that are culturally done at home for home delivered mothers. So, if there is such home like ceremonies at health facility what a mother need at home. Moreover, at health facility, service providers follow the delivered mothers timely until she leaves the facility.”(Fgure –2)
Early Postnatal care service utilization
Regarding the post natal care service utilization, 47.2% of the respondents received postnatal care services, of which 54% of them got the service within 24 hours. The reasons mentioned among the study participants for not receiving the postnatal care service were: not feeling ill (65%), giving delivered at home (34%) and 5.7% had no awareness about the services. After delivery, about 4% of the respondents had health problems during their last delivery which includes heavy vaginal bleeding (75%), fever (16.7%), smelly vaginal bleeding (12.5%) and unconsciousness (8.5%) and all of mothers with these health problems had got emergency care and referred for better treatment (Figure 3).
Services such as, physical examination (27.9%), counseling on breastfeeding (85.3%), use of contraceptives (73.2%), blood test for anemia (26.4%), nutritional supplements (54%) and provision of information on warning signs (38.1%) were delivered for respondents after delivery. The result of FGDs also supports this finding in which the majority of the discussants said that physical examination, counseling on breastfeeding, contraceptives, nutritional supplements and information on danger signs were among the post-natal services mentioned by the study participants..
About 13% of the respondents reported that they paid for maternal health services they got and about 69% of the decision making for maternal health services utilization was done by husband while the remaining decided by themselves to utilize the services (Figure 3).
Factors affecting maternal health services utilization .
On multiple logistic regression analysis, mothers who had occupation and own business were 24% less likely to utilize ANC service when compared to the reference category (Farmer) [AOR 0.24(0.08–0.69) (95% CI)]. The decision making power of both mothers and husband had positive influence to utilize ANC service. These means, mothers who decided with their husband had 4 times more likely to attend ANC visit than non-decision makers in collaboration with their husband [AOR 4.12(2.12–8.00) (95% CI)].
The likelihood of delivering at health facility (health center and hospital) was 1.6 times more likely for mothers who completed primary and above educational level than those who had no formal education [AOR 1.56(1.03–2.38) (95% CI)]. Regarding the time of traveling to the health facility, mothers who could reach the health facility within 30–60 minutes were 54% less likely in delivering at health facility (health center and Hospital) when compared to the reference category (> = 60 minutes) [AOR 0.54(0.31–0.95) (95% CI)].
Mothers who decided the place of delivery with their husband were 6 times more likely to deliver at health facilities (health center and Hospital) than who cannot decide with their husband [AOR 5.91 (3.79–9.22) (95% CI)]. Additionally, mothers who decided the place of delivery by advice of health workers were 2.75 times more delivered at health facility when compared to those who decided without interference of the health workers [AOR 2.75(1.67–4.55) (95% CI)]. Respondents who attended ANC visit had 14.5 times more in delivering at health institution (health center and Hospital) than the reference category (non-attendant of ANC) [AOR 14.54(6.23–33.96) (95% CI)].
Regarding the post natal care utilization, age of the respondents, marital status of the mothers, time of travelling to the nearest health facility, attending ANC services, place of delivery and experiencing any health problem after delivery obtained were among the variables that showed association with post natal care utilization.
Accordingly, mothers whose age were between 15–24 years were 2.65 times more likely for visiting/staying health facility for early PNC service after delivery than the reference category (> = 35 years) [AOR 2.65(1.29–5.46) (95% CI)]. Regarding marital status, being widowed and divorced had negative influence on PNC services utilization after delivery. These means, widowed and divorced mothers were 14% less likely to utilize early PNC service after delivery when compared to the reference category (married) [AOR 0.14(0.03–0.69) (95% CI)].
The probability to visit/stay at health facility after delivery for early PNC service utilization was 2.7 times more likely for mothers who travelled about 30–60 minutes to reach health facility when compared to those travelled greater than one hour [AOR 2.72(1.56–4.75) (95% CI)]. On the other hand, mothers who travelled only less than 30 minutes were 1.8 times more likely to visit/stay at health facility after delivery for early PNC service utilization when compared to those travelled greater than one hour [AOR 1.79(1.01–3.17) (95% CI)].
Those mothers attending ANC visit and delivered at health facility (health center and hospital) were 3.5 and 23.8 times more likely to utilize early PNC service after delivery when compared to non-attendances to ANC visit [ AOR 3.51(1.15–10.71) (95% CI)] and home delivered [AOR 23.78(12.83–44.06) (95% CI)] respectively. The likelihood of utilizing early PNC service after experiencing health problem following delivery was 15 times more probable when compared to the healthy mothers after delivery [AOR 14.98(4.23–52.88) (95% CI)](Table 2)