The objective of this study was to identify the determinants of frequency of antenatal care visit in Ethiopia by using zero inflated Poisson regression.
In this study 74.38 % of women attend antenatal care at least once during their current pregnancy. The finding is consistent with researches in Afghanistan( 69.3% ) (64), Southern Ethiopia (76.2%)(40), Zambia (69%)(65), Nepal (76.0%)(66). The finding is higher than the study in Benishangul Gumuz Region, Ethiopia (37.7% ) (62), Nigeria (65.1%)(67), Eastern Ethiopia (53.6%)(59). The finding was lower than studies in Southwestern Ethiopia (91.9)(68), Ghana (98.3%)(69), Pakistan ( 83.5 %)(70), Guinea(80.3%) (55).
In this study, only 41.8% of women use WHO recommended number of antenatal care. The finding is lower than studies in Rwanda (54%)(71), sub-Saharan countries (58.53) (61), India (51.7%)(72), Nigeria (56.2%)(67) and Pakistan (57.3)(70). The finding is higher than findings in Bangladesh (32%)(73), Eastern Ethiopia (15.3%)(59) and Zambia (29%)(65). The difference might be due to study population coverage, study setting and time.
Women in the middle age group have high frequency of antenatal care utilization. The probability of antenatal care utilization not zero is lower in this group of women. The result is similar with findings in Ethiopia(51), Uganda (74), Bangladesh (75), East African Countries (60), Nigeria (76, 77). Middle age women might experiences previous pregnancy related complications that make them conscious to use maternal health services (54, 78, 79).
The frequency of antenatal care visit was high in urban dwellers than rural residents. The finding is in line with previous researches (55, 56, 64, 80). Urban residence reduces distance to get services (81–84). Rural dwellers might face transportation problem to access the service (78, 79, 85, 86). Moreover, urban dwellers might have mass media accesses on importance of antenatal care (61, 87–89).
The frequency of antenatal care increases as the educational status of the women was increased. The odds of not attending antenatal care service were reduced when educational status is increased. The finding was supported by previous researches in Western Ethiopia (62), Ethiopia(56), rural Ethiopia(51), Kenya (90), Guinea (55, 91), Afghanistan (64), Angola(54), East African countries (60), India(92, 93), Ghana (94), Nepal (95), Nigeria (96). Educated women might empowered to get services (97–102), education make women to have decision making (103, 104). Moreover educated women have knowledge on danger sign (105–108). Educated women might have awareness on the advantage of antenatal care different services provided in the service delivery points for the fetus and herself (53, 109–111).
As the household wealth index increases the frequency of antenatal care service utilization is increased and decreases the probability of not taking antenatal care services. The estimated IRR and OR, indicates that the probability no antenatal care take and the frequency of ANC visits increased with increasing household wealth status. the result was consistent with other findings in Western Ethiopia (62), Nepal (112), Guinea (55, 113), Angola (54), Nigeria (67), India (72), Ghana (69) Bangladesh (73, 102). It might be due to women who belong to rich household usually have higher (114, 115)educational status, access to mass media (55, 116–118), and an ability to spend more money to take frequent ANC visits compared to women from poorer families (119–121).
There was religious variation on the frequency and utilization of antenatal care. Orthodox religion followers have high number of antenatal care utilization than Protestant and Muslim religious followers. Studies suggest there is religious variation on utilization and frequency antenatal care (75, 122, 123).
The odds of not antenatal care were less in married and widowed/divorced women than single women. The result is consistent with findings in Rwanda (83), Debre Berhan (124), Benin (125), Middle and low income countries (126). Married women might get partner support to attend antenatal care (55, 127, 128). Moreover, single women might face stigma to use antenatal care services by the community and health care workers (129–131).
Women who lived in developing regions had low frequency of antenatal care utilization than women who resided in urban areas. The finding is agreed with previous researches in different parts of Africa (54, 56, 132, 133). There might be differences in socio-cultural, power relationships, accessibility of service in different parts of the country.
The result of this study was more representative than other studies and the model considered different levels of analysis as the outcome was count data. Despite this strength, the result may be prone to recall bias because the data were collected from a history of the event and some variables were missed since the data set was intermediate.
Conclusion: utilization of minimum number of antenatal care utilization is low in Ethiopia. Being in middle age group, urban residence, increased educational level, improved household wealth status, Orthodox religious follower increases the number of antenatal care utilization.
Being middle age group, married, increased educational status, improved household wealth status; Orthodox religion follower decreases the probability of not attending antenatal care. Advocacy and behavioral change communication should be area of concern for different organizations that are working on antenatal care especially for rural, poor and uneducated women through mass campaign, community dialoging and enhance the effectiveness of health extension programs.