Factors associated with antenatal care service content utilization in selected rural areas of Southern Ethiopia: Assessing the extent of compliance with World Health Organization recommendations—A mixed-methods study

Abstract

BACKGROUND: The quality of antenatal care (ANC) plays a crucial role in maternal and child health, yet little is known about the actual service content received by pregnant women in rural southern Ethiopia. OBJECTIVES: To explore the factors influencing ANC content utilization in selected rural areas of southern Ethiopia, shedding light on critical gaps in service delivery. DESIGN: A mixed-methods study. DATA SOURCES: Quantitative data were collected from 851 systematically selected women, and qualitative data from 20 purposefully selected participants including mothers, health extension workers, and healthcare professionals. METHODS: Data were collected using a pre-tested structured interviewer-administered questionnaire. Quantitative data were analyzed using descriptive statistics and a generalized linear model to assess associations between variables. Qualitative data were transcribed, translated verbatim, and processed using Atlas software. RESULTS: Only 5.7% of women received the full spectrum of ANC services. Weight (82.6%) and blood pressure (82%) measurements were the most commonly utilized services, while height measurement (22%) and counseling on pregnancy-related complications (31%) were significantly underutilized. Key determinants of ANC content utilization included husband support (risk ratio (RR) = 1.82, 95% CI = 1.01-2.43), perception of proximity to a health facility-short (RR = 1.38, 95% CI = 1.08-1.90) and medium (RR = 1.13, 95% CI = 1.00-1.17) distances-early initiation of ANC (RR = 1.6, 95% CI = 1.01-2.20), positive provider-patient interaction-good (RR = 1.22, 95% CI = 1.03-1.41) and medium (RR = 1.18, 95% CI = 1.00-1.27)-and a high wealth index (RR = 1.26, 95% CI = 1.16-1.37). CONCLUSIONS: This study underscores the critical shortfall in comprehensive ANC service utilization in rural Ethiopia. Strengthening health services in underserved areas, actively involving husbands in maternal care, empowering women, and enhancing healthcare provider training and accountability are essential to improving service delivery. A concerted effort is needed to bridge these gaps and ensure that every pregnant woman receives the full spectrum of essential ANC services.