Maternal continuum of care utilization in rural communities of South Ethiopia: Insights from a cross‐sectional household survey

Abstract

BACKGROUND: The maternal continuum of care (CoC) refers to an integrated sequence of health services delivered across time and space, which women should access without interruption. It is a vital strategy for reducing maternal morbidity and mortality. This study assessed the level and determinants of maternal CoC utilization among women in the Gamo Zone, South Ethiopia. METHODS: A community-based cross-sectional study was conducted from February 1 to 30, 2025, among women who had given birth within the 12 months preceding the data collection. A multi-stage sampling technique was used to select the study population. A total of 1294 women were selected using simple random sampling. Data were collected using Kobo Collect and analyzed in SPSS version 25.0. A multivariable model was fitted, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Statistical significance was set at P < 0.05. RESULTS: The overall rate of maternal CoC utilization (defined as receiving four or more antenatal care visits, institutional delivery, and postnatal care within 2 days after birth) was 16.1%. Key factors significantly associated with full CoC utilization included knowledge of pregnancy danger signs (AOR = 12.59; 95% CI: 7.84, 20.02), perceived shorter distance to health facility (AOR = 2.12; 95% CI: 1.28, 3.53), urban residency (AOR = 12.00; 95% CI: 7.57, 20.00), maternal educational status (AOR = 2.93; 95% CI: 1.33, 6.45), and having a birth preparedness and complication readiness (BPCR) plan (AOR = 4.96; 95% CI: 2.89, 8.53). CONCLUSION: The overall CoC utilization in the study area remains low, indicating that women are not getting the maximum possible health benefits from the existing healthcare services. Place of residence, distance to reach health facility, maternal education, knowledge of pregnancy danger signs, and BPCR were the factors affecting CoC utilization. Therefore, policymakers should consider strategies for the existing health system that focus on empowering women's education, counseling women about pregnancy danger signs, and implementing the BPCR, as well as ensuring the physical accessibility of health facilities within a reasonable distance to enhance maternal CoC utilization.