Abstract:
Background: The high maternal mortality, home delivery, unwanted pregnancies, incidence of unsafe abortion,
and unmeet family planning needs are maternal health gaps attributed to health care access barriers and
responsible for the observed health care disparities. Over the last decades remarkable achievements have made in
relation to maternal health problems and the reduction of health care access barriers. Thus, this study aimed to
assess the decomposition and spatial-temporal analysis of health care access challenges among reproductive-age
women in Ethiopia.
Methods: Secondary data analysis was conducted based on the three consecutive Ethiopian Demographic and
Health Surveys (2005–2016 EDHSs). A total weighted sample of 46,235 reproductive-age women was included in
this study. A logit based multivariate decomposition analysis was employed for identifying factors contributing to
the overall decrease in health care access challenges over time. For the spatial analysis, ArcGIS version 10.6 and
SaTScan™ version 9.6 were used to explore hotspot areas of health care access challenges in Ethiopia over time.
Variables with p-value < 5% in the multivariable Logit based multivariate decomposition analysis were considered as
significantly contributed predictors for the decrease in health care access challenges over time.
Result: The mean age of the women was 27.8(±9.4) years in 2005, 27.7(±9.2) years in 2011, and 27.9 (±9.1) years in
2016. Health care access challenges have been significantly decreased from 96% in 2005 to 70% in 2016 with the
Annual Rate of Reduction (ARR) of 2.7%. In the decomposition analysis, about 85.2% of the overall decrease in
health care access challenge was due to the difference in coefficient and 14.8% were due to differences in the
composition of the women (endowment) across the surveys. Socio-demographic characteristics (age, residence,
level of education, female household head, better wealth and media exposure) and service utilization history before
the survey (facility delivery and had ANC follow up) contribute to the observed decrease over time. The spatial
analysis revealed that health care access challenges were significantly varied across the country over time. The
SaTScan analysis identified significant hotspot areas of health care access challenges in the southern, eastern, and
western parts of Ethiopia consistently over the surveys.
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