Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Helena Lindgren, Karolinska Institutet, Sweden
- Second opponent: Chief Executive Officer Mamady Cham, Bwiam General Hospital, The Gambia
- Third member and chair of the evaluation committee: Associate Professor Katariina Laine, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor II Tone Rustøen, University of Oslo
Principal Supervisor
Director Centre for Global Health Jeanette H. Magnus, Faculty of Medicine, University of Oslo
Summary
The actions we take to prevent ourselves from becoming ill are influenced by social determinants of health. The same is true for a pregnant woman who wants to make sure that her unborn child and herself are healthy during the course of the pregnancy and childbirth, and beyond. Whether she attends antenatal care and/or delivers at a health facility or not is dependent on a host of determinants at the individual and community level, and within a socioeconomic and political context. Available studies in Ethiopia have not sufficiently explored the impact of local social determinants of maternal health care utilization. The thesis aims to study the impact of various social determinants and intimate partner violence on the utilization of maternal healthcare services. It also explores the characteristics of women identified as a positive deviant in relation to use of maternal health care services. Existing data from almost 50 000 responses from the Ethiopian Demographic and health Surveys in 2005, 2011 and 2016 was used. A large number of social determinants were analyzed.
The results showed that the country has witnessed an encouraging improvement in the ANC coverage (at least one visit) in the last decade from 28.5% in 2005 to 62.8% in 2016. On the other hand, the receipt of adequate ANC by the women is a real challenge – only 32% of the Ethiopian women met the current Ethiopian policy recommendation of four ANC visits for the index pregnancy in 2016. In addition, health facility deliveries is staggering low in the country. Only 26% of the women who had a live birth in preceding five years of the 2016 survey were delivered in health facilities although this represented an improvement from 5% in 2005. Moreover, significant disparities in ANC and health facility delivery uptake between urban and rural areas, across regions and by socio-economic status were detected. We also identified that there are several risk and protective factors with a significant impact on the utilization of maternal healthcare services. Lower maternal age, low socioeconomic status, lack of education, living rural areas and pastoralist region, perceived challenge to reach health facility and partner violence were shown to be risk factors, as higher socioeconomic status, partner's education, woman's employment status, having employed partner’s, media exposure, women empowerment and living in urban area were a protective factor.
Overall, the findings of the study provide additional insights for addressing the identified risk and protective factors is essential in order to better understand the social process related to maternal healthcare services utilization and design appropriate context specific strategies and policies if Ethiopia desires to progress towards the SDGs set for maternal health.