Effect of high-quality antenatal care on skilled birth attendant utilization in Ethiopia: a propensity score matching analysis.

backgroundExisting evidence suggests that access to and utilization of skilled birth attendants in Ethiopia remain suboptimal. High-quality antenatal care (ANC), adequate ANC contacts and components, is associated with an increased likelihood of receiving assistance from skilled birth attendants. However, the effect of these ANC interventions on the utilization of skilled birth attendants in Ethiopia has not been thoroughly investigated using rigorous statistical methods. Therefore, this study, aimed to assess the effects of receiving high-quality ANC services, adequate ANC contacts, and comprehensive ANC components on the utilization of skilled birth attendants in Ethiopia employing a robust analytical approach.

methodsWe utilized secondary data from the six-week postpartum survey of the second cohort, alongside the baseline information from the Performance Monitoring for Action (PMA) Ethiopia longitudinal study, which was conducted from November 2021 to October 2022. The study involved selection 1596 participants using a multistage stratified cluster sampling method. To establish rigorous causal estimates, we applied multiple analytical methods to assess the effect of high-quality ANC, adequate ANC contact, and adequate ANC components on the utilization of skilled birth attendants. The primary analysis utilized propensity score matching followed by adjusted regression to account for remaining confounders. Additionally, we performed a supplementary multivariable logistic regression analysis.

resultsAfter adjusting for residual confounding in the matched sample, the adjusted average treatment effect on the treated (ATT) showed that high-quality ANC was associated with a 5.7 percentage point increase in the likelihood of utilizing skilled birth attendants (adjusted ATT = 0.0575; 95% CI 0.024-0.090; p = 0.001). Similarly, the adjusted ATT was 0.0605 (95% CI 0.028-0.092; p < 0.001) for adequate ANC contact and 0.0574 (95% CI 0.024-0.090; p = 0.001) for adequate ANC components, reflecting 6.0 and 5.7 percentage point increases in skilled birth attendant use, respectively. In addition, the average marginal effects (AME) indicated that, on average, high-quality ANC, adequate ANC contact, and adequate ANC components increased the probability of skilled birth attendant utilization by 7.1, 6.0, and 9.2 percentage points, respectively.

conclusionThis study provides robust evidence that high-quality ANC services increase the likelihood of skilled birth attendant utilization during delivery. It also reported a positive association between adequate ANC contacts, the receipt of adequate ANC components, and the use of skilled birth attendants. Therefore, our findings underscore that increasing the number of ANC contacts, ensuring the provision of recommended ANC components, and consistently promoting overall high-quality ANC are critical strategies for improving skilled birth attendant utilization.